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Nunes Pombo J, van Mourik Zoio M, Santos MM, Faria CC, Miguéns J, Guimarães-Ferreira J. Metopic craniosynostosis: Dynamic cranioplasty for trigonocephaly versus fronto-orbital remodeling and advancement - A retrospective study. J Craniomaxillofac Surg 2024; 52:966-973. [PMID: 38851955 DOI: 10.1016/j.jcms.2024.04.008] [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: 08/04/2023] [Revised: 02/15/2024] [Accepted: 04/17/2024] [Indexed: 06/10/2024] Open
Abstract
The aim of this study was to compare a traditional fronto-orbital remodeling and advancement (FORA) with the dynamic cranioplasty for trigonocephaly (DCT). The authors analyzed patients who underwent surgery for trigonocephaly. Perioperative data were compared. Parents were asked to use a visual analog scale to evaluate the pre- and postoperative distance between the eyes, the forehead shape, and the global appearance of the face. A panel of observers was asked to grade pre- and postoperative photographs using a similar visual analog scale. Pre- and postoperative anthropometric data were collected and analyzed in a subset of the study population aged 9 years or older. The total sample size was 51 patients (DCT n = 39; FORA n = 12). Durations of surgery and anesthesia were shorter in the DCT group (115 vs 194 min, p = 0.001; 226 vs 289 min, p = 0.001). Patients in the DCT group received similar preoperative ratings to those in the FORA group, but significantly higher postoperative ratings by parents for all three questions. There were no significant differences in postoperative ratings by the panel or postoperative anthropometric data. DCT is safe and effective. It is preferred over FORA because it is associated with shorter durations of surgery and anesthesia, while providing higher degrees of parental satisfaction and similar aesthetic and anthropometric outcomes.
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Affiliation(s)
- João Nunes Pombo
- Department of Plastic Surgery, Unidade Local de Saúde Santa Maria, Lisbon, Portugal; Clínica Universitária de Cirurgia Plástica e Reconstrutiva, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal.
| | - Marta van Mourik Zoio
- Clínica Universitária de Cirurgia Plástica e Reconstrutiva, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
| | - Maria Manuel Santos
- Department of Neurosurgery, Unidade Local de Saúde Santa Maria, Lisbon, Portugal
| | - Cláudia C Faria
- Department of Neurosurgery, Unidade Local de Saúde Santa Maria, Lisbon, Portugal; Clínica Universitária de Neurocirurgia, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal; Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
| | - José Miguéns
- Department of Neurosurgery, Unidade Local de Saúde Santa Maria, Lisbon, Portugal; Clínica Universitária de Neurocirurgia, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
| | - José Guimarães-Ferreira
- Department of Plastic Surgery, Unidade Local de Saúde Santa Maria, Lisbon, Portugal; Clínica Universitária de Cirurgia Plástica e Reconstrutiva, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
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Moscarelli J, Almeida MN, Lacadie C, Hu KG, Ihnat JMH, Parikh N, Persing JA, Alperovich M. A diffusion tensor imaging comparison of white matter development in nonsyndromic craniosynostosis to neurotypical infants. Childs Nerv Syst 2024; 40:1477-1487. [PMID: 38175271 DOI: 10.1007/s00381-023-06262-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 12/17/2023] [Indexed: 01/05/2024]
Abstract
PURPOSE Nonsyndromic craniosynostosis (NSC) is associated with neurocognitive deficits, and intervention at infancy is standard of care to limit the negative effects of NSC on brain development. In this study, diffusion tensor imaging (DTI) was implemented to investigate white matter microstructure in infants with NSC undergoing cranial vault remodeling, and a comparison was made with white matter development in neurotypical controls. METHODS Infants presenting with NSC (n = 12) underwent DTI scans before and after cranial vault remodeling. Neurotypical infants (n = 5), age matched to NSC patients at preoperative scans, were compared to preoperative DTI scans. Pre- and postoperative NSC scans were compared in aggregate, and the sagittal synostosis (n = 8) patients were evaluated separately. Finally, neurotypical infants from the University of North Carolina/University of New Mexico Baby Connectome Project (BCP), who underwent DTI scans at timepoints matching the NSC pre- and postoperative DTI scans, were analyzed (n = 9). Trends over the same time period were compared between NSC and BCP scans. RESULTS No significant differences were found between preoperative NSC scans and controls. White matter development was more limited in NSC patients than in BCP patients, with microstructural parameters of the corpus body and genu and inferior and superior longitudinal fasciculi consistently lagging behind developmental changes observed in healthy patients. CONCLUSION Infant white matter development appears more limited in NSC patients undergoing cranial vault remodeling relative to that in neurotypical controls. Further investigation is needed to explore these differences and the specific effects of early surgical intervention.
