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Skadorwa T, Skadorwa J, Wierzbieniec O. The Accuracy of Classification Systems in Nonsyndromic Sagittal Craniosynostosis. J Craniofac Surg 2024; 35:13-17. [PMID: 37639642 PMCID: PMC10749678 DOI: 10.1097/scs.0000000000009670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 06/28/2023] [Indexed: 08/31/2023] Open
Abstract
Numerous classification systems of nonsyndromic sagittal craniosynostosis (NSC) are applied but none has gained a wide acceptance, since each classification is focused on distinct aspects. The aim of the study was to assess the accuracy of 4 classifications of NSC discussed in the literature by defining the associations among the classifications, individual features (sex, age, cranial index), and objective morphologic criteria (frontal bossing, retrocoronal constriction, sagittal ridge, and occipital bulleting). The study was conducted on anonymized thin-cut CT scans of 133 children with NSC 1 to 12 months old (mean age 5.42 mo). The type of cranial dysmorphology was assessed using 4 classification systems, focusing on skull shape, pattern of sagittal suture closure (Heuzé classification), deformation of skull vault (Sakamoto classification), and a single-dominant feature (David classification). Each patient was also independently investigated for the presence of morphologic criteria. A multivariate analysis was performed to explore the relations among the classifications and assess their accuracy. In the analyzed cohort sphenocephaly (38.3%), CFF type by Heuzé (30.8%), type I by Sakamoto (72.9%), and a central type by David (42.9%) were dominant findings. Regarding the morphologic criteria, frontal bossing was observed the most frequently (91.7%). The age of patients and cranial index differed significantly among the shapes of skull and David classifications ( P <0.001). The shape-based system showed the strongest correlation with other classifications and with measurable variables. Other classifications have much in common and some overlap, but none of them constitutes a standalone system to define all aspects of cranial dysmorphology in NSC.
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Affiliation(s)
- Tymon Skadorwa
- Department of Pediatric Neurosurgery, Bogdanowicz Memorial Hospital for Children
- Department of Descriptive and Clinical Anatomy, The Medical University of Warsaw
| | | | - Olga Wierzbieniec
- Department of Descriptive and Clinical Anatomy, The Medical University of Warsaw
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Skadorwa T, Wierzbieniec O, Sośnicka K, Podkowa K. Radiomorphologic profiles of nonsyndromic sagittal craniosynostosis. Childs Nerv Syst 2023; 39:3225-3233. [PMID: 37243812 PMCID: PMC10643241 DOI: 10.1007/s00381-023-05998-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 05/18/2023] [Indexed: 05/29/2023]
Abstract
PURPOSE Numerous classification systems of nonsyndromic sagittal craniosynostosis (NSC) are applied but none has gained a wide acceptance, since each classification is focused on distinct aspects of cranial dysmorphology. The goal of this study was to depict the most common combinations of radiomorphologic characteristics of NSC and to separate groups where the patients were morphologically similar to one another and at the same time significantly different from others. METHODS The study was conducted on anonymized thin-cut CT scans of 131 children with NSC aged 1-12 months (mean age 5.42 months). The type of cranial dysmorphology was assessed using four criteria: skull shape, pattern of sagittal suture fusion, morphologic features and cerebrospinal fluid (CSF) spaces alterations. After assigning the categories, an unsupervised k-modes clustering algorithm was applied to identify distinct patients clusters representing radiomorphologic profiles determined by investigated characteristics. RESULTS Cluster analysis revealed three distinct radiomorphologic profiles including the most common combinations of features. The profiles were not influenced by sex nor age but were significantly determined by skull shape (V = 0.58, P < 0.0001), morphologic features (V = 0.50, P < 0.0001) and pattern of sagittal suture fusion (V = 0.47, P < 0.0001). CSF alterations did not significantly correlate with the profiles (P = 0.3585). CONCLUSION NSC is a mosaic of radiologic and morphologic features. The internal diversity of NSC results in dissimilar groups of patients defined by unique combinations of radiomorphologic characteristics, from which the skull shape is the most differentiating factor. Radiomorphologic profiles support the idea of clinical trials targeted at more selective outcomes assessment.
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Affiliation(s)
- Tymon Skadorwa
- Department of Pediatric Neurosurgery, Bogdanowicz Memorial Hospital for Children, 4/24 Nieklanska St, 03924, Warsaw, Poland.
