Mild trigonocephaly and intracranial pressure: report of 56 patients

Mild trigonocephaly associated with microcephaly: surgical outcomes for 15 cases

BACKGROUND AND IMPORTANCE

Surgical treatment for mild trigonocephaly associated with microcephaly is often attempted if neuroradiological studies show evidence of increased intracranial pressure. However, it is difficult to decide how to approach surgically these patients. Herein, we report the surgical outcomes of the patients we have treated surgically in our center.

CLINICAL PRESENTATION

We performed surgery on 15 patients (ten girls and five boys) who were all diagnosed as microcephalic during infancy. All patients presented clinical symptoms and evidence of short stature. Symptoms included mental retardation, language delay, hyperactivity, motor dysfunction, and self-mutilation (head banging). Head circumferences were > 2 standard deviations below the normal range for their sex and age at the time of surgery. All patients were diagnosed with mild trigonocephaly based on three-dimensional computed tomography (3D-CT). No abnormal findings could be observed in the brain of 14 patients, as assessed by magnetic resonance imaging (MRI). One patient showed brain atrophy. 3D-CT showed marked digital markings in all. Intracranial pressure (ICP) was measured under normocapnia. Increased ICP could be observed in 13 patients. Decompressive cranioplasty was performed in all patients. After surgery, evidence of enlargement of the head circumference could be observed in six patients. Some degree of intelligence problems remained. However, every patient made some improvement in at least one of the other symptoms.

CONCLUSION

We suggest that decompressive cranioplasty may be indicated in patients with mild trigonocephaly associated with microcephaly, if pre-surgical evaluation shows high ICP and no abnormal brain findings can be identified on MRI.

Metopic synostosis

Premature closure of the metopic suture results in a growth restriction of the frontal bones, which leads to a skull malformation known as trigonocephaly. Over the course of recent decades, its incidence has been rising, currently making it the second most common type of craniosynostosis. Treatment consists of a cranioplasty, usually preformed before the age of 1 year. Metopic synostosis is linked with an increased level of neurodevelopmental delays. Theories on the etiology of these delays range from a reduced volume of the anterior cranial fossa to intrinsic malformations of the brain. This paper aims to provide an overview of this entity by giving an update on the epidemiology, etiology, evolution of treatment, follow-up, and neurodevelopment of metopic synostosis.

Risk factors associated with craniosynostosis: a case control study

BACKGROUND

Craniosynostosis is a relatively common congenital abnormality. The underlying etiology and most probable risk factors of nonsyndromic craniosynostosis are unknown. We conducted a study to identify the risk factors for craniosynostosis.

MATERIALS AND METHODS

In this case-control project, 70 children with craniosynostosis (syndromic or nonsyndromic) hospitalized at the Children's Hospital Medical Center from September 2010 to 2011 were studied for the potential risk factors. At the same time, 70 age- and sex-matched children hospitalized with other congenital anomalies were reviewed. Information from case and control groups was obtained via personal interviews with parents of patients and a prepared checklist was filled out for each child.

RESULTS

The mean (±SE) age at admission time in the case-control group was 13 ± 1.95 (1.5-96) months, and almost half of them were boys (n = 37 or 53%). The most frequent sutures involved in craniosynostosis were coronal (n = 30 or 42.9%) and then metopic sutures (n = 16 or 22.9%), multiple (n = 12 or 17.1%), sagittal (n = 11 or 15.7%) and lambdoid (n = 1 or 1.4%). In the case group, maternal diabetes mellitus and thyroid disease were found in 8 (11.6%) and 6 (8.6%) patients, respectively. The most frequent medication used by mothers (n = 66 or 94%) in the case group during pregnancy were vitamins (including iron supplements, omega 3, folic acid and multivitamins).

CONCLUSION

A positive family history of craniosynostosis [odds ratio (OR) 19.01 and 95% confidence interval (CI) 2.24-160.7] and using clomiphene citrate for infertility (OR 12.71 and 95% CI 1.42-113.6) were the strongest independent risk factors for craniosynostosis. More comprehensive studies with a larger sample size are required to confirm the role of environmental factors in order to decrease the occurrence of craniosynostosis.