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Mellgren J, Maltese G, Tarnow P, Bhatti-Søfteland M, Kölby L, Säljö K. Spring-Assisted Surgery of Unilambdoid Craniosynostosis. J Craniofac Surg 2024; 35:00001665-990000000-01350. [PMID: 38353548 PMCID: PMC11045546 DOI: 10.1097/scs.0000000000010035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 01/03/2024] [Indexed: 04/28/2024] Open
Abstract
Craniosynostosis is traditionally treated with extensive cranial vault reconstructions (CVRs). Although less invasive techniques, such as endoscopic strip craniectomy with postoperative helmet therapy, have been successful, they also present difficulties. An alternative method is distraction osteogenesis using either manually controlled devices or specially designed springs. In this study, the authors provide the first comparison of spring-assisted surgery (SAS) with CVR for the treatment of unilambdoid synostosis (ULS). Fourteen consecutive patients (8 CVR and 6 SAS) treated for ULS at Sahlgrenska University Hospital between 2005 and 2018 were included. Skull shape and deviations were evaluated using previously defined measurement points on 3-dimensional computed tomography scans preoperatively, at spring removal, and at 3 years of age. Posterior and middle cranial fossa (PCF and MCF, respectively), skull-base cant, facial twist, and mastoid bulge (MB) were measured, and clinical data were obtained from chart reviews. The results indicated that at the 3-year follow-up, PCF, MCF, and MB improved in both groups, with no significant difference in outcome observed between methods. In the SAS group, duration of operation [61±27 min (mean±SD)] and perioperative bleeding (3.5±2.8 mL/kg body weight) were both significantly lower relative to the CVR group (P<0.05). These findings showed that both SAS and CVR resulted in similar improvements in treating ULS, although neither produced complete normalization of skull shape. The results suggest that early diagnosis and operation allow less extensive SAS to be performed without adversely affecting the results.
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Affiliation(s)
- Jonas Mellgren
- Department of Plastic Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg
- Department of Plastic Surgery, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - Giovanni Maltese
- Department of Plastic Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg
- Department of Plastic Surgery, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - Peter Tarnow
- Department of Plastic Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg
- Department of Plastic Surgery, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - Madiha Bhatti-Søfteland
- Department of Plastic Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg
- Department of Plastic Surgery, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - Lars Kölby
- Department of Plastic Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg
- Department of Plastic Surgery, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - Karin Säljö
- Department of Plastic Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg
- Department of Plastic Surgery, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
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De Vito A, Ben Zvi I, D'Arco F. MR Protocols for Paediatric Neurosurgical Common Conditions: An Update Guide for Neurosurgeons. Adv Tech Stand Neurosurg 2023; 48:57-72. [PMID: 37770681 DOI: 10.1007/978-3-031-36785-4_3] [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] [Indexed: 09/30/2023]
Abstract
The biggest challenge for clinicians and surgeons when it comes to radiological examinations is the ability to request the right modalities and to understand the strengths and limitations of each modality. This is particularly important in paediatric neurosciences where despite magnetic resonance imaging (MRI) being the main imaging modality, there are several protocols, technical limitations of specific scanners and issues related to sedation that need to be taken into account. In this chapter, we describe a simple approach for six common neurosurgical conditions to guide the paediatric neurosurgeons in requesting the right MR protocol and understanding the rationale of it.Paediatric neuro-oncology, epilepsy and neck/skull base protocols are discussed elsewhere in this book and therefore will not be a focus in this chapter (Bernasconi et al., Epilepsia 60:1054-68, 2019; D'Arco et al., Neuroradiology 64:1081-100; 2022; Avula et al., Childs Nerv Syst 37:2497-508; 2021).
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Affiliation(s)
- Andrea De Vito
- Department of Neuroradiology, H. S. Gerardo Monza, Monza, Italy.