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Affiliation(s)
- Jake Moscarelli
- Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, 330 Cedar Street, Boardman Building, New Haven, CT, 06510, USA
| | - Mariana N Almeida
- Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, 330 Cedar Street, Boardman Building, New Haven, CT, 06510, USA
| | - Cheryl Lacadie
- Department of Diagnostic Radiology, Yale School of Medicine, New Haven, CT, USA
| | - Kevin G Hu
- Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, 330 Cedar Street, Boardman Building, New Haven, CT, 06510, USA
| | - Jacqueline M H Ihnat
- Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, 330 Cedar Street, Boardman Building, New Haven, CT, 06510, USA
| | - Neil Parikh
- Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, 330 Cedar Street, Boardman Building, New Haven, CT, 06510, USA
| | - John A Persing
- Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, 330 Cedar Street, Boardman Building, New Haven, CT, 06510, USA
| | - Michael Alperovich
- Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, 330 Cedar Street, Boardman Building, New Haven, CT, 06510, USA.
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Lutz K, Röhrig A, Al-Hourani J, Kunze S, Forkosh J, Wermelinger J, Messing-Jünger M. Long-term results of minimally invasive strip craniectomy without helmet therapy for scaphocephaly - a single-centre experience. Neurosurg Rev 2024; 47:164. [PMID: 38630329 DOI: 10.1007/s10143-024-02406-z] [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: 02/13/2024] [Revised: 03/25/2024] [Accepted: 04/09/2024] [Indexed: 04/19/2024]
Abstract
Scaphocephaly is the most common type of craniosynostosis and various surgical techniques are used for treatment. Due to late postoperative changes of the head shape, long-term outcome data is important for evaluating any new surgical technique. At our institution, minimally invasive strip craniectomy without regular helmet therapy is the standard treatment in scaphocephalic patients. Between October 2021 and February 2023, we retrospectively examined the skull shape of patients who underwent minimally invasive strip craniectomy for scaphocephaly using a 3D surface scan technique. The cephalic index (CI), the need for helmet therapy and additional cosmetic outcome parameters were investigated. We included 70 patients (72.5% male). The mean follow-up time was 46 (10-125) months and the mean CI was 75.7 (66.7-85.2). In 58 patients, the final cosmetic result was rated as "excellent/good" (mean CI: 76.3; 70.4-85.0), in 11 as "intermediate" (mean CI: 73.3; 66.7-77.6), and in one case as "unsatisfactory" (CI 69.3). The presence of a suboccipital protrusion was associated with a "less than good" outcome. The CI correlated significantly with the overall outcome, the presence of frontal bossing, and the interval between scan and surgery (age at scan). Minimally invasive strip craniectomy is an elegant and safe method to correct scaphocephaly. Our data show good cosmetic results in the long term even without regular postoperative helmet therapy.
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Affiliation(s)
- Katharina Lutz
- Neurosurgery Department, Inselspital, Bern University Hospital and University of Bern, Bern, 3010, Switzerland.
- Pediatric Neurosurgery, Asklepios Children's Hospital, 53757, Sankt Augustin, Germany.
| | - Andreas Röhrig
- Pediatric Neurosurgery, Asklepios Children's Hospital, 53757, Sankt Augustin, Germany
| | - Jasmin Al-Hourani
- Pediatric Neurosurgery, Asklepios Children's Hospital, 53757, Sankt Augustin, Germany
| | - Sandra Kunze
- Pediatric Neurosurgery, Asklepios Children's Hospital, 53757, Sankt Augustin, Germany
| | - Jana Forkosh
- Pediatric Neurosurgery, Asklepios Children's Hospital, 53757, Sankt Augustin, Germany
| | - Jonathan Wermelinger
- Neurosurgery Department, Inselspital, Bern University Hospital and University of Bern, Bern, 3010, Switzerland
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Skadorwa T, Strzelecka J. QEEG findings in nonsyndromic sagittal craniosynostosis. Sci Rep 2024; 14:1301. [PMID: 38221524 PMCID: PMC10788330 DOI: 10.1038/s41598-024-51858-2] [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: 05/12/2023] [Accepted: 01/10/2024] [Indexed: 01/16/2024] Open
Abstract
Despite the undertaken treatment, children with nonsyndromic sagittal craniosynostosis (NSC) are burdened with problems with speech development, visuospatial and other cognitive deficits. The electroencephalographic assessment has not influenced the diagnostics and treatment strategy of craniosynostosis so far but the introduction of quantitative EEG (QEEG) protocols renewed an interest in the functional aspect of this disease. In this study we retrospectively assessed the QEEG records of 25 children with NSC aged 1-18 months (mean age 9.62 months) before and after surgery. In each case, the amplitude, interhemispheric (ICoh) and intrahemispheric (HCoh) coherence indices were calculated. Obtained data were compared to age-matched control group of 25 normocephalic children. Children with NSC presented significantly lower values of amplitudes and intrahemispheric coherence in occipital, posterior parietal and posterior temporal regions than normocephalic children. The values of amplitudes, ICoh and HCoh in pre- and postoperative QEEG records mostly remained unchanged, with a slight improvement in HCoh in centro-parietal area. These findings suggest that NSC children present their own QEEG profile. The operative treatment improves an intrahemispheric connectivity, but there still exists a significant difference in the occipitotemporal, frontotemporal and centro-frontal areas, which may be considered as a functional substrate of reported speech and neurocognitive problems. QEEG findings in nonsyndromic sagittal craniosynostosis.
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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, Medical University of Warsaw, 5 Chalubinskiego St., 02004, Warsaw, Poland.
| | - Jolanta Strzelecka
- Department of Pediatric Neurology, Medical University of Warsaw, 63A Żwirki i Wigury St., 02091, Warsaw, Poland
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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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Moreno-Villagómez J, Yáñez-Téllez G, Prieto-Corona B, Seubert-Ravelo AN, García A, Hernández-Echeagaray E. Cognitive performance in preschoolers with non-syndromic craniosynostosis undergoing surgery: A comparison with typically developing children. APPLIED NEUROPSYCHOLOGY. CHILD 2023:1-7. [PMID: 36840597 DOI: 10.1080/21622965.2023.2183476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
This study aimed to determine the cognitive profile of preschool children undergoing surgery to correct non-syndromic craniosynostosis, compare them with typically developing children, and analyze possible cognitive deficits in the most prevalent subtypes: sagittal and unicoronal. Thirty-one children aged 3 years to 5 years and 11 months with non-syndromic craniosynostosis (11 sagittal, 9 unicoronal, 4 metopic, 3 lambdoid, 4 multisutural) who underwent surgery were compared with thirty-one typically developing children. The Wechsler Preschool and Primary Scale of Intelligence-Third Edition (WPPSI-III) was used to assess cognitive function. Children with non-syndromic craniosynostosis scored below the typically developing children in the Verbal Intelligence Quotient (VIQ) and Full-Scale Intelligence Quotient (FISQ). When specific subtypes were compared, children with sagittal synostosis scored similarly to the typically developing children; in contrast, children with unicoronal synostosis had lower performance in the Processing Speed Quotient and FISQ. The proportion of participants scoring below one standard deviation on the VIQ, General Language Composite, and FISQ was greater in the non-syndromic craniosynostosis group. This study supports the finding that children with non-syndromic craniosynostosis, particularly those with unicoronal synostosis, have more cognitive difficulties than those with normal development. Assessing cognition at preschool age in children with non-syndromic craniosynostosis is important in order to detect difficulties before they become more apparent at school age.
