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Doerga PN, Goederen RD, van Veelen MLC, Joosten KFM, Tasker RC, Mathijssen IMJ. What We Know About Intracranial Hypertension in Children With Syndromic Craniosynostosis. J Craniofac Surg 2023; 34:1903-1914. [PMID: 37487059 DOI: 10.1097/scs.0000000000009517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 05/17/2023] [Indexed: 07/26/2023] Open
Abstract
OBJECTIVE A scoping review of literature about mechanisms leading to intracranial hypertension (ICH) in syndromic craniosynostosis (sCS) patients, followed by a narrative synopsis of whether cognitive and behavioral outcome in sCS is more related to genetic origins, rather than the result of ICH. METHODS The scoping review comprised of a search of keywords in EMBASE, MEDLINE, Web of science, Cochrane Central Register of Trials, and Google scholar databases. Abstracts were read and clinical articles were selected for full-text review and data were extracted using a structured template. A priori, the authors planned to analyze mechanistic questions about ICH in sCS by focusing on 2 key aspects, including (1) the criteria for determining ICH and (2) the role of component factors in the Monro-Kellie hypothesis/doctrine leading to ICH, that is, cerebral blood volume, cerebrospinal fluid (CSF), and the intracranial volume. RESULTS Of 1893 search results, 90 full-text articles met criteria for further analysis. (1) Invasive intracranial pressure measurements are the gold standard for determining ICH. Of noninvasive alternatives to determine ICH, ophthalmologic ones like fundoscopy and retinal thickness scans are the most researched. (2) The narrative review shows how the findings relate to ICH using the Monro-Kellie doctrine. CONCLUSIONS Development of ICH is influenced by different aspects of sCS: deflection of skull growth, obstructive sleep apnea, venous hypertension, obstruction of CSF flow, and possibly reduced CSF absorption. Problems in cognition and behavior are more likely because of genetic origin. Cortical thinning and problems in visual function are likely the result of ICH.
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Affiliation(s)
- Priya N Doerga
- Sophia Children's Hospital, Dutch Craniofacial Center, Department of Plastic and Reconstructive Surgery and Hand Surgery, Erasmus MC, University Medical Center
| | - Robbin de Goederen
- Sophia Children's Hospital, Dutch Craniofacial Center, Department of Plastic and Reconstructive Surgery and Hand Surgery, Erasmus MC, University Medical Center
| | - Marie-Lise C van Veelen
- Sophia Children's Hospital, Department of Neurosurgery, Erasmus MC, University Medical Center
| | - Koen F M Joosten
- Sophia Children's Hospital Pediatric Intensive Care Unit, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Robert C Tasker
- Department of Anaesthesia (Pediatrics) and Division of Critical Care Medicine, Harvard Medical School and Boston Children's Hospital, Boston, MA
| | - Irene M J Mathijssen
- Sophia Children's Hospital, Dutch Craniofacial Center, Department of Plastic and Reconstructive Surgery and Hand Surgery, Erasmus MC, University Medical Center
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Discussion of "Does the Mutation Type Affect the Response to Cranial Vault Expansion in Children With Apert Syndrome?". J Craniofac Surg 2023; 34:913-915. [PMID: 36727961 DOI: 10.1097/scs.0000000000009173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 10/03/2022] [Indexed: 02/03/2023] Open
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Hearing, Speech, Language, and Communicative Participation in Patients With Apert Syndrome: Analysis of Correlation With Fibroblast Growth Factor Receptor 2 Mutation. J Craniofac Surg 2021; 33:243-250. [PMID: 34310431 DOI: 10.1097/scs.0000000000008019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Apert syndrome (AS) is caused by the heterozygous presence of 1 of 2 specific missense mutations of the fibroblast growth factor receptor 2 (FGFR2) gene. The 2 adjacent substitutions, designated p.Ser252Trp (S252W) and p.Pro253Arg (P253R), account for more than 98% of cases. Previous research has identified elevated hearing difficulties and incidence of cleft palate in this population. However, the influence of FGFR2 genotype on the speech, language, and communicative participation of children with AS has yet to be examined. METHODS A retrospective case note analysis was completed for all patients with a genetically-confirmed Apert mutation who attended the Oxford Craniofacial Unit over a 43-year period (1978-2020). Medical records were analyzed for speech, language, hearing, and communication data in detail. The therapy outcome measures, based on the World Health Organization International Classification of Functioning, Disability, and Health was used to classify patient's communicative participation. RESULTS The authors identified 55 AS patients with genetically-confirmed mutation of the FGFR2 gene. One patient with a S252F mutation was excluded. There were 31 patients with the S252W mutation (male = 14; female = 17), age range of last hearing assessment (1-18 years), 64% (18/28) of patients had a cleft palate (including bifid uvula), 15 patients had conductive hearing loss, 1 patient had mixed hearing loss, 18 had otitis media with effusion (4 of whom had a cleft palate); 88% (21/24) of patients had receptive language difficulties, 88% (22/25) of patients had expressive language difficulties, 96% (27/28) of patients had a speech sound disorder. There were 23 patients with the P253R mutation (male = 13; female = 10); age range of last hearing assessment (1-13 years), 35% (8/23) patients had a cleft palate (including bifid uvula), 14 patients had a conductive hearing loss, 17 had otitis media with effusion (2 of whom had a cleft palate). Results indicated that 85% (17/20) of patients had receptive language difficulties, 80% (16/20) had expressive language difficulties, 100% (21/21) had a speech sound disorder. The S252W mutation was significantly-associated with the presence of cleft palate (including bifid uvula) (P = 0.05).Data about the cumulative impact of all of these factors for communicative participation using the therapy outcome measures were available for 47 patients: (30 S252W; 17 P253R). Patients with a S252W mutation had significantly more severe difficulties with communicative participation when compared to individuals with a P253R mutation (P = 0.0005) Cochran-Armitage trend test. CONCLUSIONS Speech, language, communicative participation, and hearing difficulties are pervasive in patients with AS. The severity and functional impact of these difficulties are magnified in patients with the S252W mutation. Results reinforce the importance of considering patients with AS according to genotype.
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Munarriz PM, Pascual B, Castaño-Leon AM, García-Recuero I, Redondo M, de Aragón AM, Romance A. Apert syndrome: Cranial procedures and brain malformations in a series of patients. Surg Neurol Int 2020; 11:361. [PMID: 33194294 PMCID: PMC7655990 DOI: 10.25259/sni_413_2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 09/28/2020] [Indexed: 11/25/2022] Open
Abstract
Background: Apert syndrome is one of the most severe craniofacial disorders. This study aims to describe the craniofacial surgeries and central nervous system malformations of a cohort of children with Apert syndrome treated in the past 20 years and to compare these data with previously published data. Methods: Retrospective analysis of a series of patients with Apert syndrome treated between 1999 and 2019 in our hospital. Information was analyzed regarding craniofacial procedures, hydrocephalus and presence of shunts, Chiari malformation Type 1, and other brain malformations such as corpus callosum and septum pellucidum anomalies. Results: Thirty-seven patients were studied. Ventriculoperitoneal shunt prevalence was 24.3%, and 8.1% of patients required decompressive surgery for Chiari malformation. All of them needed at least one cranial vault remodeling procedure. The median age for this procedure was 8 months. In 69.7% of patients, the first cranial vault intervention was performed in the fronto-orbital region. In 36.4% of patients, a midface advancement had been performed at the time of this review, although this proportion was very dependent on the follow-up period and the age of the patients. The median age for the midface advancement procedure was 5.25 years. Anomalies of the corpus callosum and the septum pellucidum were reported in 43.2% and 59.5% of patients, respectively. Conclusion: Apert syndrome is a type of syndromic craniosynostosis, and patients usually require one or more cranial and facial surgeries. In comparison with other syndromic craniosynostosis types, Apert syndrome less frequently requires a VP shunt or treatment for a Chiari malformation.