| | - Ido Ben Zvi
- Paediatric Neurosurgery Department, Great Ormond Street Hospital, London, UK
| | - Felice D'Arco
- Department of Radiology, Great Ormond Street Hospital, London, UK
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Examining the Role of Early Diagnostic Imaging for Craniosynostosis in the Era of Endoscopic Suturectomy: A Single Institution Experience. J Craniofac Surg 2022; 33:1363-1368. [PMID: 35132031 DOI: 10.1097/scs.0000000000008534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 01/15/2022] [Indexed: 11/25/2022] Open
Abstract
ABSTRACT Endoscopic suturectomy is a minimally invasive surgical treatment for single-suture craniosynostosis in children between 1 and 4 months of age. This study sought to characterize the role played by diagnostic imaging in facilitating early surgical management with endoscopic suturectomy. The authors also characterized the overall diagnostic utility of imaging in patients assessed for abnormal head shape at their institution, regardless of surgical status. A retrospective cohort of children diagnosed with single-suture synostosis undergoing either primary endoscopic suturectomy or open calvarial reconstruction at the authors' institution from 1998 to 2018 was first reviewed. Of 132 surgical patients, 53 underwent endoscopic suturectomy and 79 underwent open repair. There was no difference in the proportion of endoscopic and open surgery patients imaged preoperatively before (24.5% versus 35.4%; P = 0.24) or after (28.3% versus 25.3%; P = 0.84) craniofacial assessment. Stratifying by historical epoch (1998-2010 versus 2011-2018), there was also no difference found between preoperative imaging rates (63.6% versus 56.4%; P = 0.35). In another cohort of 175 patients assessed for abnormal head shape, 26.9% were imaged to rule out craniosynostosis. Positive diagnostic imaging rates were recorded for suspected unicoronal (100%), metopic (87.5%), lambdoidal (75.0%), sagittal (63.5%), multi-suture (50%), and bicoronal (0%) synostosis. The authors conclude that the use of diagnostic imaging at their institution has not increased despite higher utilization of endoscopic suturectomy and need for expedient identification of surgical candidates. However, their results suggest that imaging may play a greater diagnostic role for suspected bicoronal, sagittal, and multi-sutural synostosis among sutural subtypes of synostosis.
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Sharma A, Sharma M. Sinus Pericranii (Parietal and Occipital) With Epicranial Varicosities in a Case of Craniosynostosis. Cureus 2022; 14:e21891. [PMID: 35273853 PMCID: PMC8901151 DOI: 10.7759/cureus.21891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2022] [Indexed: 11/12/2022] Open
Abstract
Sinus pericranii is a type of slow flow venous malformation with communication between intracranial venous system and epicranial veins through transosseous emissary veins. They can be isolated or may be seen with malformations like craniosynostosis. It has been postulated that transient intracranial venous hypertension in the late embryonic period could lead to the development of venous anomalies, including sinus pericranii. We present a case of oxycephaly with concurrent presence of sinus pericranii in parietal and occipital regions with epicranial varicosities with other imaging findings of raised intracranial pressure. Other findings suggestive of raised intracranial pressure were cerebellar tonsillar herniation/prominent optic nerve dural sleeves. The paucity of literature warrants future studies to establish role of intracranial hypertension in etiopathogenesis of sinus pericranii.
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Whittall I, Lambert WA, Moote DJ, Bookland MJ, Martin JE, Hughes CD, Hersh DS. Postnatal diagnosis of single-suture craniosynostosis with cranial ultrasound: a systematic review. Childs Nerv Syst 2021; 37:3705-3714. [PMID: 34611761 DOI: 10.1007/s00381-021-05301-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 07/19/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION The optimal protocol for diagnostic workup of craniosynostosis and the role of specific imaging modalities remain controversial. Skull X-rays and 3-dimensional head CTs are options when physical exam is equivocal but involve ionizing radiation. Ultrasound has emerged as an alternative modality for visualization of cranial sutures, but its use is not widespread. METHODS The authors performed a systematic review of the literature on the use of ultrasound for the diagnosis of craniosynostosis. RESULTS A total of 12 studies involving 1062 patients were included. Overall, 300 patients (28.2%) were diagnosed with craniosynostosis. A total of 369 (34.7%) patients had their diagnosis (craniosynostosis vs. patent sutures) confirmed with another imaging modality in addition to ultrasound. Among studies, the specificity of ultrasound ranged from 86 to 100%, and the sensitivity from 71 to 100%. CONCLUSIONS Ultrasonography of cranial sutures is a feasible and accurate tool for the diagnosis of single-suture craniosynostosis when physical exam findings are insufficient. Although technical aspects of ultrasonography and its interpretation have an associated learning curve, ultrasound can achieve high sensitivity and specificity among patients with suspected craniosynostosis.
