title: Papilledema in patients with Apert, Crouzon, and Pfeiffer syndrome: prevalence, efficacy of treatment, and risk factors.
abstract: 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.
authors.affiliation: Dutch Craniofacial Center, Erasmus Medical Center Sophia Children's Hospital, Rotterdam, The Netherlands. n.bannink@erasmusmc.nl
authors.forename: Natalja
authors.initials: N
authors.lastname: Bannink
authors.forename: Koen F M
authors.initials: KF
authors.lastname: Joosten
authors.forename: Marie-Lise C
authors.initials: ML
authors.lastname: van Veelen
authors.forename: Marjolijn C
authors.initials: MC
authors.lastname: Bartels
authors.forename: Robert C
authors.initials: RC
authors.lastname: Tasker
authors.forename: Léon N A
authors.initials: LN
authors.lastname: van Adrichem
authors.forename: Jacques J N M
authors.initials: JJ
authors.lastname: van der Meulen
authors.forename: J Michiel
authors.initials: JM
authors.lastname: Vaandrager
authors.forename: Tjeerd H R
authors.initials: TH
authors.lastname: de Jong
authors.forename: Irene M J
authors.initials: IM
authors.lastname: Mathijssen
mesh_terms: D000168:Acrocephalosyndactylia / Q000150:complications* / Q000601:surgery; D014695:Cerebral Ventriculography; D002648:Child; D002675:Child, Preschool; D003394:Craniofacial Dysostosis / Q000150:complications* / Q000601:surgery; D003398:Craniosynostoses / Q000150:complications / Q000601:surgery; D019299:Decompression, Surgical / Q000379:methods; D004108:Dilatation, Pathologic / Q000000981:diagnostic imaging; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D019586:Intracranial Hypertension / Q000209:etiology / Q000628:therapy; D009887:Ophthalmoscopy; D009915:Orbit / Q000002:abnormalities / Q000601:surgery; D010211:Papilledema / Q000209:etiology* / Q000628:therapy; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D012307:Risk Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome