The Current State of Non-Invasive Measurement of Intracranial Pressure in Patients with Craniosynostosis: A Systematic Review

Abstract

Introduction: Despite being invasive, direct measurements remain the gold standard to measure intra-cranial pressure (ICP) in patients with craniosynostosis. However, there has been persistent effort to develop non-invasive modalities to measure ICP, possibly avoiding some of the risks of direct measurements. Here, we conduct a systematic review of the evidence behind various non-invasive modalities to monitor ICP in patients with craniosynostosis. Methods: A systematic review was conducted using PubMed, Cochrane, and Web of Science databases to identify studies describing the use of non-invasive ICP measurements in patients with craniosynostosis. Studies were included if they assessed a non-invasive method of ICP monitoring against a direct/invasive ICP monitoring technique in patients with craniosynostosis. Non-English and non-human studies were excluded. Results: A total of 735 studies were screened, of which 52 were included in the study. Nine methods of non-invasive ICP measurement were identified, with varying sensitivities and specificities in detecting elevated ICP. Specifically, optical coherence tomography (OCT), and ocular ultrasonography demonstrated ability to accurately measure ICP when compared to direct measurements. Conclusion: Here, we present the first systemic-review of the current literature surrounding non-invasive modalities to measure ICP in patients with craniosynostosis. While direct measurement remains the gold-standard, multiple reviewed modalities have shown promise in accurately measuring ICP. Of these, OCT has the most rigorous evidence supporting its use. Ocular sonography has also shown promise, albeit without as robust evidence supporting its use. Regardless, further investigation is required before any modality is able to obviate the need for invasive, direct measurements.