Papilledema in patients with Apert, Crouzon, and Pfeiffer syndrome: prevalence, efficacy of treatment, and risk factors

• Published in: The Journal of craniofacial surgery Vol. 19; no. 1; p. 121
• Main Authors: Bannink, Natalja, Joosten, Koen F M, van Veelen, Marie-Lise C, Bartels, Marjolijn C, Tasker, Robert C, van Adrichem, Léon N A, van der Meulen, Jacques J N M, Vaandrager, J Michiel, de Jong, Tjeerd H R, Mathijssen, Irene M J
• Format: Journal Article
• Language: English
• Published: United States 01.01.2008
• Subjects: Acrocephalosyndactylia - complications; Acrocephalosyndactylia - surgery; Cerebral Ventriculography; Child; Child, Preschool; Craniofacial Dysostosis - complications; Craniofacial Dysostosis - surgery; Craniosynostoses - complications; Craniosynostoses - surgery; Decompression, Surgical - methods; Dilatation, Pathologic - diagnostic imaging; Follow-Up Studies; Humans; Infant; Intracranial Hypertension - etiology; Intracranial Hypertension - therapy; Ophthalmoscopy; Orbit - abnormalities; Orbit - surgery; Papilledema - etiology; Papilledema - therapy; Reconstructive Surgical Procedures - methods; Retrospective Studies; Risk Factors; Tomography, X-Ray Computed; Treatment Outcome
• ISSN: 1049-2275
• DOI: 10.1097/SCS.0b013e31815f4015

Patients with syndromic craniosynostosis are at risk for elevated intracranial pressure because of various physiologic and anatomic abnormalities. The aims of this study were to determine the prevalence of papilledema in syndromic craniosynostosis, to evaluate the results of the treatment, and to examine the risk factors. This is a retrospective study on 84 patients with Apert, Crouzon, or Pfeiffer syndrome. Papilledema was defined as blurring of the margins of the optic disk. The association between clinical symptoms, beaten-copper pattern on skull radiograph, ventricular dilatation on computed tomography scan, and papilledema was assessed. Papilledema was present in 51% of the patients. No relation between specific clinical symptoms and papilledema was found. The significant associations were complex craniosynostosis, exorbitism, and ventricular dilatation. The prevalence of papilledema in patients with Apert, Crouzon, or Pfeiffer syndrome is high, not only before cranial decompression but also after vault expansion. Annual fundoscopy is recommended to screen for papilledema. We consider that early decompressive surgery (within the first year of age) prevents the development of papilledema and, most likely, elevated intracranial pressure.