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Affiliation(s)
- Julieta Moreno-Villagómez
- Neuroscience Group, Facultad de Estudios Superiores Iztacala, Universidad Nacional Autónoma de México, Tlalnepantla, Mexico
| | - Guillermina Yáñez-Téllez
- Neuroscience Group, Facultad de Estudios Superiores Iztacala, Universidad Nacional Autónoma de México, Tlalnepantla, Mexico
| | - Belén Prieto-Corona
- Neuroscience Group, Facultad de Estudios Superiores Iztacala, Universidad Nacional Autónoma de México, Tlalnepantla, Mexico
| | - Ana Natalia Seubert-Ravelo
- Neuroscience Group, Facultad de Estudios Superiores Iztacala, Universidad Nacional Autónoma de México, Tlalnepantla, Mexico
| | - Antonio García
- Pediatric Neurosurgery Department, Unidad Médica de Alta Especialidad "La Raza" IMSS, México City, Mexico
| | - Elizabeth Hernández-Echeagaray
- Biomedical Unit, Facultad de Estudios Superiores Iztacala, Universidad Nacional Autónoma de México, Tlalnepantla, Mexico
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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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Delattre MH, Hennocq Q, Stricker S, Paternoster G, Khonsari RH. Scaphocephaly and increased intra-cranial pressure in non-operated adults: A controlled anthropological study on 21 skulls. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2022; 123:e212-e218. [PMID: 35131525 DOI: 10.1016/j.jormas.2022.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 01/30/2022] [Indexed: 06/14/2023]
Abstract
AIM AND SCOPE The prevalence of increased intra-cranial pressure (ICP) in patients with scaphocephaly is controversial. Here, based on anthropological material, we aimed to determine whether adults with non-operated sagittal synostosis show indirect signs of increased ICP. MATERIALS AND METHODS Thirty-eight dry skulls (21 skulls with sagittal craniosynostosis and 17 controls) were selected from the collections of the National Museum of Natural History (Paris, France). All skulls registered as 'fused sagittal suture' or 'scaphocephaly' in the registry of the Museum were included. All had total fusion of the sagittal suture. Controls were selected within skulls of similar origin (France), without visible craniofacial anomalies. The 38 skulls were CT-scanned using a standard medical CT-scan with a protocol dedicated to dry bone imaging. Eight radiological signs associated with raised ICP were assessed: (1) calvaria and (2) skull base thinning, (3) dorsum sellae erosion, (4) sella turcica lengthening, (5) copper beaten skull, (6) suture diastasis, (7) persistent metopic suture, and (8) small frontal sinus. Scaphocephaly was assessed based on head circumference, cranial index, intra-cranial volume, fronto-nasal angle, and inter-zygomatic distance. Linear and non-linear logistic models were used to compare groups. RESULTS 19/21 skulls with sagittal synostosis were significantly scaphocephalic. None of the criteria for ICP were significantly different in skulls with scaphocephaly relative to controls. Nevertheless, 5 individual skulls with scaphocephaly had ≥ 3 signs in favor of a history of raised ICP. We do not report the significant prevalence of indirect signs of raised ICP in adults with scaphocephaly. These results do not allow ruling out a history of early raised ICP or of minor prolonged raised ICP. Even though our findings support the fact that scaphocephaly is not significantly associated with prolonged raised ICP, individual cases (5/21) with clear signs in favor of a history of brain compression indicate that scaphocephaly correction should be considered as a functional procedure until the production of clear evidence. Cognitive assessments of non-operated adult patients with scaphocephaly could contribute to tackle this recurring question in craniofacial surgery.