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Affiliation(s)
| | | | - Douglas J Moote
- Division of Radiology, Connecticut Children's, Hartford, CT, USA
| | - Markus J Bookland
- Division of Neurosurgery, Connecticut Children's, Hartford, CT, USA.,Department of Surgery, UConn School of Medicine, Farmington, CT, USA.,Department of Pediatrics, UConn School of Medicine, Farmington, CT, USA
| | - Jonathan E Martin
- Division of Neurosurgery, Connecticut Children's, Hartford, CT, USA.,Department of Surgery, UConn School of Medicine, Farmington, CT, USA
| | - Christopher D Hughes
- Department of Surgery, UConn School of Medicine, Farmington, CT, USA.,Division of Plastic Surgery, Connecticut Children's, Hartford, CT, USA
| | - David S Hersh
- Division of Neurosurgery, Connecticut Children's, Hartford, CT, USA. .,Department of Surgery, UConn School of Medicine, Farmington, CT, USA. .,Department of Pediatrics, UConn School of Medicine, Farmington, CT, USA.
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Cacciaguerra G, Palermo M, Marino L, Rapisarda FAS, Pavone P, Falsaperla R, Ruggieri M, Marino S. The Evolution of the Role of Imaging in the Diagnosis of Craniosynostosis: A Narrative Review. CHILDREN (BASEL, SWITZERLAND) 2021; 8:children8090727. [PMID: 34572159 PMCID: PMC8467503 DOI: 10.3390/children8090727] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 08/15/2021] [Accepted: 08/23/2021] [Indexed: 11/24/2022]
Abstract
Craniosynostosis, the premature closure of cranial sutures, is one of the principal causes of pediatric skull deformities. It can cause aesthetic, neurological, acoustic, ophthalmological complications up to real emergencies. Craniosynostosis are primarily diagnosed with accurate physical examination, skull measurement and observation of the deformity, but the radiological support currently plays an increasingly important role in confirming a more precise diagnosis and better planning for therapeutic interventions. The clinician must know how to diagnose in the earliest and least invasive way for the child. In the past, technological limitations reduced the choices; today, however, there are plenty of choices and it is necessary to use the various types of available imaging correctly. In the future, imaging techniques will probably rewrite the common classifications we use today. We provide an updated review of the role of imaging in this condition, through the ages, to outline the correct choice for the clinician for an early and non-invasive diagnosis.
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Affiliation(s)
- Giovanni Cacciaguerra
- Department of Clinical and Experimental Medicine, Section of Pediatrics and Child Neuropsychiatry, Unit of Rare Diseases of the Nervous System in Childhood, University of Catania, 95125 Catania, Italy; (G.C.); (P.P.); (M.R.)
| | - Monica Palermo
- Radiology Unit 1, Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”, University of Catania, 95125 Catania, Italy;
| | - Lidia Marino
- Neonatal Intensive Care Unit, AOU “Policlinico”, PO “San Marco”, University of Catania, 95121 Catania, Italy; (L.M.); (R.F.)
| | | | - Piero Pavone
- Department of Clinical and Experimental Medicine, Section of Pediatrics and Child Neuropsychiatry, Unit of Rare Diseases of the Nervous System in Childhood, University of Catania, 95125 Catania, Italy; (G.C.); (P.P.); (M.R.)
| | - Raffaele Falsaperla
- Neonatal Intensive Care Unit, AOU “Policlinico”, PO “San Marco”, University of Catania, 95121 Catania, Italy; (L.M.); (R.F.)
- Unit of Pediatrics and Pediatric Emergency, AOU “Policlinico”, PO “San Marco”, University of Catania, 95121 Catania, Italy
| | - Martino Ruggieri
- Department of Clinical and Experimental Medicine, Section of Pediatrics and Child Neuropsychiatry, Unit of Rare Diseases of the Nervous System in Childhood, University of Catania, 95125 Catania, Italy; (G.C.); (P.P.); (M.R.)