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Affiliation(s)
- Pablo M Munarriz
- Department of Neurosurgery, Hospital 12 de Octubre, Madrid, Spain.,Department of Craniofacial Unit (ERN CRANIO), Hospital 12 de Octubre, Madrid, Spain
| | - Beatriz Pascual
- Department of Neurosurgery, Hospital 12 de Octubre, Madrid, Spain.,Department of Craniofacial Unit (ERN CRANIO), Hospital 12 de Octubre, Madrid, Spain
| | - Ana M Castaño-Leon
- Department of Neurosurgery, Hospital 12 de Octubre, Madrid, Spain.,Department of Craniofacial Unit (ERN CRANIO), Hospital 12 de Octubre, Madrid, Spain
| | - Ignacio García-Recuero
- Department of Oral and Maxillofacial Surgery Hospital 12 de Octubre, Madrid, Spain.,Department of Craniofacial Unit (ERN CRANIO), Hospital 12 de Octubre, Madrid, Spain
| | - Marta Redondo
- Department of Oral and Maxillofacial Surgery Hospital 12 de Octubre, Madrid, Spain.,Department of Craniofacial Unit (ERN CRANIO), Hospital 12 de Octubre, Madrid, Spain
| | - Ana Martínez de Aragón
- Department of Radiology, Hospital 12 de Octubre, Madrid, Spain.,Department of Craniofacial Unit (ERN CRANIO), Hospital 12 de Octubre, Madrid, Spain
| | - Ana Romance
- Department of Oral and Maxillofacial Surgery Hospital 12 de Octubre, Madrid, Spain.,Department of Craniofacial Unit (ERN CRANIO), Hospital 12 de Octubre, Madrid, Spain
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Abstract
BACKGROUND Apert syndrome causes normal or enlarged intracranial volume overall as patients grow. This study aimed to trace the segmental anterior, middle, and posterior cranial fossae volume and structural morphology in these patients, to help discern a more focused and individualized surgical treatment plan for patients with Apert syndrome. METHODS This study included 82 preoperative computed tomographic scans (Apert, n = 32; control, n = 50) divided into five age-related subgroups. The scans were measured using image processing and three-dimensional modeling software. RESULTS The middle cranial fossa volume was increased and was the earliest change noted. It was increased by 45 percent (p = 0.023) compared with controls before 6 months of age and remained increased into adulthood (161 percent, p = 0.016), with gradually increasing severity. The anterior and posterior cranial fossae volumes also increased, by 35 percent (p = 0.032) and 39 percent (p = 0.007), respectively. Increased depth of cranial fossae contributed most to the increase in volumes of patients with Apert syndrome, with correlation coefficients of 0.799, 0.908, and 0.888 for anterior, middle, and posterior cranial fossa, respectively. The intracranial volume was increased 12 percent (p = 0.098) across the entire test age range (0 to 26 years old), but only had statistical significance during the age range of 6 to 18 years (22 percent, p = 0.001). CONCLUSIONS Malformation of the middle cranial fossa is an early, perhaps the initial, pivotal cranial morphologic change in Apert syndrome. Increased cranial fossae depth is an inherent characteristic of the maldevelopment. Normalization of cranial volume and circumference overall may not achieve a normal skull structure, as it does not correct regional craniocerebral disproportion.
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Abstract
Craniosynostosis is one of the most common craniofacial conditions treated by neurologic and plastic surgeons. In addition to disfigurement, children with craniosynostosis experience significant cognitive dysfunction later in life. Surgery is performed in infancy to correct skull deformity; however, the field is at a crossroads regarding the best approach for correction. Since the cause of brain dysfunction in these patients has remained uncertain, the role and type of surgery might have in attenuating the later-observed cognitive deficits through impact on the brain has been unclear. Recently, however, advances in imaging such as event-related potentials, diffusion tensor imaging, and functional MRI, in conjunction with more robust clinical studies, are providing important insight into the potential etiologies of brain dysfunction in syndromic and nonsyndromic craniosynostosis patients. This review aims to outline the cause(s) of such brain dysfunction including the role extrinsic vault constriction might have on brain development and the current evidence for an intrinsic modular developmental error in brain development. Illuminating the cause of brain dysfunction will identify the role of surgery can play in improving observed functional deficits and thus direct optimal primary and adjuvant treatment.
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Tan AP, Mankad K. Apert syndrome: magnetic resonance imaging (MRI) of associated intracranial anomalies. Childs Nerv Syst 2018; 34:205-216. [PMID: 29198073 DOI: 10.1007/s00381-017-3670-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 11/20/2017] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Apert syndrome is one of the most common craniosynostosis syndrome caused by mutations in genes encoding fibroblast growth factor receptor 2 (FGFR2). It is characterized by multisuture craniosynostosis, midfacial hypoplasia, abnormal skull base development and syndactyly of all extremities. Apert syndrome is associated with a wide array of central nervous system (CNS) anomalies, possibly the cause of the common occurrence of mental deficiency in patients with Apert syndrome. These CNS anomalies can be broadly classified into two groups; (1) those that are primary malformations and (2) those that occur secondary to osseous deformity/malformation. CONCLUSION Familiarity with CNS anomalies associated with Apert syndrome is important to both clinicians and radiologist as it impacts on management and prognostication. Cognitive development of patients has been linked to associated CNS anomalies, timing of surgery and social aspects. These associated anomalies can be broadly classified into (1) those that are primary malformations and (2) those that occur secondary to osseous deformity/malformation, as illustrated in our review paper.
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Affiliation(s)
- Ai Peng Tan
- Department of Diagnostic Radiology, National University Health System, 5 Lower Kent Ridge Road, Singapore, 119074, Singapore.
| | - Kshitij Mankad
- Department of Neuroradiology, Great Ormond Street Hospital NHS Foundation Trust, Great Ormond Street, London, WC1N 3JH, UK
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Maximino LP, Ducati LG, Abramides DVM, Corrêa CDC, Garcia PF, Fernandes AY. Syndromic craniosynostosis: neuropsycholinguistic abilities and imaging analysis of the central nervous system. ARQUIVOS DE NEURO-PSIQUIATRIA 2017; 75:862-868. [DOI: 10.1590/0004-282x20170171] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 09/13/2017] [Indexed: 02/02/2023]
Abstract
ABSTRACT Objective: To characterize patients with syndromic craniosynostosis with respect to their neuropsycholinguistic abilities and to present these findings together with the brain abnormalities. Methods: Eighteen patients with a diagnosis of syndromic craniosynostosis were studied. Eight patients had Apert syndrome and 10 had Crouzon syndrome. They were submitted to phonological evaluation, neuropsychological evaluation and magnetic resonance imaging of the brain. The phonological evaluation was done by behavioral observation of the language, the Peabody test, Token test and a school achievement test. The neuropsychological evaluation included the WISC III and WAIS tests. Results: Abnormalities in language abilities were observed and the school achievement test showed abnormalities in 66.67% of the patients. A normal intelligence quotient was observed in 39.3% of the patients, and congenital abnormalities of the central nervous system were observed in 46.4% of the patients. Conclusion: Abnormalities of language abilities were observed in the majority of patients with syndromic craniosynostosis, and low cognitive performance was also observed.
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Munshi A, Khetarpal P, Das S, Rao V, Valecha M, Bansal M, Kumar R. Apert's syndrome: Study by whole exome sequencing. Genes Dis 2017; 5:119-122. [PMID: 30258940 PMCID: PMC6147108 DOI: 10.1016/j.gendis.2017.07.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 07/28/2017] [Indexed: 12/17/2022] Open
Abstract
In the present study we attempted a parent–child trio, whole exome sequencing (WES) approach to study Apert's syndrome. Clinical characteristics of the child were noted down and WES was carried out using Ion Torrent System that revealed the presence of previously reported P253R mutation in FGFR2 gene. Presence of two SNPs rs1047057 and rs554851880 in FGFR2 gene with an allelic frequency of 0.5113 and 0.001176 respectively and 161 complete damaging mutations were found. This study is the first reported case of exome sequencing approach on an Apert's syndrome patient aimed at providing better genetic counselling in a non-consanguineous relationship.