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Affiliation(s)
- Maddy-Hélène Delattre
- Service de Chirurgie Maxillo-Faciale et Chirurgie Plastique, Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Faculté de Médecine, Université de Paris, 149 rue de Sèvres, Paris 75015, France
| | - Quentin Hennocq
- Service de Chirurgie Maxillo-Faciale et Chirurgie Plastique, Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Faculté de Médecine, Université de Paris, 149 rue de Sèvres, Paris 75015, France
| | - Sarah Stricker
- Klinik für Neurochirurgie, Universitätsspial Basel, Basel, Switzerland
| | - Giovanna Paternoster
- Service de Neurochirurgie, Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Faculté de Médecine, Université de Paris, Paris, France; Centre de Référence Maladies Rares Craniosténoses et Malformations Craniofaciales CRANIOST, Filière Maladies Rares TeteCou, France
| | - Roman Hossein Khonsari
- Service de Chirurgie Maxillo-Faciale et Chirurgie Plastique, Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Faculté de Médecine, Université de Paris, 149 rue de Sèvres, Paris 75015, France; Centre de Référence Maladies Rares Craniosténoses et Malformations Craniofaciales CRANIOST, Filière Maladies Rares TeteCou, France.
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Assessing Long-Term Neurodevelopment among Children with Non-Syndromic Single Suture Craniosynostosis. World J Plast Surg 2022; 11:57-61. [PMID: 36117890 PMCID: PMC9446125 DOI: 10.52547/wjps.11.2.57] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 02/15/2022] [Indexed: 11/18/2022] Open
Abstract
Background: Single suture craniosynostosis (SSC) is a disorder, affecting brain growth. Reviewing literature reveals controversialists of papers in this field. Methods: This prospective study was conducted from 2014 to 2016. All the individuals, aged 2 to 16 years, whose medical records files were complete, with SSC from 1999 to 2013 were included. All patients had undergone cranial vault remodeling at Mofid Hospital, Tehran, Iran. Wechsler questionnaires, WPPSI-III and WISC-IV, were completed for each child based on his/her age. Results: Seventy children were included, with the mean age of 6.7 (±2.9) years. Forty-six (65.7%) children were boys while 24 (34.3%) were girls. Mean FSIQ for all of children was 95.5 (±13.2). Mean verbal IQ, performance IQ, verbal comprehension, perceptual reasoning, processing speed, and working memory are 93.4 (±14.1), 96.1 (±13.3), 97.5 (±13.9), 102.2 (±12.5), 94.5 (±9.8), and 97.5 (±12.9), respectively. There was statistically significant difference between FSIQ of children with SSC and that of unaffected children (P-value<0.05). There was significant difference between verbal IQ of children with SSC and that of unaffected ones (P-value< 0.007). There was significant difference between in processing speed between affected children and unaffected children (P-value<0.012). Conclusion: Children, aged 2 to 6 years, with SSC had a significantly lower Verbal IQ, and children, aged 6 to 16 years, with SSC had a significantly lower processing speed than their healthy counterparts. Though FSIQ of children with SSC falls within normal range, it is a little lower than healthy peers.
