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Serial Visual Evoked Potentials in Patients with Craniosynostosis and Invasive Intracranial Pressure Monitoring

Haredy, Mostafa M. M.D.; Liasis, Alki Ph.D.; Fu, Valeria Ph.D.; Davis, Amani B.S.; Pollack, Ian F. M.D.; Losee, Joseph E. M.D.; Saied, Samia M.D.; Nischal, Ken K. M.D.; Goldstein, Jesse A. M.D.

Plastic and Reconstructive Surgery: September 2019 - Volume 144 - Issue 3 - p 446e-452e
doi: 10.1097/PRS.0000000000005935
Pediatric/Craniofacial: Ideas and Innovations
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Summary: This study aimed to detect the ability of pattern visual evoked potentials to detect visual pathway dysfunction in a cohort of patients with craniosynostosis who also had invasive intracranial pressure measurement. A retrospective review was conducted on craniosynostosis patients who had invasive intracranial pressure measurement and at least one pattern visual evoked potentials test. Reversal pattern visual evoked potentials were performed with both eyes open. Thirteen patients met the inclusion criteria (mean age at intracranial pressure measurement, 5.7 years). Seven patients had raised intracranial pressure, and of these, five (71.4 percent) had abnormal or deteriorated pattern visual evoked potentials parameters on serial testing, whereas all patients (100 percent) with normal intracranial pressure had normal pattern visual evoked potentials amplitude and latency. Four of the five patients (80 percent) with raised intracranial pressure and abnormal pattern visual evoked potentials did not show evidence of papilledema. The mean latency in patients with raised intracranial pressure (118.7 msec) was longer than in those with normal intracranial pressure (108.1 msec), although it did not reach statistical significance (p = 0.09), whereas the mean amplitude in patients with raised intracranial pressure (12.4 µV) was significantly lower than in patients with normal intracranial pressure (23.3 µV) (p = 0.03). The authors’ results showed that serial pattern visual evoked potentials testing was able to detect visual pathway dysfunction resulting from raised intracranial pressure in five of seven craniosynostosis patients, and of these five patients, 80 percent had no evidence of papilledema, demonstrating the utility of serial pattern visual evoked potentials in follow-up of the visual function in craniosynostosis patients.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Diagnostic, II.

Pittsburgh, Pa.; and Sohag, Egypt

From the Department of Plastic Surgery, Cleft-Craniofacial Center, the Department of Ophthalmology, UPMC Eye Center, and the Department of Neurosurgery, Children’s Hospital of Pittsburgh, University of Pittsburgh Medical Center; and the Plastic Surgery Department, Cleft and Craniofacial Unit, Sohag University Hospital.

Received for publication June 25, 2018; accepted January 25, 2019.

Presented at the Annual Meeting of the American Cleft Palate-Craniofacial Association, in Pittsburgh, Pennsylvania, April 9 through 14, 2018.

Disclosure:The authors have no financial interest to declare in relation to the content of this article. No funding was received for this article.

Jesse A. Goldstein, M.D., Division of Pediatric Plastic Surgery, Children’s Hospital of Pittsburgh, One Children’s Hospital Drive, 4401 Penn Avenue, Faculty Pavilion Suite 7107, Pittsburgh, Pa. 15224, jesse.goldstein@chp.edu, Instagram: @JesseGoldsteinMD, Facebook: @JesseGoldsteinMD, Twitter: @jgoldsteinMD

Copyright © 2019 by the American Society of Plastic Surgeons