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Affiliation(s)
- Anjana Munshi
- Centre for Human Genetics and Molecular Medicine, School of Health Sciences, Central University of Punjab, Bathinda, Punjab, India
- Corresponding author.
| | - Preeti Khetarpal
- Centre for Human Genetics and Molecular Medicine, School of Health Sciences, Central University of Punjab, Bathinda, Punjab, India
| | - Satrupa Das
- Institute of Genetics and Hospital for Genetic Diseases, Osmania University, Begumpet, Hyderabad, India
- Dr. NTR University of Health Sciences, Vijayawada, Andhra Pradesh, India
| | | | | | - Manita Bansal
- Dept. of Paediatrics, Civil Hospital, Bathinda, Punjab, India
| | - Roshan Kumar
- Centre for Human Genetics and Molecular Medicine, School of Health Sciences, Central University of Punjab, Bathinda, Punjab, India
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Motch Perrine SM, Stecko T, Neuberger T, Jabs EW, Ryan TM, Richtsmeier JT. Integration of Brain and Skull in Prenatal Mouse Models of Apert and Crouzon Syndromes. Front Hum Neurosci 2017; 11:369. [PMID: 28790902 PMCID: PMC5525342 DOI: 10.3389/fnhum.2017.00369] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 06/29/2017] [Indexed: 01/23/2023] Open
Abstract
The brain and skull represent a complex arrangement of integrated anatomical structures composed of various cell and tissue types that maintain structural and functional association throughout development. Morphological integration, a concept developed in vertebrate morphology and evolutionary biology, describes the coordinated variation of functionally and developmentally related traits of organisms. Syndromic craniosynostosis is characterized by distinctive changes in skull morphology and perceptible, though less well studied, changes in brain structure and morphology. Using mouse models for craniosynostosis conditions, our group has precisely defined how unique craniosynostosis causing mutations in fibroblast growth factor receptors affect brain and skull morphology and dysgenesis involving coordinated tissue-specific effects of these mutations. Here we examine integration of brain and skull in two mouse models for craniosynostosis: one carrying the FGFR2c C342Y mutation associated with Pfeiffer and Crouzon syndromes and a mouse model carrying the FGFR2 S252W mutation, one of two mutations responsible for two-thirds of Apert syndrome cases. Using linear distances estimated from three-dimensional coordinates of landmarks acquired from dual modality imaging of skull (high resolution micro-computed tomography and magnetic resonance microscopy) of mice at embryonic day 17.5, we confirm variation in brain and skull morphology in Fgfr2cC342Y/+ mice, Fgfr2+/S252W mice, and their unaffected littermates. Mutation-specific variation in neural and cranial tissue notwithstanding, patterns of integration of brain and skull differed only subtly between mice carrying either the FGFR2c C342Y or the FGFR2 S252W mutation and their unaffected littermates. However, statistically significant and substantial differences in morphological integration of brain and skull were revealed between the two mutant mouse models, each maintained on a different strain. Relative to the effects of disease-associated mutations, our results reveal a stronger influence of the background genome on patterns of brain-skull integration and suggest robust genetic, developmental, and evolutionary relationships between neural and skeletal tissues of the head.
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Affiliation(s)
- Susan M Motch Perrine
- Department of Anthropology, Pennsylvania State UniversityUniversity Park, PA, United States
| | - Tim Stecko
- Center for Quantitative Imaging, Penn State Institutes for Energy and the Environment, Pennsylvania State UniversityUniversity Park, PA, United States
| | - Thomas Neuberger
- High Field MRI Facility, Huck Institutes of the Life Sciences, Pennsylvania State UniversityUniversity Park, PA, United States.,Department of Bioengineering, Pennsylvania State UniversityUniversity Park, PA, United States
| | - Ethylin W Jabs
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount SinaiNew York, NY, United States
| | - Timothy M Ryan
- Department of Anthropology, Pennsylvania State UniversityUniversity Park, PA, United States.,Center for Quantitative Imaging, Penn State Institutes for Energy and the Environment, Pennsylvania State UniversityUniversity Park, PA, United States
| | - Joan T Richtsmeier
- Department of Anthropology, Pennsylvania State UniversityUniversity Park, PA, United States
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Luo F, Xie Y, Xu W, Huang J, Zhou S, Wang Z, Luo X, Liu M, Chen L, Du X. Deformed Skull Morphology Is Caused by the Combined Effects of the Maldevelopment of Calvarias, Cranial Base and Brain in FGFR2-P253R Mice Mimicking Human Apert Syndrome. Int J Biol Sci 2017; 13:32-45. [PMID: 28123344 PMCID: PMC5264259 DOI: 10.7150/ijbs.16287] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 09/24/2016] [Indexed: 02/04/2023] Open
Abstract
Apert syndrome (AS) is a common genetic syndrome in humans characterized with craniosynostosis. Apert patients and mouse models showed abnormalities in sutures, cranial base and brain, that may all be involved in the pathogenesis of skull malformation of Apert syndrome. To distinguish the differential roles of these components of head in the pathogenesis of the abnormal skull morphology of AS, we generated mouse strains specifically expressing mutant FGFR2 in chondrocytes, osteoblasts, and progenitor cells of central nervous system (CNS) by crossing Fgfr2+/P253R-Neo mice with Col2a1-Cre, Osteocalcin-Cre (OC-Cre), and Nestin-Cre mice, respectively. We then quantitatively analyzed the skull and brain morphology of these mutant mice by micro-CT and micro-MRI using Euclidean distance matrix analysis (EDMA). Skulls of Col2a1-Fgfr2+/P253R mice showed Apert syndrome-like dysmorphology, such as shortened skull dimensions along the rostrocaudal axis, shortened nasal bone, and evidently advanced ossification of cranial base synchondroses. The OC-Fgfr2+/P253R mice showed malformation in face at 8-week stage. Nestin-Fgfr2+/P253R mice exhibited increased dorsoventral height and rostrocaudal length on the caudal skull and brain at 8 weeks. Our study indicates that the abnormal skull morphology of AS is caused by the combined effects of the maldevelopment in calvarias, cranial base, and brain tissue. These findings further deepen our knowledge about the pathogenesis of the abnormal skull morphology of AS, and provide new clues for the further analyses of skull phenotypes and clinical management of AS.
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Affiliation(s)
- Fengtao Luo
- Department of Rehabilitation Medicine, Center of Bone Metabolism and Repair, State Key Laboratory of Trauma, Burns and Combined Injury, Trauma Center, Research Institute of Surgery, Daping Hospital, Third Military Medical University, Chongqing 400042, China
| | - Yangli Xie
- Department of Rehabilitation Medicine, Center of Bone Metabolism and Repair, State Key Laboratory of Trauma, Burns and Combined Injury, Trauma Center, Research Institute of Surgery, Daping Hospital, Third Military Medical University, Chongqing 400042, China
| | - Wei Xu
- Department of Rehabilitation Medicine, Center of Bone Metabolism and Repair, State Key Laboratory of Trauma, Burns and Combined Injury, Trauma Center, Research Institute of Surgery, Daping Hospital, Third Military Medical University, Chongqing 400042, China
| | - Junlan Huang
- Department of Rehabilitation Medicine, Center of Bone Metabolism and Repair, State Key Laboratory of Trauma, Burns and Combined Injury, Trauma Center, Research Institute of Surgery, Daping Hospital, Third Military Medical University, Chongqing 400042, China
| | - Siru Zhou
- Department of Rehabilitation Medicine, Center of Bone Metabolism and Repair, State Key Laboratory of Trauma, Burns and Combined Injury, Trauma Center, Research Institute of Surgery, Daping Hospital, Third Military Medical University, Chongqing 400042, China
| | - Zuqiang Wang
- Department of Rehabilitation Medicine, Center of Bone Metabolism and Repair, State Key Laboratory of Trauma, Burns and Combined Injury, Trauma Center, Research Institute of Surgery, Daping Hospital, Third Military Medical University, Chongqing 400042, China
| | - Xiaoqing Luo
- Department of Rehabilitation Medicine, Center of Bone Metabolism and Repair, State Key Laboratory of Trauma, Burns and Combined Injury, Trauma Center, Research Institute of Surgery, Daping Hospital, Third Military Medical University, Chongqing 400042, China
| | - Mi Liu
- Department of Rehabilitation Medicine, Center of Bone Metabolism and Repair, State Key Laboratory of Trauma, Burns and Combined Injury, Trauma Center, Research Institute of Surgery, Daping Hospital, Third Military Medical University, Chongqing 400042, China