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11
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Böcü Y, Karabağli H, Taşkapilioğlu MÖ, Ocakoğlu G. Statistical shape analyses of corpus callosum changes at preoperative and postoperative scaphocephaly patients. Childs Nerv Syst 2022; 38:773-780. [PMID: 34999992 DOI: 10.1007/s00381-021-05430-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 12/02/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE Scaphocephaly is the premature closure of the sagittal suture. The treatment strategies mainly focus on correcting the shape of the head, but there are very limited studies examining changes in brain structure. This study aimed to investigate shape differences in the shape of corpus callosum regarding the pre-treatment and post-treatment term at scaphocephaly patients. METHODS Cranium shape data were collected from the two-dimensional digital images. The generalized Procrustes analysis was used to obtain mean shapes in the pre- and postoperative phases. The shape deformation of the corpus callosum from the pre- to postoperative phases was evaluated using the thin plate spline method. RESULTS There is an enlargement of the splenium part of corpus callosum in the late group. In the early group, corpus callosum genu and body enlargement were observed in the postoperative period compared to the preoperative period, followed by a narrowing of the isthmus region. CONCLUSION This study showed structural deformations in the corpus callosum in scaphocephaly patients using head shape with the landmark-based geometric morphometric method by taking into consideration the topographic distribution. An enlargement at the splenium part of corpus callosum exposes after the cranial vault expansion depending on time.
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Affiliation(s)
- Yasin Böcü
- Department of Neurosurgery, School of Medicine, Selcuk University, Konya, Turkey.
| | - Hakan Karabağli
- Department of Neurosurgery, School of Medicine, Selcuk University, Konya, Turkey
| | | | - Gökhan Ocakoğlu
- Department of Bioistatistic, School of Medicine, Bursa Uludag University, Bursa, Turkey
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Gulati S, N M S. Craniosynostosis: A pediatric neurologist’s perspective. J Pediatr Neurosci 2022; 17:S54-S60. [DOI: 10.4103/jpn.jpn_25_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 03/12/2022] [Indexed: 11/04/2022] Open
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13
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Hemicraniectomy and externalized ventricular drain placement in a pediatric patient with myelin oligodendrocyte glycoprotein-associated tumefactive demyelinating disease. Childs Nerv Syst 2022; 38:185-189. [PMID: 33796928 DOI: 10.1007/s00381-021-05139-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 03/17/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Acquired demyelination of the central nervous system in children can manifest as multiple sclerosis, neuromyelitis optica, myelin oligodendrocyte glycoprotein (MOG)-associated demyelination, or as an acute monophasic illness without serum antibodies. Rarely do patients with demyelinating disease need surgical intervention for fulminant crises. CASE We report a case of anti-MOG antibody-related tumefactive demyelination in a 10-year-old female who required urgent hemicraniectomy and external ventricular drain placement for progressive white matter edema with obstructive hydrocephalus, subfalcine, and transtentorial herniation.
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Lang SS, Meier PM, Paden WZ, Storm PB, Heuer GG, Bartlett SP, Taylor JA, Swanson JW, Meara JG, Proctor M, Okunowo O, Stricker PA. Spring-mediated cranioplasty versus endoscopic strip craniectomy for sagittal craniosynostosis. J Neurosurg Pediatr 2021; 28:416-424. [PMID: 34298510 DOI: 10.3171/2021.2.peds20983] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 02/23/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Endoscopic strip craniectomy (ESC) and spring-mediated cranioplasty (SMC) are two minimally invasive techniques for treating sagittal craniosynostosis in early infancy. Data comparing the perioperative outcomes of these two techniques are sparse. Here, the authors hypothesized that outcomes would be similar between patients undergoing SMC and those undergoing ESC and conducted a study using the multicenter Pediatric Craniofacial Surgery Perioperative Registry (PCSPR). METHODS The PCSPR was queried for infants under the age of 6 months who had undergone SMC or ESC for sagittal synostosis. SMC patients were propensity score matched 1:2 with ESC patients on age and weight. Primary outcomes were transfusion-free hospital course, intensive care unit (ICU) admission, ICU length of stay (LOS), and hospital length of stay (HLOS). The authors also obtained data points regarding spring removal. Comparisons of outcomes between matched groups were performed with multivariable regression models. RESULTS The query returned data from 676 infants who had undergone procedures from June 2012 through September 2019, comprising 580 ESC infants from 32 centers and 96 SMC infants from 5 centers. Ninety-six SMC patients were matched to 192 ESC patients. There was no difference in transfusion-free hospital course between the two groups (adjusted odds ratio [aOR] 0.78, 95% CI 0.45-1.35). SMC patients were more likely to be admitted to the ICU (aOR 7.50, 95% CI 3.75-14.99) and had longer ICU LOSs (incident rate ratio [IRR] 1.42, 95% CI 1.37-1.48) and HLOSs (IRR 1.28, 95% CI 1.17-1.39). CONCLUSIONS In this multicenter study of ESC and SMC, the authors found similar transfusion-free hospital courses; however, SMC infants had longer ICU LOSs and HLOSs. A trial comparing longer-term outcomes in SMC versus ESC would further define the roles of these two approaches in the management of sagittal craniosynostosis.