| | - Silvia Marino
- Unit of Pediatrics and Pediatric Emergency, AOU “Policlinico”, PO “San Marco”, University of Catania, 95121 Catania, Italy
- Correspondence: ; Tel.: +39-0954794046
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Kronig SAJ, Kronig ODM, Zurek M, Van Adrichem LNA. Orbital volume, ophthalmic sequelae and severity in unilateral coronal synostosis. Childs Nerv Syst 2021; 37:1687-1694. [PMID: 33566143 PMCID: PMC8084761 DOI: 10.1007/s00381-021-05065-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 01/27/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE Unilateral coronal synostosis (UCS) results in an asymmetrical skull, including shallow and asymmetrical orbits, associated with reduced orbital volume and high prevalences of ophthalmic sequelae. Aim is to link orbital volumes in patients with UCS to severity according to UCSQ (Utrecht Cranial Shape Quantifier) and presence of ophthalmic sequelae. METHODS We included preoperative patients with UCS (≤ 18 months). Orbital volume was measured on CT scans by manual segmentation (Mimics software (Materialise, Leuven, Belgium)), and severity of UCS was determined by UCSQ. Orbital volume of affected side was compared to unaffected side using Wilcoxon signed rank test. Orbital volume ratio was calculated (affected/unaffected volume) and compared to the category of UCSQ by Kruskal-Wallis test. Opthalmic sequelae were noted. RESULTS We included 19 patients (mean age 7 months). Orbital volume on affected side was significantly lower (p = 0.001), mean orbital volume ratio was 0.93 (SD 0.03). No significant differences in group means of orbital volume ratio between different levels of severity of UCSQ were found (Kruskal-Wallis H (2) = 0.873; p > 0.05). Ophthalmic sequelae were found in 3 patients; one had adduction impairment and strabismus (mild UCS), one had astigmatism (moderate UCS), and one had abduction impairment (on both ipsi- and contralateral side) and vertical strabismus (severe UCS). CONCLUSION No association between orbital volume ratio and severity of UCS was found. Side-to-side asymmetry in orbital volume was noted. No association between either preoperative orbital volume ratio or severity of UCS and the presence of preoperative ophthalmic sequelae was found.
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Affiliation(s)
- Sophia A. J. Kronig
- Department of Plastic and Reconstructive Surgery and Hand Surgery, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Otto D. M. Kronig
- Department of Plastic and Reconstructive Surgery and Hand Surgery, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Marcel Zurek
- Department of Ophthalmology, Erasmus University Medical Centre (Erasmus MC), Rotterdam, The Netherlands
| | - Léon N. A. Van Adrichem
- Department of Plastic and Reconstructive Surgery and Hand Surgery, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
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Sutures ultrasound: useful diagnostic screening for posterior plagiocephaly. Childs Nerv Syst 2021; 37:3715-3720. [PMID: 34453581 PMCID: PMC8604816 DOI: 10.1007/s00381-021-05324-3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 08/04/2021] [Indexed: 02/08/2023]
Abstract
PURPOSE Posterior plagiocephaly (PP) is a common clinical condition in pediatric age. There are two main causes of PP: postural plagiocephaly and craniosynostosis. Early diagnosis is important, as it prevents neurological complications and emergencies. Diagnosis in the past was often made late and with imaging tests that subjected the infant to a high radiation load. Suture ultrasound does not use ionizing radiation; it is easy to perform, allows an early diagnosis, and directs toward the execution of the cranial 3D-CT scan, neurosurgical consultation, and possible intervention. The aim of the study is to describe the high sensitivity and specificity of suture ultrasound for the differential diagnosis between plagiocephaly and craniosynostosis. METHODS We reported our prospective experience and compared it with the data in the literature through a systematic review. The systematic review was conducted on electronic medical databases (PubMed, Embase, Cochrane Library, Scopus, and Web of Science) evaluating the published literature up to November 2020. According to Preferred Reporting Items for Systematic Reviews and Meta-ANALYSES (PRISMA statement), we identified 2 eligible studies. Additionally, according to AMSTAR 2, all included reviews have been critically rated as high quality. A total of 120 infants with abnormal skull shape were examined in NICU. All underwent clinical and ultrasound examination. RESULTS Of the total, 105 (87.5%) had plagiocephaly and 15 dolichocephaly/scaphocephaly (12.5%). None of these had associated other types of malformations and/or neurological disorders. The synostotic suture was identified ultrasonographically in 1 infant and subsequently confirmed by 3D CT scan (100%). CONCLUSION Cranial sutures ultrasonography can be considered in infants a selective, excellent screening method for the evaluation of skull shape deformities as first technique before the 3D CT scan exam and subsequent neurosurgical evaluation. Cranial suture ultrasonography should be considered part of clinical practice especially for pediatricians.
