ASOPRSFall Scientific SymposiumSyllabus
115
1:24pm
Intracranial HypotensionRelatedSkull RemodelingWithEnophthalmos and
SphenoidSinus Expansion
TimthyMcCulley
1
, JordanPiluek
1
, JesicaChang
1
, ThomasHwang
2
.
1
Wilmer Eye Institute, JohnsHopkinsUniversity, Baltimore,MD,
UnitedStates,
2
Ophthalmology, StanfordUniversitySchool ofMedicine, Stanford, CA, UnitedStates
Introduction:
Previously,we investigated bony skull changes in patient presentingwith enophthalmos following ventriculoperitoneal
shunting.
1,2
Herewe collate volumetric analyses of the orbits and sphenoid sinuses in a cohort with enophthalmos secondary to
intracranial hypotension related skull remodeling.
Methods:
In this retrospective case controlled study five patients (3males, 2 females,mean age 24.8 years, range 16 to 38 years)
were identifiedwith enophthalmos related to chronic intracranial hypotension. For two patientswith adequate computed tomography
(CT) imaging, orbit volumeswere calculated using ImageJ software (v1.40g, National Institute of Health). For four patientswith
adequate CT imaging, three sphenoid sinusmeasurementswere taken: the distance between the orbital apices, the posterior
extension of the sphenoid sinus posterior to the orbital apices and themaximal horizontal width.Themean of eachwas determined
and compared to that of the control group (5males, 5 females,mean age 35.6 years old, range 23 to 45 years).
Results:
Orbital volumeswere significantly greater in enophthalmic patients than controls (33.3+1.7cm
3
vs . 24.3±3.3cm³,
P=0.03,Wilcoxon rank-sum test). Sphenoid sinus posterior extension (26.3+4.1mm vs. 13.4+6.3mm, p=0.0015, student’s t-test),
andwidth of the sphenoid sinuswidth (39.2+8.7mm vs. 25.1+6.9mm, p=0.0035, student’s t-test) weremarkedly larger in the
enophthalmic than the control group.Mean distance between the orbital apiceswas slightly greater (36.3+1.7mm vs. 34.1+2.1mm,
p=0.047, student’s t-test).
Conclusions:
Our recognition of the relationship between skull remodeling and intracranial pressure is just beginning. In extreme
casesmarked enophthalmos results from orbit volume expansion. Bony changes are not limited to the orbits, as demonstrated in this
cohort with documented sphenoid sinus expansion.These findings are of clinical, diagnostic and pathophysiologic importance.
References:
1) HwangTN1, Rofagha S,McDermott MW, HoytWF, Horton JC,McCulleyTJ. Sunken eyes, sagging brain syndrome:
bilateral enophthalmos from chronic intracranial hypotension. Ophthalmology. 2011Nov;118(11):2286-95.
2) McCulleyTJ. Sphenoid sinus expansion: a radiographic sign of intracranial hypotension and the sunken eyes, sagging brain
syndrome (anAmericanOphthalmological Society thesis).TransAmOphthalmol Soc. 2013 Sep;111:145-54.
1:30pm
Questions andPanel Discussion
Moderator: SuzanneK. Freitag,MD
Panel: Raghuraj Hegde,MD, ChadBingham,MD, SaraAlshaker,MD, Jenny Temnogorod,MD, TimothyMcCulley,MD
Featured Speaker— SureshMukherji,MD,MBA, FACR
1:40pm
Introductionof Dr. SureshMukherji
AlonKahana,MD
DetailedProgram
—Friday,October 17, 2014