- Department of Descriptive and Clinical Anatomy, The Medical University of Warsaw, 5 Chalubinskiego St, 02004, Warsaw, Poland.
| | - Olga Wierzbieniec
- Department of Descriptive and Clinical Anatomy, The Medical University of Warsaw, 5 Chalubinskiego St, 02004, Warsaw, Poland
| | - Kamila Sośnicka
- Department of Descriptive and Clinical Anatomy, The Medical University of Warsaw, 5 Chalubinskiego St, 02004, Warsaw, Poland
| | - Klaudia Podkowa
- Department of Descriptive and Clinical Anatomy, The Medical University of Warsaw, 5 Chalubinskiego St, 02004, Warsaw, Poland
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Ahmadpour S, Foghi K. A rare case of the scaphocephalic skull of an adult male. EGYPTIAN JOURNAL OF FORENSIC SCIENCES 2022. [DOI: 10.1186/s41935-022-00303-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Scaphocephaly is a craniofacial anomaly where the skull is disproportionately long and narrow. Premature closure of the sagittal suture is thought to be at the core of the etiopathology for scaphocephaly.
Case presentation
The skull is a well-preserved skull found in an antiquated graveyard at Parkand village Daregaz, Iran, with no visible signs of surgical manipulation. The craniofacial indices were measured. The maximum cranial length was 200 mm, and the measured length of nasion-bregma was 140mm, whereas most of the measurements were less than the normal scaphocephalic indices. Another morphological finding was the flattening of the frontal bone.
Conclusions
The cranial vault morphometry and morphology of the presented case fit the scalp. In addition to the characteristics of scaphocephaly, the presented skull was of a rare trait, frontal flattening, which has not been reported before.
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Arenas-Ruiz JA, Martínez-Maldonado H, Hernández-Segura NE, Villarreal-Silva EE, González-Carranza V, Torres-García S, Chico-Ponce de León F. Single sagittal craniosynostosis surgical treatment with the "Peau d́ours" technique. Single-center experience in Mexico. J Clin Neurosci 2022; 99:73-77. [PMID: 35255360 DOI: 10.1016/j.jocn.2022.02.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 01/26/2022] [Accepted: 02/13/2022] [Indexed: 11/27/2022]
Abstract
Scaphocephaly (SC) is defined as an elongation of the anteroposterior axis of the skull resulting from the abnormal fusion of the sagittal suture. This study describes the "Peau d'ours" technique and results for correcting SC. We conducted a consecutive and retrospective analysis of patients treated from 2011 to 2016. We evaluated the gender, age, and surgical outcomes. A total of 53 patients were enrolled with a mean age of 19 months old. The advantages of this technique are healthy coronal and lambdoid suture preservation and symmetrical parietal bone flap opening. This technique is safe and simple to reproduce, allowing good surgical outcomes with a low incidence of secondary craniosynostosis. This technique is ideal for patients older than six months old.
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Affiliation(s)
- José Ascención Arenas-Ruiz
- Servicio de Neurocirugía y Terapia Endovascular Neurológica, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León. Madero y Gonzalitos SN, mitras centro, 64460 Monterrey, Nuevo León, Mexico.
| | - Horus Martínez-Maldonado
- Hospital Infantil de México Federico Gómez, National Institute of Health, Dr. Márquez 162, Cuauhtémoc, 06720 Ciudad de México, CDMX, Mexico
| | - Natalia Edith Hernández-Segura
- Hospital Infantil de México Federico Gómez, National Institute of Health, Dr. Márquez 162, Cuauhtémoc, 06720 Ciudad de México, CDMX, Mexico
| | - Eliud Enrique Villarreal-Silva
- Servicio de Neurocirugía y Terapia Endovascular Neurológica, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León. Madero y Gonzalitos SN, mitras centro, 64460 Monterrey, Nuevo León, Mexico
| | - Vicente González-Carranza
- Hospital Infantil de México Federico Gómez, National Institute of Health, Dr. Márquez 162, Cuauhtémoc, 06720 Ciudad de México, CDMX, Mexico
| | - Samuel Torres-García
- Hospital Infantil de México Federico Gómez, National Institute of Health, Dr. Márquez 162, Cuauhtémoc, 06720 Ciudad de México, CDMX, Mexico
| | - Fernando Chico-Ponce de León
- Hospital Infantil de México Federico Gómez, National Institute of Health, Dr. Márquez 162, Cuauhtémoc, 06720 Ciudad de México, CDMX, Mexico.