| | - Lin Chen
- Department of Rehabilitation Medicine, Center of Bone Metabolism and Repair, State Key Laboratory of Trauma, Burns and Combined Injury, Trauma Center, Research Institute of Surgery, Daping Hospital, Third Military Medical University, Chongqing 400042, China
| | - Xiaolan Du
- Department of Rehabilitation Medicine, Center of Bone Metabolism and Repair, State Key Laboratory of Trauma, Burns and Combined Injury, Trauma Center, Research Institute of Surgery, Daping Hospital, Third Military Medical University, Chongqing 400042, China
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Fernandes MBL, Maximino LP, Perosa GB, Abramides DVM, Passos-Bueno MR, Yacubian-Fernandes A. Apert and Crouzon syndromes-Cognitive development, brain abnormalities, and molecular aspects. Am J Med Genet A 2016; 170:1532-7. [PMID: 27028366 DOI: 10.1002/ajmg.a.37640] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2015] [Accepted: 03/13/2016] [Indexed: 12/27/2022]
Abstract
Apert and Crouzon are the most common craniosynostosis syndromes associated with mutations in the fibroblast growth factor receptor 2 (FGFR2) gene. We conducted a study to examine the molecular biology, brain abnormalities, and cognitive development of individuals with these syndromes. A retrospective longitudinal review of 14 patients with Apert and Crouzon syndromes seen at the outpatient Craniofacial Surgery Hospital for Rehabilitation of Craniofacial Anomalies in Brazil from January 1999 through August 2010 was performed. Patients between 11 and 36 years of age (mean 18.29 ± 5.80), received cognitive evaluations, cerebral magnetic resonance imaging, and molecular DNA analyses. Eight patients with Apert syndrome (AS) had full scale intelligence quotients (FSIQs) that ranged from 47 to 108 (mean 76.9 ± 20.2), and structural brain abnormalities were identified in five of eight patients. Six patients presented with a gain-of-function mutation (p.Ser252Trp) in FGFR2 and FSIQs in those patients ranged from 47 to78 (mean 67.2 ± 10.7). One patient with a gain-of-function mutation (p.Pro253Arg) had a FSIQ of 108 and another patient with an atypical splice mutation (940-2A →G) had a FSIQ of 104. Six patients with Crouzon syndrome had with mutations in exons IIIa and IIIc of FGFR2 and their FSIQs ranged from 82 to 102 (mean 93.5 ± 6.7). These reveal that molecular aspects are another factor that can be considered in studies of global and cognitive development of patients with Apert and Crouzon syndrome (CS). © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
| | | | - Gimol B Perosa
- Departamento de Neurologia, Psicologia e Psiquiatria, UNESP, Botucatu, SP, Brazil
| | | | | | - Adriano Yacubian-Fernandes
- Departamento de Fonoaudiologia, FOB-USP, Bauru, SP, Brazil.,Departamento de Neurologia, Psicologia e Psiquiatria, UNESP, Botucatu, SP, Brazil
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13
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Stark Z, McGillivray G, Sampson A, Palma-Dias R, Edwards A, Said JM, Whiteley G, Fink AM. Apert syndrome: temporal lobe abnormalities on fetal brain imaging. Prenat Diagn 2014; 35:179-82. [DOI: 10.1002/pd.4515] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Revised: 09/08/2014] [Accepted: 10/04/2014] [Indexed: 11/06/2022]
Affiliation(s)
- Zornitza Stark
- Victorian Clinical Genetics Services; Murdoch Children's Research Institute; Melbourne Australia
- Fetal Medicine Unit; Royal Women's Hospital; Melbourne Australia
- Maternal Fetal Medicine, Sunshine Hospital; Western Health; Melbourne Australia
| | - George McGillivray
- Victorian Clinical Genetics Services; Murdoch Children's Research Institute; Melbourne Australia
- Fetal Medicine Unit; Royal Women's Hospital; Melbourne Australia
| | - Amanda Sampson
- Fetal Medicine Unit; Royal Women's Hospital; Melbourne Australia
- Pauline Gandell Women's Imaging Centre; The Royal Women's Hospital; Melbourne Australia
| | - Ricardo Palma-Dias
- Fetal Medicine Unit; Royal Women's Hospital; Melbourne Australia
- Pauline Gandell Women's Imaging Centre; The Royal Women's Hospital; Melbourne Australia
- Pregnancy Research Centre, Department of Obstetrics and Gynaecology; University of Melbourne; Melbourne Australia
| | - Andrew Edwards
- Fetal Diagnostic Unit; Monash Medical Centre; Melbourne Australia
- The Ritchie Centre; Monash Institute of Medical Research; Melbourne Australia
| | - Joanne M. Said
- Fetal Medicine Unit; Royal Women's Hospital; Melbourne Australia
- Maternal Fetal Medicine, Sunshine Hospital; Western Health; Melbourne Australia
- NorthWest Academic Centre; The University of Melbourne; Melbourne Australia
| | - Gillian Whiteley
- Department of Radiology; Monash Medical Centre; Melbourne Australia
| | - A. Michelle Fink
- Fetal Medicine Unit; Royal Women's Hospital; Melbourne Australia
- Department of Radiology; University of Melbourne; Melbourne Australia
- Medical Imaging Department; The Royal Children's Hospital; Melbourne Australia
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Giancotti A, D'Ambrosio V, De Filippis A, Aliberti C, Pasquali G, Bernardo S, Manganaro L. Comparison of ultrasound and magnetic resonance imaging in the prenatal diagnosis of Apert syndrome: report of a case. Childs Nerv Syst 2014; 30:1445-8. [PMID: 24566675 DOI: 10.1007/s00381-014-2377-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Accepted: 01/28/2014] [Indexed: 12/11/2022]
Abstract
BACKGROUND The birth prevalence of Apert syndrome is estimated at 1:64,500 and accounts for about 4.5 % of all craniosynostosis with a male/female ratio equal to 1:1. It is associated to allelic mutations in the fibroblast growth factor receptor 2 (FGFR2) gene. Majority cases are sporadic. Prenatal ultrasound diagnosis is based on the detection of abnormal cranial shape, midfacial hypoplasia and bilateral syndactyly of hands and feet, hypertelorism, and exorbitism. Other abnormalities includes central nervous system anomalies, congenital heart diseases, cleft palate, and urogenital diseases. CASE REPORT A 37-year-old Caucasian woman, gravida 2, para 1, was referred to our center of Prenatal Diagnosis for routine ultrasound at 21 weeks of gestation. We detected irregular head shape, dolicocephaly, prominent forehead, bilateral mild ventriculomegaly, suspicion of partial agenesis of the corpus callosum, hypertelorism, and midfacial hypoplasia, with a depressed nasal bridge and syndactyly, prompting a suspicion for Apert syndrome. Magnetic resonance excluded agenesis of corpus callosum and confirmed bilateral mild ventriculomegaly. A follow-up ultrasound, performed at 23 weeks, confirmed the anomalies showed in the previous scan. An amniocentesis was performed. The results showed a normal male karyotype, while the molecular genetic test confirmed a mutation in FGFR2 gene. Fetus macroscopic analysis showed compatible features. CONCLUSIONS Our case underlines the complementary role of ultrasound and magnetic resonance imaging in the early prenatal diagnosis of Apert syndrome.
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Affiliation(s)
- A Giancotti
- Department of Obstetrics, Gynecology and Urologic Sciences, Umberto I Hospital, "Sapienza" University, Viale del Policlinico 155, 00161, Rome, Italy,
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Tao G, Lu G, Zhan X, Li J, Cheng L, Lee K, Poon WS. Sonographic appearance of the cavum septum pellucidum et vergae in normal fetuses in the second and third trimesters of pregnancy. JOURNAL OF CLINICAL ULTRASOUND : JCU 2013; 41:525-531. [PMID: 24037650 DOI: 10.1002/jcu.22084] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Revised: 04/28/2013] [Accepted: 07/01/2013] [Indexed: 06/02/2023]
Abstract
BACKGROUND To characterize the cavum septum pellucidum et vergae (CSPV) in normal fetuses in the second to third trimester. METHODS The cavum septum pellucidum (CSP) and CSPV were investigated in 322 uncomplicated singleton pregnancies from 25 to 39 weeks' gestation. Visualization rate, width, and morphology of both CSP and cavum vergae (CV) were assessed by ultrasound and MRI. RESULTS The CSP and CSPV visualization rates were 100% and 7.8% (25/322), respectively. The mean widths were 6.3 ± 1.2 mm (3.4-10 mm) and 6.7 ± 1.0 mm (5.1-9 mm), respectively, with no significant correlation between width and gestational age (r = -0.108, p > 0.05 and r = -0.182, p > 0.05, respectively). In CSPV fetuses, the CV to CSP ratio was 1.004 ± 0.018 (0.967-1.033). All CSPVs were rectangular in the transverse plane and extended posteriorly beyond the midpoint of the brain. CONCLUSIONS Common features of CSPVs include (1) a rectangular morphology, (2) communication between the two cavities, (3) a CV width within the normal range for CSP, and (4) a CV-CSP ratio of 1. These findings may help distinguish normal from abnormal CSPV.