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Affiliation(s)
- Shih-Shan Lang
- 1Division of Neurosurgery, Children's Hospital of Philadelphia, Department of Neurosurgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Petra M Meier
- 2Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - Phillip B Storm
- 1Division of Neurosurgery, Children's Hospital of Philadelphia, Department of Neurosurgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Gregory G Heuer
- 1Division of Neurosurgery, Children's Hospital of Philadelphia, Department of Neurosurgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Scott P Bartlett
- 5Division of Plastic and Reconstructive Surgery, Children's Hospital of Philadelphia, Department of Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Jesse A Taylor
- 5Division of Plastic and Reconstructive Surgery, Children's Hospital of Philadelphia, Department of Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Jordan W Swanson
- 5Division of Plastic and Reconstructive Surgery, Children's Hospital of Philadelphia, Department of Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania
| | | | - Mark Proctor
- 7Neurosurgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts; and
| | - Oluwatimilehin Okunowo
- 8Data Science and Biostatistics Unit, Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Pennsylvania
| | - Paul A Stricker
- 4Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, University of Pennsylvania, Perelman School of Medicine, Philadelphia
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Intracranial pressure, brain morphology and cognitive outcome in children with sagittal craniosynostosis. Childs Nerv Syst 2020; 36:689-695. [PMID: 32016575 DOI: 10.1007/s00381-020-04502-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 01/02/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND Patients with sagittal craniosynostosis are at increased risk of developing raised intracranial pressure (ICP) and neurocognitive deficiencies such as reduced attention, planning, speech, behavioural and learning disabilities. AIM To determine if the existing literature supports a correlation between elevated ICP and negative cognitive outcome in patients with sagittal craniosynostosis. Secondly, to investigate if the risk of developing neurocognitive deficiencies can be explained by changes in brain morphology in this patient category. METHODS Systematic literature review in PubMed. RESULTS A total of 190 publications were reviewed to determine a possible correlation between raised ICP and cognitive outcome, of which four were included in the study. No significant association was found. Forty-four publications on brain morphology in sagittal craniosynostosis were identified, of which 11 were included in the review. Clear evidence of morphologic changes in multiple areas of the brains of sagittal craniosynostosis patients was found in the literature. CONCLUSION The existing literature does not support an association between increased ICP and negative global cognitive outcome measures in patients with sagittal craniosynostosis. Brain morphology is altered in areas related to neurocognition and language in the same patient group. These changes might play a role in the development of neurocognitive deficiencies, though no definitive link is yet established, and further investigation is warranted.
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Clinical and aesthetic outcome analysis of a case series of trigonocephaly patients after early fronto-orbital advancement. Int J Oral Maxillofac Surg 2020; 49:1115-1121. [PMID: 32171618 DOI: 10.1016/j.ijom.2020.02.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 12/27/2019] [Accepted: 02/26/2020] [Indexed: 11/24/2022]
Abstract
The timing of operation for trigonocephaly is recommended before the age of 1 year. To evaluate the outcome of a consecutive series operated in a single centre, the current study was performed. The study cohort comprised a retrospective single-centre series of 20 patients with trigonocephaly operated before the age of 12 months. Intra- and postoperative clinical data, as well as aesthetic outcome measured by two-dimensional asymmetry index (2D AI) and correction of the curvature on lateral and pictures from above were evaluated. Furthermore, to evaluate postoperative aesthetic outcome, a new classification (Grades I-IV) was proposed. The mean age of the cohort was 7.9 months. 2D AI changed from 0.049 pre- to 0.03 postoperatively (P=0.165). The correction of the curvature in lateral pictures yielded a significant change on postoperative pictures (P=0.002) as well as on pictures from above. Using the proposed classification, 16/20 (80%) patients had a postoperative outcome of Grade I, 4/20 (20%) Grade II. In patients operated before the age of 12 months an excellent (Grade I, AI <0.03) or good aesthetic (Grade II, adequate parents' or surgeon's opinion) result could be reached in all patients.