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Herlin C, Captier G, Bigorre M, Chan-Seng E, Roujeau T. Partial hybrid cranial vault remodeling in late correction of scaphocephaly and revision surgery. A monocentric retrospective study of nine consecutive cases. Neurochirurgie 2019; 66:110-115. [PMID: 31655099 DOI: 10.1016/j.neuchi.2019.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 10/04/2019] [Accepted: 10/06/2019] [Indexed: 11/30/2022]
Abstract
There is currently no consensus on the surgical attitude to be adopted for late management of sagittal synostosis or for revision scaphocephaly surgeries without prolapse of the cerebellar tonsils. We present here a monocentric retrospective study of nine patients operated consecutively by a fixed expansion method of the cranial vault which may be associated with a fronto-orbital remodeling. The procedure consists in the realization of multiple parietal tongue-in-groove osteotomies fixed by resorbable plates. Simultaneous fronto-orbital remodeling have been performed when needed. No intraoperative complication was noted. The average operating time was 141min. Six patients (66.7%) had a blood transfusion during the perioperative period. The average hospital stay was 4.8days. With a mean follow-up of 26,7months, no surgical revision was noted. In all patients with clinical or ophthalmologic signs of intracranial hypertension, we highlighted a disappearance of signs within 4months. No protective helmet has been used. The craniofacial remodeling was judged very good by the family and the surgical team. Multiple tongue-in-groove tenons remolding cranioplasty associated or not with a fronto-orbital advancement is a safe technique. It seems to us to be a good alternative to floating or fixed bi-parietal or bi-parieto-frontal cranial flaps because of the very large increase in endocranial volume and the possibility of physiologically and aesthetically remodeling the parietal and fronto-orbital regions.
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Affiliation(s)
- C Herlin
- Department of Plastic and Craniofacial Pediatric Surgery, Lapeyronie University Hospital, Avenue du Doyen-Gaston-Giraud, 34295 Montpellier, France; Department of Plastic and Reconstructive Surgery and Burns, Lapeyronie University Hospital, Avenue du Doyen-Gaston-Giraud, 34295 Montpellier, France.
| | - G Captier
- Department of Plastic and Craniofacial Pediatric Surgery, Lapeyronie University Hospital, Avenue du Doyen-Gaston-Giraud, 34295 Montpellier, France
| | - M Bigorre
- Department of Plastic and Craniofacial Pediatric Surgery, Lapeyronie University Hospital, Avenue du Doyen-Gaston-Giraud, 34295 Montpellier, France
| | - E Chan-Seng
- Department of Pediatric Neurosurgery, Gui de Chauliac University Hospital, Avenue Augustin-Fliche, 34295 Montpellier, France
| | - T Roujeau
- Department of Pediatric Neurosurgery, Gui de Chauliac University Hospital, Avenue Augustin-Fliche, 34295 Montpellier, France
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Vinchon M, Pellerin P, Guerreschi P, Baroncini M, Dhellemmes P. Atypical scaphocephaly: a review. Childs Nerv Syst 2012; 28:1319-25. [PMID: 22872243 DOI: 10.1007/s00381-012-1807-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Accepted: 05/14/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND AND PURPOSE Sagittal craniosynostosis (SCS) is common and easily recognized and corrected surgically. However, rare cases of SCS are more complex: these associate closure of the metopic or delayed closure of the coronal suture, uni- or bilaterally. MATERIAL AND METHODS We reviewed the available literature on atypical sagittal craniosynostosis (ASCS). We also reviewed retrospectively our series of SCS treated since 1980 and selected cases with simultaneous closure of the metopic (leptocephaly) or delayed closure of other sutures (plagiocephaly, oxycephaly, or Crouzon syndrome). RESULTS ASCS is rare, representing <10 % of SCS. In our series, among 447 cases of SCS followed for a mean duration of 63.7 months, we identified 22 cases of ASCS: 6 with leptocephaly, 9 with non-syndromic oxycephaly, 4 with Crouzon syndrome, and 3 with plagiocephaly. Fourteen patients required a second operation, either planned initially (severe leptocephaly) or because of brain compression. The actuarial incidence of ASCS requiring reoperation was 5.3 % of SCS at 10 years. After a mean follow-up of 113 months, morphological results in ASCS were grade 1 (no defect) in 5, grade 2 (mild defect) in 2, grade 3 (minor reoperation) in 3, and grade 4 (major reoperation) in 12; one patient had visual impairment, and two had learning difficulties. CONCLUSIONS ACSC can be detected initially or occur with a delay in apparently standard SCS. Leptocephaly is a specific entity. Because of the implications on the management and risk for the patient, preoperative evaluation of patients with SCS with CT scanner and prolonged follow-up are necessary.
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Affiliation(s)
- Matthieu Vinchon
- Department of Pediatric Neurosurgery, Lille University Hospital, Lille, France.
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Antúnez S, Arnaud E, Cruz A, Marchac D, Renier D. Scaphocephaly: Part I. J Craniofac Surg 2009; 20 Suppl 2:1837-42. [DOI: 10.1097/scs.0b013e3181b6c4ea] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Identifying reproducible patterns of calvarial dysmorphology in nonsyndromic sagittal craniosynostosis may affect operative intervention and outcomes assessment. Plast Reconstr Surg 2008; 121:696-697. [PMID: 18176241 DOI: 10.1097/01.prs.0000294949.41575.52] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Affiliation(s)
- D Renier
- Groupe d'Ettudes des Malformations Craniofaciales, Service de Neurochirurgie, CHU Necker-Enfants Malades, 149, rue de Sèvres, 75743 Paris.
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