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Affiliation(s)
- Guowei Tao
- Department of Ultrasound, Qilu Hospital of Shandong University, Jinan, China; Division of Neurosurgery, The Chinese University of Hong Kong, Hong Kong, China
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Chen CP, Su YN, Chang TY, Chern SR, Chen CY, Su JW, Wang W. Rapid detection of de novo P253R mutation in FGFR2 using uncultured amniocytes in a pregnancy affected by polyhydramnios, Blake's pouch cyst, and Apert syndrome. Taiwan J Obstet Gynecol 2013; 52:273-7. [PMID: 23915865 DOI: 10.1016/j.tjog.2013.04.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2013] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVE To present prenatal ultrasound and molecular genetic diagnosis of Apert syndrome. CASE REPORT A 30-year-old, gravida 3, para 2 woman was referred for genetic counseling at 32 weeks of gestation because of polyhydramnios and craniofacial and digital abnormalities in the fetus. She had undergone amniocentesis at 18 weeks of gestation because of maternal anxiety. Results of amniocentesis revealed a karyotype of 46,XX. A prenatal ultrasound at 32 weeks of gestation revealed a female fetus with a fetal biometry equivalent to 32 weeks, polyhydramnios with an increased amniotic fluid index of 26.1 cm, frontal bossing, midface hypoplasia, hypertelorism, Blake's pouch cyst with an apparent posterior fossa cyst in communication with the fourth ventricle on axial images, digital fusion, and bilateral syndactyly of the hands and feet. A DNA testing for the FGFR2 gene was immediately performed using uncultured amniocytes obtained by repeated amniocentesis, which revealed a heterozygous c.758C>G, CCT>CGT transversion leading to a p.Pro253Arg (P253R) mutation in the FGFR2 gene. Subsequently, a diagnosis of Apert syndrome was made. Molecular analysis of the FGFR2 gene in the parents did not reveal such a mutation. The fetus postnatally manifested frontal bossing, midface hypoplasia, and bilateral syndactyly of the hands (mitten hands) and feet. CONCLUSION Prenatal diagnosis of polyhydramnios, frontal bossing, and midface hypoplasia associated with brain and digital abnormalities should include a differential diagnosis of Apert syndrome. A molecular analysis of FGFR2 using uncultured amniocytes is useful for rapid confirmation of Apert syndrome at prenatal diagnosis.
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Affiliation(s)
- Chih-Ping Chen
- Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Taipei, Taiwan.
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Yeh E, Fanganiello RD, Sunaga DY, Zhou X, Holmes G, Rocha KM, Alonso N, Matushita H, Wang Y, Jabs EW, Passos-Bueno MR. Novel molecular pathways elicited by mutant FGFR2 may account for brain abnormalities in Apert syndrome. PLoS One 2013; 8:e60439. [PMID: 23593218 PMCID: PMC3617104 DOI: 10.1371/journal.pone.0060439] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2012] [Accepted: 02/27/2013] [Indexed: 11/18/2022] Open
Abstract
Apert syndrome (AS), the most severe form craniosynostosis, is characterized by premature fusion of coronal sutures. Approximately 70% of AS patients carry S252W gain-of-function mutation in FGFR2. Besides the cranial phenotype, brain dysmorphologies are present and are not seen in other FGFR2-asociated craniosynostosis, such as Crouzon syndrome (CS). Here, we hypothesized that S252W mutation leads not only to overstimulation of FGFR2 downstream pathway, but likewise induces novel pathological signaling. First, we profiled global gene expression of wild-type and S252W periosteal fibroblasts stimulated with FGF2 to activate FGFR2. The great majority (92%) of the differentially expressed genes (DEGs) were divergent between each group of cell populations and they were regulated by different transcription factors. We than compared gene expression profiles between AS and CS cell populations and did not observe correlations. Therefore, we show for the first time that S252W mutation in FGFR2 causes a unique cell response to FGF2 stimulation. Since our gene expression results suggested that novel signaling elicited by mutant FGFR2 might be associated with central nervous system (CNS) development and maintenance, we next investigated if DEGs found in AS cells were also altered in the CNS of an AS mouse model. Strikingly, we validated Strc (stereocilin) in newborn Fgfr2S252W/+ mouse brain. Moreover, immunostaining experiments suggest a role for endothelial cells and cerebral vasculature in the establishment of characteristic CNS dysmorphologies in AS that has not been proposed by previous literature. Our approach thus led to the identification of new target genes directly or indirectly associated with FGFR2 which are contributing to the pathophysiology of AS.
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Affiliation(s)
- Erika Yeh
- Human Genome Center, Department of Genetics and Evolutive Biology, Institute of Bioscience, University of Sao Paulo, Sao Paulo, SP, Brazil
| | - Roberto D. Fanganiello
- Human Genome Center, Department of Genetics and Evolutive Biology, Institute of Bioscience, University of Sao Paulo, Sao Paulo, SP, Brazil
| | - Daniele Y. Sunaga
- Human Genome Center, Department of Genetics and Evolutive Biology, Institute of Bioscience, University of Sao Paulo, Sao Paulo, SP, Brazil
| | - Xueyan Zhou
- Department of Genetics and Genomic Sciences, The Mount Sinai Medical Center, New York, New York, United States of America
| | - Gregory Holmes
- Department of Genetics and Genomic Sciences, The Mount Sinai Medical Center, New York, New York, United States of America
| | - Katia M. Rocha
- Human Genome Center, Department of Genetics and Evolutive Biology, Institute of Bioscience, University of Sao Paulo, Sao Paulo, SP, Brazil
| | - Nivaldo Alonso
- Department of Plastic Surgery, Faculty of Medicine, University of Sao Paulo, Sao Paulo, SP, Brazil
| | - Hamilton Matushita
- Department of Neurology, Faculty of Medicine, University of Sao Paulo, Sao Paulo, SP, Brazil
| | - Yingli Wang
- Department of Genetics and Genomic Sciences, The Mount Sinai Medical Center, New York, New York, United States of America
| | - Ethylin W. Jabs
- Department of Genetics and Genomic Sciences, The Mount Sinai Medical Center, New York, New York, United States of America
| | - Maria Rita Passos-Bueno
- Human Genome Center, Department of Genetics and Evolutive Biology, Institute of Bioscience, University of Sao Paulo, Sao Paulo, SP, Brazil
- * E-mail:
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Hill CA, Martínez-Abadías N, Motch SM, Austin JR, Wang Y, Jabs EW, Richtsmeier JT, Aldridge K. Postnatal brain and skull growth in an Apert syndrome mouse model. Am J Med Genet A 2013; 161A:745-57. [PMID: 23495236 PMCID: PMC3606655 DOI: 10.1002/ajmg.a.35805] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Accepted: 11/14/2012] [Indexed: 12/12/2022]
Abstract
Craniofacial and neural tissues develop in concert throughout prenatal and postnatal growth. FGFR-related craniosynostosis syndromes, such as Apert syndrome (AS), are associated with specific phenotypes involving both the skull and the brain. We analyzed the effects of the FGFR P253R mutation for AS using the Fgfr2(+/P253R) Apert syndrome mouse to evaluate the effects of this mutation on these two tissues over the course of development from day of birth (P0) to postnatal day 2 (P2). Three-dimensional magnetic resonance microscopy and computed tomography images were acquired from Fgfr2(+/P253R) mice and unaffected littermates at P0 (N = 28) and P2 (N = 20).Three-dimensional coordinate data for 23 skull and 15 brain landmarks were statistically compared between groups. Results demonstrate that the Fgfr2(+/P253R) mice show reduced growth in the facial skeleton and the cerebrum, while the height and width of the neurocranium and caudal regions of the brain show increased growth relative to unaffected littermates. This localized correspondence of differential growth patterns in skull and brain point to their continued interaction through development and suggest that both tissues display divergent postnatal growth patterns relative to unaffected littermates. However, the change in the skull-brain relationship from P0 to P2 implies that each tissue affected by the mutation retains a degree of independence, rather than one tissue directing the development of the other.