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Bellew M, Mandela RJ, Chumas PD. Impact of age at surgery on neurodevelopmental outcomes in sagittal synostosis. J Neurosurg Pediatr 2019; 23:434-441. [PMID: 30660108 DOI: 10.3171/2018.8.peds18186] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 08/22/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The aim of this study was to ascertain whether age at surgery has an impact on later neurodevelopmental outcomes for children with sagittal synostosis (SS). METHODS The developmental outcome data from patients who had surgery for SS and who attended their routine preoperative, 6-7 months postoperative, and 5-year-old developmental assessments (yielding general quotients [GQs]) (n = 50), 10-year-old IQ assessment (n = 54), and 15-year-old IQ assessment (n = 23) were examined, comparing whether they had surgery at < 7 months, 7 to < 12 months, or ≥ 12 months). RESULTS There was no significant effect for age at surgery for GQ at 5 years of age, but there was a significant effect (p = 0.0001) for those undergoing surgery at < 7 months in terms of preoperative gross locomotor deficit that resolved by 6-7 months postoperatively (increase of 22.1 points), and had further improved by 5 years of age (total increase of 29.4 points). This effect was lessened when surgery was performed later (total increase of 7.3 points when surgery was performed at ≥ 12 months). At 10 years of age, 1-way ANOVA showed a significant difference in Full Scale IQ (FSIQ) score (p = 0.013), with the highest mean FSIQ being obtained when surgery was performed at < 7 months of age (score 107.0), followed by surgery at 7 to < 12 months (score 94.4), and the lowest when surgery was performed at ≥ 12 months (score 93.6). One-way ANOVA for the Performance IQ (PIQ) was very similar (p = 0.012), with PIQ scores of 101.4, 91.4, and 87.3, respectively. One-way ANOVA for Verbal IQ (VIQ) was again significant (p = 0.05), with VIQ scores of 111.3, 98.9, and 100.4, respectively. At 15 years, 1-way ANOVA showed a significant difference in PIQ (p = 0.006), with the highest mean PIQ being obtained when surgery was performed at < 7 months (score 104.8), followed by surgery at 7 to < 12 months (score 90.0), and the lowest when surgery was at performed at ≥ 12 months of age (score 85.3). There were no significant results for FSIQ and VIQ, although there was a similar trend for better outcomes with early surgery. CONCLUSIONS The findings of this study add to the literature that suggests that early surgery for SS may result in improved neurodevelopmental outcomes, with surgery optimally undertaken when patients are < 7 months of age, and with those undergoing surgery at ≥ 12 months performing the least well. These results also have potential implications for ensuring early diagnosis and referral and for the type of surgery offered. Further research is needed to control for confounding factors and to identify the mechanism by which late surgery may be associated with poorer neurodevelopmental outcomes.
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Affiliation(s)
- Maggie Bellew
- Departments of1Plastic, Reconstructive and Hand Surgery; and
| | | | - Paul D Chumas
- 2Neurosurgery, Leeds General Infirmary, Leeds, United Kingdom
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Jaskolka MS. Current Controversies in Metopic Suture Craniosynostosis. Oral Maxillofac Surg Clin North Am 2017; 29:447-463. [DOI: 10.1016/j.coms.2017.07.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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