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Boyajian MK, Al-Samkari H, Nguyen DC, Naidoo S, Woo AS. Partial Suture Fusion in Nonsyndromic Single-Suture Craniosynostosis. Cleft Palate Craniofac J 2020; 57:499-505. [PMID: 32013562 DOI: 10.1177/1055665620902299] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Partial synostosis of cranial sutures has been shown to have clinical and diagnostic significance. However, there is limited published information about how suture fusion progresses over time. In this study, we evaluate patients with nonsyndromic single-suture synostosis. We aim to define the incidence of partial versus complete suture fusion and whether a correlation exists between the degree of suture fusion and age. METHODS Two hundred fifty-four patients with nonsyndromic single-suture synostosis were evaluated. Preoperative computed tomography (CT) scans were rendered in 3-dimensions, all sutures were visualized and assessed for patency or fusion, and length of fusion was measured. Findings were grouped according to suture type (sagittal, coronal, metopic, or lambdoid), the degree of fusion (full, >50%, or <50%), and patient age at time of CT scan (0-90, 91-180, 181-360, or >360 days). Data were analyzed to correlate patient age versus the degree of suture fusion. RESULTS For all patients, 72% had complete and 28% had partial synostosis. Ratios of full to partial fusion for each suture type were as follows: sagittal 97:36, coronal 35:22, metopic 46:4, and lambdoid 4:10. The sagittal, coronal, and metopic groups demonstrated greater probabilities of complete suture fusion as patient age increases (P = .021, P < .001, P = .001, respectively). This trend was also noted when all sutures were considered together by age-group (P < .001). CONCLUSION We note a partial suture fusion rate of 28.3%. Our analysis shows a correlation between the extent of suture synostosis and patient age. Finally, we demonstrate that different sutures display different patterns of partial and complete fusion.
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Affiliation(s)
- Michael K Boyajian
- Division of Plastic and Reconstructive Surgery, Brown University Warren Alpert Medical School, Providence, RI, USA
| | - Hanny Al-Samkari
- Division of Hematology Oncology, Massachusetts General Hospital Cancer Center, Boston, MA, USA
| | - Dennis C Nguyen
- Division of Plastic and Reconstruction Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Sybill Naidoo
- Division of Plastic and Reconstruction Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Albert S Woo
- Division of Plastic and Reconstructive Surgery, Brown University Warren Alpert Medical School, Providence, RI, USA
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Massimi L, Bianchi F, Frassanito P, Calandrelli R, Tamburrini G, Caldarelli M. Imaging in craniosynostosis: when and what? Childs Nerv Syst 2019; 35:2055-2069. [PMID: 31289853 DOI: 10.1007/s00381-019-04278-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 06/25/2019] [Indexed: 12/14/2022]
Abstract
PURPOSE Currently, the interest on craniosynostosis in the clinical practice is raised by their increased frequency and their genetic implications other than by the still existing search of less invasive surgical techniques. These reasons, together with the problem of legal issues, make the need of a definite diagnosis for a crucial problem, even in single-suture craniosynostosis (SSC). Although the diagnosis of craniosynostosis is primarily the result of physical examination, craniometrics measuring, and observation of the skull deformity, the radiological assessment currently plays an important role in the confirmation of the diagnosis, the surgical planning, and even the postoperative follow-up. On the other hand, in infants, the use of radiation or the need of sedation/anesthesia raises the problem to reduce them to minimum to preserve such a delicate category of patient from their adverse effects. METHODS, RESULTS AND CONCLUSIONS This review aims at summarizing the state of the art of the role of radiology in craniosynostosis, mainly focusing on indications and techniques, to provide an update not only to pediatric neurosurgeons or maxillofacial surgeons but also to all the other specialists involved in their management, like neonatologists, pediatricians, clinical geneticists, and pediatric neurologists.
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Affiliation(s)
- L Massimi
- Fondazione Policlinico Gemelli IRCCS, Neurochirurgia Infantile, Rome, Italy.
- Università Cattolica del Sacro Cuore, Istituto Neurochirurgia, Rome, Italy.