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Affiliation(s)
- Cheryl A. Hill
- Department of Pathology & Anatomical Sciences, University of Missouri-School of Medicine, Columbia, MO 65212
- Department of Basic Medical Sciences, University of Arizona College of Medicine Phoenix, Phoenix AZ 85004
| | - Neus Martínez-Abadías
- Department of Anthropology, The Pennsylvania State University, University Park, PA 16802
- EMBL-CRG Systems Biology Research Unit, Center for Genomic Regulation, Universitat Pompeu Fabra, Barcelona, Spain
| | - Susan M. Motch
- Department of Anthropology, The Pennsylvania State University, University Park, PA 16802
| | - Jordan R. Austin
- Department of Pathology & Anatomical Sciences, University of Missouri-School of Medicine, Columbia, MO 65212
| | - Yingli Wang
- Department of Genetics and Genomic Sciences, Mt. Sinai School of Medicine, New York, NY 10029
| | - Ethylin Wang Jabs
- Department of Genetics and Genomic Sciences, Mt. Sinai School of Medicine, New York, NY 10029
| | - Joan T. Richtsmeier
- Department of Anthropology, The Pennsylvania State University, University Park, PA 16802
| | - Kristina Aldridge
- Department of Pathology & Anatomical Sciences, University of Missouri-School of Medicine, Columbia, MO 65212
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Abstract
Le syndrome d'Apert est une affection congénitale rare, caractérisée par une sténose cranio-faciale associée à une syndactylie des mains et des pieds. Sa prise en charge doit être précoce et multidisciplinaire. Sa gravité réside dans la coexistence de plusieurs malformations avec un risque d'hypertension intracrânienne chronique responsable d'une cécité et d'une débilité mentale. Les auteurs rapportent une nouvelle observation à travers laquelle ils illustrent les aspects cliniques et évolutifs ainsi que les difficultés thérapeutiques de cette affection.
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Affiliation(s)
- Sarra Benmiloud
- Service de pédiatrie, Hôpital Mère-Enfant, CHU Hassan II-Fès, Morocco
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Al-Holou WN, Terman S, Kilburg C, Garton HJL, Muraszko KM, Maher CO. Prevalence and natural history of arachnoid cysts in adults. J Neurosurg 2013; 118:222-31. [DOI: 10.3171/2012.10.jns12548] [Citation(s) in RCA: 169] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
Arachnoid cysts are a frequent finding on intracranial imaging. The prevalence and natural history of these cysts in adults are not well defined.
Methods
We retrospectively reviewed the electronic medical records of a consecutive series of adults who underwent brain MRI over a 12-year interval to identify those with arachnoid cysts. The MRI studies were reviewed to confirm the diagnosis. For those patients with arachnoid cysts, we evaluated presenting symptoms, cyst size, and cyst location. Patients with more than 6 months' clinical and imaging follow-up were included in a natural history analysis.
Results
A total of 48,417 patients underwent brain MRI over the study period. Arachnoid cysts were identified in 661 patients (1.4%). Men had a higher prevalence than women (p < 0.0001). Multiple arachnoid cysts occurred in 30 patients. The most common locations were middle fossa (34%), retrocerebellar (33%), and convexity (14%). Middle fossa cysts were predominantly left-sided (70%, p < 0.001). Thirty-five patients were considered symptomatic and 24 underwent surgical treatment. Sellar and suprasellar cysts were more likely to be considered symptomatic (p < 0.0001). Middle fossa cysts were less likely to be considered symptomatic (p = 0.01. The criteria for natural history analysis were met in 203 patients with a total of 213 cysts. After a mean follow-up of 3.8 ± 2.8 years (for this subgroup), 5 cysts (2.3%) increased in size and 2 cysts decreased in size (0.9%). Only 2 patients developed new or worsening symptoms over the follow-up period.
Conclusions
Arachnoid cysts are a common incidental finding on intracranial imaging in all age groups. Although arachnoid cysts are symptomatic in a small number of patients, they are associated with a benign natural history for those presenting without symptoms.
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Abstract
Apert syndrome (Acrocephalosyndactyly type I; AS) is a rare but well-known autosomal dominant disorder characterized by craniosynostosis, midface hypoplasia, bony/cutaneous syndactyly of fingers and toes as well as a variety of associated congenital anomalies involving the brain, heart, limbs and other organ systems. We report the case of a fetus with molecularly confirmed Apert syndrome and additional fusion of the thalamic nuclei. Various central nervous system anomalies, have been reported in patients with AS. However, as far as we know cases of fused thalami in Apert syndrome have never been reported so far.
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Affiliation(s)
- Kathrin Ludwig
- Pathology Unit, Department of Medical Diagnostic Sciences & Special Therapies, Padova, Italy
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de Jong T, Rijken BFM, Lequin MH, van Veelen MLC, Mathijssen IMJ. Brain and ventricular volume in patients with syndromic and complex craniosynostosis. Childs Nerv Syst 2012; 28:137-40. [PMID: 22011964 PMCID: PMC3252498 DOI: 10.1007/s00381-011-1614-7] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2011] [Accepted: 10/10/2011] [Indexed: 11/16/2022]
Abstract
PURPOSE Brain abnormalities in patients with syndromic craniosynostosis can either be a direct result of the genetic defect or develop secondary to compression due to craniosynostosis, raised ICP or hydrocephalus. Today it is unknown whether children with syndromic craniosynostosis have normal brain volumes. The purpose of this study was to evaluate brain and ventricular volume measurements in patients with syndromic and complex craniosynostosis. This knowledge will improve our understanding of brain development and the origin of raised intracranial pressure in syndromic craniosynostosis. METHODS Brain and ventricular volumes were calculated from MRI scans of patients with craniosynostosis, 0.3 to 18.3 years of age. Brain volume was compared to age matched controls from the literature. All patient charts were reviewed to look for possible predictors of brain and ventricular volume. RESULTS Total brain volume in syndromic craniosynostosis equals that of normal controls, in the age range of 1 to 12 years. Brain growth occurred particularly in the first 5 years of age, after which it stabilized. Within the studied population, ventricular volume was significantly larger in Apert syndrome compared to all other syndromes and in patients with a Chiari I malformation. CONCLUSIONS Patients with syndromic craniosynostosis have a normal total brain volume compared to normal controls. Increased ventricular volume is associated with Apert syndrome and Chiari I malformations, which is most commonly found in Crouzon syndrome. We advice screening of all patients with Apert and Crouzon syndrome for the development of enlarged ventricle volume and the presence of a Chiari I malformation.
