Quantitative CT Imaging Features Associated With High Risk of Elevated Intracranial Pressure in Children Under 2 Years of Age With Craniosynostosis: A Patient-Control Study

OBJECTIVE: Elevated intracranial pressure (ICP) is an important complication of craniosynostosis, and early identification may help optimize surgical planning and treatment. Although invasive ICP monitoring remains the reference standard, its routine use in infants and young children is limited by procedural risks. This study aimed to evaluate whether quantitative computed tomography (CT) parameters could serve as noninvasive imaging markers associated with a high risk of elevated ICP in children under 2 years of age with craniosynostosis, compared with age- and sex-matched controls. METHODS: The authors retrospectively analyzed cranial CT images from 36 children under 2 years of age with craniosynostosis who were classified as having a high risk of elevated ICP according to a previously published clinical prediction rule (20 nonsyndromic and 16 syndromic cases), along with 24 age- and sex-matched control children. Patients with hydrocephalus, traumatic brain injury, or other intracranial space-occupying lesions known to increase ICP were excluded. Quantitative CT parameters, including optic nerve sheath diameter (ONSD), skull base thickness, and calvarial thickness, were measured on axial and coronal images and compared between groups. RESULTS: A total of 36 children with craniosynostosis and 24 control children were included. Both nonsyndromic and syndromic craniosynostosis groups demonstrated significant differences in mean ONSD, skull base thickness, and calvarial thickness compared with controls (all P<0.001). Specifically, compared with controls, the nonsyndromic group showed a larger mean ONSD (4.96 versus 3.90 mm), thinner skull base (3.11 versus 3.85 mm), and thinner calvarium (1.99 versus 2.85 mm). Similarly, the syndromic group exhibited increased ONSD (4.79 versus 3.90 mm), reduced skull base thickness (3.19 versus 3.85 mm), and reduced calvarial thickness (1.97 versus 2.85 mm) (all P<0.001). No statistically significant differences in these CT parameters were observed between the nonsyndromic and syndromic groups. CONCLUSIONS: Children under 2 years of age with craniosynostosis who are classified as being at high risk of elevated ICP demonstrate characteristic CT findings, including optic nerve sheath enlargement and thinning of the skull base and calvarium. The combined assessment of ONSD and cranial bone thickness on CT may serve as a useful noninvasive adjunct for preoperative screening and risk stratification in young children with craniosynostosis.