Computed tomography quantitative analysis of cranial vault dysmorphology and severity of facial complex changes in posterior synostotic plagiocephaly patients

Anterior Craniofacial Changes Following Occipital Switch Cranioplasty in Unilateral Lambdoid Craniosynostosis

ObjectiveAnterior craniofacial changes in unilateral lambdoid craniosynostosis include forehead bossing, increased orbital heights, and asymmetry of the midface and mandible, creating a facial twist. The purpose of this study is to comprehensively analyze the post-operative anterior craniofacial changes in patients with unilateral lambdoid craniosynostosis following occipital switch cranioplasty.DesignRetrospective review of three-dimensional images collected pre-operatively and post-operatively around 2 years.SettingTertiary care pediatric institution.ParticipantsEighteen patients with unilateral lambdoid craniosynostosis.InterventionsCranial vault remodeling with occipital switch cranioplasty.Main Outcome MeasuresFrontal, occipital, height, midface, ear, and orbital asymmetry. Nasal and chin deviation.ResultsFrontal and occipital asymmetry significantly improved post-operatively (P = .03; P < .01). Cranial height asymmetry and midface projection asymmetry did not significantly improve (P = .24; P = .59). The nasal deviation was, on average, 3.58 ± 1.69° prior to surgery and significantly improved with a residual deviation of 2.18 ± 1.35° (P = .01). The chin deviation significantly improved post-operatively from an average of 2.21 ± 1.52° to a residual deviation of 1.07 ± 1.12° (P = .04). Ear asymmetry, orbital width, and orbital height asymmetry did not significantly change with surgery.ConclusionsTwo years after occipital switch cranioplasty, patients with unilateral lambdoid craniosynostosis had significant improvements in frontal asymmetry, nasal deviation, and chin deviation. However, nasal and chin deviation remained residually asymmetric. Midface projection contralateral deficiency did not significantly change post-operatively over the study period. The release of the affected suture with occipital switch cranioplasty allowed for remodeling and growth to improve anterior craniofacial symmetry.

Jugular foramen stenosis in external hydrocephalus in infants

OBJECTIVE

To measure the size of jugular foramina in infants affected by external hydrocephalus (EH) and in a control group, to support the hypothesis that a jugular foramen (JF) stenosis may determine dural venous sinus alterations and increased venous outflow resistance as main pathophysiological factor.

METHODS

Minimum, maximum, and mean values of JF areas were measured in a series of phase-contrast magnetic resonance venous angiography (angio MRV PCA3D) performed on 81 infants affected by EH. Results were compared with a group of 54 controls.

RESULTS

Smaller JF area was significantly smaller in patients versus controls (43.1 ± 14.6 vs. 52.7 ± 17.8; p < 0.001) resulting in a significantly smaller mean JF areas in patients vs. controls (51.6 ± 15.8 vs. 57.0 ± 18.3; p = 0.043). In patients, smaller JF areas were significantly associated with higher venous obstruction grading score (VOGS) both on the right (p = 0.018) and on the left side (p = 0.005). Positional plagiocephaly (cranial vault asymmetry index > 3.5%) was more frequent among EH patients than controls (38/17) but the difference was not significant (p = 0.07). In the 38 plagiocephalic patients, JF area was smaller on the flattened side than the contralateral in a significant number of cases both in right (21/7) and left (9/1) plagiocephaly (p < 0.0005) as well as the mean area (48.2 + 16.4 mm2 vs. 57.5 + 20.7 mm2, p = 0.002) and VOGS was significantly higher on the plagiocephalic side than on the contralateral side (1.6 ± 1.1 vs. 1.1 ± 0.9, p = 0.019).

CONCLUSION

In this series of infants affected by EH, the mean size of the ostium of both JF resulted significantly smaller than controls. JF stenosis was significantly associated with higher degrees of venous obstruction on both sides, suggesting a direct extrinsic effect of JF size on dural sinus lumen and possible consequent effect on venous outflow resistance. Positional plagiocephaly, when present, was associated with a decreased JF area and increased VOGS on the flattened side.