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Affiliation(s)
- T. de Jong
- Department of Plastic and Reconstructive Surgery, and Hand Surgery, Sophia Children’s Hospital, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - B. F. M. Rijken
- Department of Plastic and Reconstructive Surgery, and Hand Surgery, Sophia Children’s Hospital, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - M. H. Lequin
- Department of Radiology, Sophia Children’s Hospital, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - M. L. C. van Veelen
- Department of Neurosurgery, Sophia Children’s Hospital, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - I. M. J. Mathijssen
- Department of Plastic and Reconstructive Surgery, and Hand Surgery, Sophia Children’s Hospital, Erasmus University Medical Center, Rotterdam, The Netherlands
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Florisson JMG, Dudink J, Koning IV, Hop WCJ, van Veelen MLC, Mathijssen IMJ, Lequin MH. Assessment of White Matter Microstructural Integrity in Children with Syndromic Craniosynostosis: A Diffusion-Tensor Imaging Study. Radiology 2011; 261:534-41. [DOI: 10.1148/radiol.11101024] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Intracranial and Extracranial Malformations in Patients With Craniofacial Anomalies. J Craniofac Surg 2010; 21:1460-4. [DOI: 10.1097/scs.0b013e3181ebcd27] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Lamônica DA, Maximino LP, Feniman MR, Silva GK, Zanchetta S, Abramides DV, Passos-Bueno MR, Rocha K, Richieri-Costa A. Saethre-Chotzen Syndrome, Pro136His TWIST Mutation, Hearing Loss, and External and Middle Ear Structural Anomalies: Report on a Brazilian Family. Cleft Palate Craniofac J 2010; 47:548-52. [DOI: 10.1597/08-251.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective To describe the clinical, speech, hearing, and imaging findings in three members of a Brazilian family with Saethre-Chotzen syndrome (SCS) who presented some unusual characteristics within the spectrum of the syndrome. Design Clinical evaluation was performed by a multidisciplinary team. Direct sequencing of the polymerase chain reaction–amplified coding region of the TWIST1 gene, routine and electrophysiological hearing evaluation, speech evaluation, and imaging studies through computed tomography (CT) scan and magnetic resonance imaging (MRI) were performed. Results TWIST1 gene analysis revealed a Pro136His mutation in all patients. Hearing evaluation showed peripherial and mixed hearing loss in two of the patients, one of them with severe unilateral microtia. Computed tomography scan showed structural middle ear anomalies, and MRI showed distortion of the skull contour as well as some of the brain structures. Conclusions We report a previously undescribed TWIST1 gene mutation in patients with SCS. There is evidence that indicates hearing loss (conductive and mixed) can be related both with middle ear (microtia, high jugular bulb, and enlarged vestibules) as well as with brain stem anomalies. Here we discuss the relationship between the gene mutation and the clinical, imaging, speech, and hearing findings.
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Affiliation(s)
- Dionísia A.C. Lamônica
- University of São Paulo, College of Dentistry, Speech-Pathology and Audiology Department, Bauru, SP, Brazil
| | - Luciana P. Maximino
- University of São Paulo, College of Dentistry, Speech-Pathology and Audiology Department, Bauru, SP, Brazil
| | - Mariza Ribeiro Feniman
- University of São Paulo, College of Dentistry, Speech-Pathology and Audiology Department, Bauru, SP, Brazil
| | - Greyce K. Silva
- University of São Paulo, College of Dentistry, Speech-Pathology and Audiology Department, Bauru, SP, Brazil
| | - Sthella Zanchetta
- University of São Paulo, College of Medicine, Department of Ophthalmology, Otorhinolaringology & Head and Neck Surgery, Ribeirão Preto, SP, Brazil
| | - Dagma V.M. Abramides
- University of São Paulo, College of Dentistry, Speech-Pathology and Audiology Department, Bauru, SP, Brazil
| | - Maria Rita Passos-Bueno
- University of São Paulo, Human Genome Project of the Institute of Biosciences, São Paulo, SP, Brazil
| | - Kátia Rocha
- University of São Paulo, Human Genome Project of the Institute of Biosciences, São Paulo, SP, Brazil
| | - Antonio Richieri-Costa
- University of São Paulo's Hospital for Rehabilitation of Craniofacial Anomalies, Bauru, Brazil
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Second-trimester molecular prenatal diagnosis of sporadic Apert syndrome following sonographic findings of mild ventriculomegaly and clenched hands mimicking trisomy 18. Taiwan J Obstet Gynecol 2010; 49:129-32. [PMID: 20466312 DOI: 10.1016/s1028-4559(10)60028-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2010] [Indexed: 11/22/2022] Open
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Aldridge K, Hill CA, Austin JR, Percival C, Martinez-Abadias N, Neuberger T, Wang Y, Jabs EW, Richtsmeier JT. Brain phenotypes in two FGFR2 mouse models for Apert syndrome. Dev Dyn 2010; 239:987-97. [PMID: 20077479 PMCID: PMC2829947 DOI: 10.1002/dvdy.22218] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Apert syndrome (AS) is one of at least nine disorders considered members of the fibroblast growth factor receptor (FGFR) -1, -2, and -3-related craniosynostosis syndromes. Nearly 100% of individuals diagnosed with AS carry one of two neighboring mutations on Fgfr2. The cranial phenotype associated with these two mutations includes coronal suture synostosis, either unilateral (unicoronal synostosis) or bilateral (bicoronal synostosis). Brain dysmorphology associated with AS is thought to be secondary to cranial vault or base alterations, but the variation in brain phenotypes within Apert syndrome is unexplained. Here, we present novel three-dimensional data on brain phenotypes of inbred mice at postnatal day 0 each carrying one of the two Fgfr2 mutations associated with AS. Our data suggest that the brain is primarily affected, rather than secondarily responding to skull dysmorphogenesis. Our hypothesis is that the skull and brain are both primarily affected in craniosynostosis and that shared phenogenetic developmental processes affect both tissues in craniosynostosis of Apert syndrome.
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Affiliation(s)
- Kristina Aldridge
- Department of Pathology and Anatomical Sciences, University of Missouri-School of Medicine, Columbia, Missouri 65212, USA.
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Raybaud C, Di Rocco C. Brain malformation in syndromic craniosynostoses, a primary disorder of white matter: a review. Childs Nerv Syst 2007; 23:1379-88. [PMID: 17882438 DOI: 10.1007/s00381-007-0474-7] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2007] [Indexed: 11/30/2022]
Abstract
BACKGROUND Syndromic craniosynostoses (Saethre-Chotzen, Pfeiffer 1, 2, 3, Apert, Crouzon, mainly) are particular in this that a single gene defect (mostly fibroblast growth factor receptor [FGFR] 2) generates different clinical phenotypes that characterize these syndromes. Significant brain abnormalities have been reported in all syndromes. However, whether these abnormalities are secondary to the bone disease or primary (e.g. callosal agenesis) is still controversial. Recent evidence suggests that the white matter defect might be a primary disorder. REVIEW OF LITERATURE From the review of the literature and the analysis of our cases, it appears that three categories of brain abnormalities can be found. (1) The global distortion of the brain is likely mechanical and in keeping with the deformity of the skull. (2) The chronic tonsillar herniation (Chiari I deformity) is likely mechanical also and a consequence of the small size of the posterior fossa, especially after an early closure (before 24 m) of the lambdoid suture. (3) On the contrary, the constellation of abnormalities that selectively involve the white matter (non-progressive, non-destructive ventriculomegaly, callosal agenesis or thinning, agenesis of septum pellucidum, paucity of the antero-mesial temporal white matter, pyramidal hypoplasia) is much more likely to constitute a primary disorder. CONCLUSIONS Recent neurobiological evidence supports this point of view. L1 cell adhesion molecule (L1CAM) gene plays a major role in the development of the white matter and its mutation in humans (callosal agenesis, retardation, adducted thumbs, spasticity, and hydrocephalus syndrome, Bickers-Adams syndrome) or in mice causes similar defects of the corpus callosum, septum pellucidum, centrum semi-ovale, and cortico-spinal tracts. To operate, L1CAM need interactions with FGFRs, whose defects are causal to the syndromic craniosynostoses. It seems logical to assumes that the FGFR defects generate both the skull abnormalities and, by lack of interaction with L1CAM, the primary defect of the white matter. The mental deficiency that is common in these patients therefore is likely to be part of the disease (through the L1CAM-FGFR interaction) rather than a consequence of the skull size or of the associated hydrocephalus.
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Affiliation(s)
- Charles Raybaud
- Neuroradiology, Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G 1X8, Canada.
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Yacubian-Fernandes A, Ducati LG, Silva MV, Abramides DVM, Perosa GB, Palhares A, Gabarra RC, Giglio A, Portela L, Marinello JLP, Plese JPP, Zanini SA. Síndrome de crouzon: fatores envolvidos no desenvolvimento neuropsicologico e na qualidade de vida. ARQUIVOS DE NEURO-PSIQUIATRIA 2007; 65:467-71. [PMID: 17665017 DOI: 10.1590/s0004-282x2007000300020] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2006] [Accepted: 02/13/2007] [Indexed: 11/21/2022]
Abstract
A síndrome de Crouzon é caracterizada por deformidade craniana, alterações faciais e exoftalmia. O retardo no desenvolvimento neuropsicomotor é observado em alguns casos. Este estudo tem como objetivo analisar a influência do momento da cirurgia, da classe sócio-econômica associada ao nível educacional dos pais e da ocorrência de malformações do sistema nervoso central no desenvolvimento cognitivo destes pacientes correlacionando estes achados à qualidade de vida deles e de suas famílias. Foram estudados 11 pacientes com diagnóstico de síndrome de Crouzon com idade entre um ano e quatro meses e treze anos. A avaliação multidisciplinar dos pacientes incluiu, avaliação social, avaliação cognitiva, estudo do encéfalo por ressonância magnética e avaliação da qualidade de vida. O quociente de inteligência variou de 46 a 102 (m=84,2) e foi correlacionado de forma inversa com o Fator 4 do Questionário de Recursos e Estresse Simplificado (incapacidade da criança); não se correlacionou com as alterações encefálicas, com a condição sócio-econômica dos pais e nem com o momento do tratamento neurocirúrgico.
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Affiliation(s)
- Adriano Yacubian-Fernandes
- Departamento de Cirurgia Craniofacial, Hospital de Reabilitação de Anomalias Craniofaciais, Universidade de São Paulo, Bauru, SP, Brasil.
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Boutros S, Shetye PR, Ghali S, Carter CR, McCarthy JG, Grayson BH. Morphology and Growth of the Mandible in Crouzon, Apert, and Pfeiffer Syndromes. J Craniofac Surg 2007; 18:146-50. [PMID: 17251854 DOI: 10.1097/01.scs.0000248655.53405.a7] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The purpose of this study was to examine mandibular morphology and growth in patients with Crouzon, Pfeiffer, and Apert syndromes using posteroanterior cephalograms. Fifteen patients with Apert (n = 2), Crouzon (n = 11), and Pfeiffer (n = 2) (11 female, 4 male) syndrome were included in this study. All patients had serial posteroanterior cephalograms at 5, 10, and 15 years of age. The bicondylar width, bigonial width, bicondylar/bigonial ratio, and ramus to intercondylar plane angle for each patient were measured on the cephalograms and compared with age-match controls. An analysis of variance analysis was carried out to detect differences between patients and controls and sex differences between patients. In both male and female patients, there was a statistically significant reduction in bicondylar width compared with age-matched controls. Male patients also had a statistically significant increase in bigonial width compared with controls and female patients at 10 and 15 years. The resulting bicondylar/bigonial ratios were significantly reduced, and the ramus to intercondylar plane angles were significantly increased in both male and female patients compared with controls. Unlike previous reports of patients with syndromic synostosis, this study demonstrates that the mandible has significant morphologic and growth abnormalities, including constriction of bicondylar width with near normal bigonial width in female patients. These findings suggest a narrowing at the cranial base with resulting restriction of normal transverse mandibular growth at the condyle. The secondary nature of the mandibular finding is suggested by the near normal or increased transverse growth at the gonion in females and males, respectively. Consequently, the ramus appears torqued inward, forming a greater angle with the cranial base.
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Affiliation(s)
- Sean Boutros
- Hermann Hospital and Hermann Children's Hospital Houston, Houston, Texas, USA.
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Campbell LE, Daly E, Toal F, Stevens A, Azuma R, Catani M, Ng V, van Amelsvoort T, Chitnis X, Cutter W, Murphy DGM, Murphy KC. Brain and behaviour in children with 22q11.2 deletion syndrome: a volumetric and voxel-based morphometry MRI study. Brain 2006; 129:1218-28. [PMID: 16569671 DOI: 10.1093/brain/awl066] [Citation(s) in RCA: 139] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
In people with velo-cardio-facial syndrome [or 22q11.2 deletion syndrome (22qDS)], a single interstitial deletion of chromosome 22q11.2 causes a wide spectrum of cognitive deficits ranging from global learning difficulties to specific cognitive deficits. People with 22qDS are also at high risk of developing attention-deficit/hyperactivity disorder and autism spectrum disorders in childhood, and schizophrenia in adolescence or adult life. However, the neurobiology of 22qDS, and the relationship between abnormalities in brain anatomy and behaviour, is poorly understood. Thus, we studied the neuroanatomy of 22qDS children using fully automated voxel-based morphometry (VBM) and manually traced single region-of-interest (ROI) analysis. Also, we investigated whether those brain regions that differed significantly between groups were related to behavioural differences within children with 22qDS. We compared the brain morphometry of 39 children and adolescents with 22qDS (mean age: 11 years, SD +/-3, IQ = 67, SD +/-10) and 26 sibling controls (mean age: 11 years, SD +/-3, IQ = 102, SD +/-12). Using VBM, we found, after correction for IQ, that individuals with 22qDS compared with controls had a significant reduction in cerebellar grey matter, and white matter reductions in the frontal lobe, cerebellum and internal capsule. Using single ROI analysis, we found that people with 22qDS had a significant (P < 0.05) reduction in bulk volume bilaterally in the occipital-parietal lobes, but a larger right caudate nucleus and lateral ventricles. Further, within people with 22qDS, there was a significant positive correlation between severity of (i) schizotypy score and grey matter volume of the temporo-occipital regions and the corpus striatum; (ii) emotional problems and grey matter volume of frontostriatal regions; and (iii) social behavioural difficulties and grey matter in frontostriatal regions. Thus, subjects with 22qDS have widespread changes in brain anatomy, particularly affecting white matter, basal ganglia and cerebellum. Also, within 22qDS, regionally specific differences in brain development may partially underpin behavioural differences. We suggest that there is preliminary evidence for specific vulnerability of the frontostriatal and cerebellar-cortical networks in 22qDS.
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Quintero-Rivera F, Robson CD, Reiss RE, Levine D, Benson C, Mulliken JB, Kimonis VE. Apert syndrome: what prenatal radiographic findings should prompt its consideration? Prenat Diagn 2006; 26:966-72. [PMID: 16906598 DOI: 10.1002/pd.1539] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Apert syndrome was diagnosed in a newborn with typical facial and digital features whose only detected prenatal abnormality had been agenesis of the corpus callosum. This prompted a review of the central nervous system findings in all cases of Apert syndrome treated at the Craniofacial Center Boston Children's Hospital between 1978 and 2004. Two of 30 patients with Apert syndrome had prenatal identification of mild dilatation of the lateral cerebral ventricles and complete agenesis of the corpus callosum (ACC) documented with both ultrasound and MRI. Both had the common S252W mutation of FGFR2. Though cranial and orbital malformations typical of Apert were eventually seen in these fetuses in the third-trimester, even in retrospect, these were not detectable at mid second-trimester, ultrasound screening for congenital malformations. Hand malformations also went undetected in the second-trimester despite extensive imaging by experienced radiologists. We conclude that prenatal ultrasonographic identification of mild ventriculomegaly or ACC should stimulate a careful search for features of Apert syndrome and prompt follow-up imaging to look for bony abnormalities that have later onset. Prenatal molecular testing for Apert mutations should be considered in cases of mild ventriculomegaly and ACC.
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Affiliation(s)
- Fabiola Quintero-Rivera
- Massachusetts General Hospital Center for Human Genetic Research, Genetics Training Program, Harvard Medical School, Boston, MA 02115, USA
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Yacubian-Fernandes A, Palhares A, Giglio A, Gabarra RC, Zanini S, Portela L, Silva MV, Perosa GB, Abramides D, Plese JPP. Apert syndrome: factors involved in the cognitive development. ARQUIVOS DE NEURO-PSIQUIATRIA 2005; 63:963-8. [PMID: 16400413 DOI: 10.1590/s0004-282x2005000600011] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Apert syndrome is characterized by craniosynostosis, symmetric syndactyly and other systemic malformations, with mental retardation usually present. The objective of this study was to correlate brain malformations and timing for surgery with neuropsychological evaluation. We also tried to determine other relevant aspects involved in cognitive development of these patients such as social classification of families and parents’ education. Eighteen patients with Apert syndrome were studied, whose ages were between 14 and 322 months. Brain abnormalities were observed in 55.6% of them. The intelligence quotient or developmental quotient values observed were between 45 and 108. Mental development was related to the quality of family environment and parents’ education. Mental development was not correlated to brain malformation or age at time of operation. In conclusion, quality of family environment was the most significant factor directly involved in mental development of patients with Apert syndrome.
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Affiliation(s)
- Adriano Yacubian-Fernandes
- Department of Craniofacial Surgery, Hospital de Reabilitação de Anomalias Craniofaciais, University of Sao Paulo, Bauru, SP, Brazil.
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