| | - F Bianchi
- Fondazione Policlinico Gemelli IRCCS, Neurochirurgia Infantile, Rome, Italy
| | - P Frassanito
- Fondazione Policlinico Gemelli IRCCS, Neurochirurgia Infantile, Rome, Italy
| | - R Calandrelli
- Polo scienze delle immagini, di laboratorio ed infettivologiche, Area diagnostica per immagini, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - G Tamburrini
- Fondazione Policlinico Gemelli IRCCS, Neurochirurgia Infantile, Rome, Italy
- Università Cattolica del Sacro Cuore, Istituto Neurochirurgia, Rome, Italy
| | - M Caldarelli
- Fondazione Policlinico Gemelli IRCCS, Neurochirurgia Infantile, Rome, Italy
- Università Cattolica del Sacro Cuore, Istituto Neurochirurgia, Rome, Italy
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Intracranial Volume Post Cranial Expansion Surgery Using Three-Dimensional Computed Tomography Scan Imaging in Children With Craniosynostosis. J Craniofac Surg 2019; 31:46-50. [PMID: 31403510 DOI: 10.1097/scs.0000000000005810] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Craniosynostosis is a congenital defect that causes ≥1 suture to fuse prematurely. Cranial expansion surgery which consists of cranial vault reshaping with or without fronto-orbital advancement (FOA) is done to correct the skull to a more normal shape of the head as well as to increase the intracranial volume (ICV). Therefore, it is important to evaluate the changes of ICV after the surgery and the effect of surgery both clinically and radiologically. OBJECTIVE The aim of this study is to evaluate the ICV in primary craniosynostosis patients after the cranial vault reshaping with or without FOA and to compare between syndromic and nonsyndromic synostosis group, to determine factors that associated with significant changes in the ICV postoperative, and to evaluate the resolution of copper beaten sign and improvement in neurodevelopmental delay after the surgery. METHODS This is a prospective observational study of all primary craniosynostosis patients who underwent operation cranial vault reshaping with or without FOA in Hospital Kuala Lumpur from January 2017 until Jun 2018. The ICV preoperative and postoperative was measured using the 3D computed tomography (CT) imaging and analyzed. The demographic data, clinical and radiological findings were identified and analyzed. RESULTS A total of 14 cases (6 males and 8 females) with 28 3D CT scans were identified. The mean age of patients was 23 months. Seven patients were having syndromic synostosis (4 Crouzon syndromes and 3 Apert syndromes) and 7 nonsyndromic synostosis. The mean preoperative ICV was 880 mL (range, 641-1234 mL), whereas the mean postoperative ICV was 1081 mL (range, 811-1385 mL). The difference was 201 mL which was statistically significant (P < 0.001). In comparison, the mean volume increment for syndromic synostosis and nonsyndromic synostosis was 282 mL and 120 mL, respectively. The difference was statistically significant (P < 0.004). Three months post-operation, the copper beaten sign was still present in the CT scan which was statistically not significant in this study (P > 1.0). However, there was 100% (n = 13) improvement of this copper beaten sign. However, the neurodevelopmental delay showed no improvement which was statistically not significant (P > 1.0). CONCLUSION Surgery in craniosynostosis patient increases the ICV besides it improves the shape of the head. From this study, the syndromic synostosis had better increment of ICV compared to nonsyndromic synostosis.
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Nicolini F, Arnaud E, Usami K, Vecchione A, Brunelle F, Di Rocco F. Impact of extra-axial cerebrospinal fluid collection in frontal morphology after surgical treatment of scaphocephaly. Surg Neurol Int 2018; 9:215. [PMID: 30505617 PMCID: PMC6219275 DOI: 10.4103/sni.sni_13_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 03/06/2018] [Indexed: 11/04/2022] Open
Abstract
Background Infants with sagittal suture synostosis often present a pathologic dilatation of subarachnoid spaces. The impact of such subarachnoid spaces' enlargement in the morphology of the skull, especially on the forehead and on the surgical outcome, was analyzed. Methods Children less than 6 months of age undergoing a surgical correction of the scaphocephaly with Renier's H technique between 2003 and 2008 were included in the study. In these patients, preoperative and postoperative fronto-occipital diameter (FOD), biparietal diameter (BPD), temporal width (TW), and naso-frontal angle (NFA) were measured. Cranial index (CI) and the difference between preoperative and postoperative CI (ΔCI) were calculated. Preoperative cranio-cortical width (CCW) was measured to analyze the subarachnoid spaces' volumes. The children here considered were then divided into two groups: Group 1 with CCW within normal estimated value corrected for age and Group 2 with CCW larger than estimated normal value. Results About 159 children were enrolled (72.3% male). CCW was larger than expected in 95 children (59.8%). A positive correlation between CCW and BPD (P ≤ 0.001) and a negative correlation between CCW and NFA (P ≤ 0.001) were found. When comparing the two groups, the mean age at preoperative computed tomography (CT) scan was 121 days in Group 1 and 110 days in Group 2. The mean age at operation was 130 days in Group 1 and 123 in Group 2. The mean age at postoperative examination (RX or CT scan) was 53.4 months in Group 1 and 51.8 months in Group 2. Preoperatively, the mean BPD, TW, and CI were significantly larger in Group 2 (P ≤ 0.01), whereas the NFA was significantly narrower (P = 0.03). Postoperative analysis showed that ΔCI was statistically different between the two groups (Group 1: 10%, Group 2: 7%; P < 0.04). The duration of follow-up period ranged between 19 and 129 months. Conclusion Two main subtypes of forehead of infants with scaphocephaly may be distinguished. Indeed, the morphology of the forehead differs when a pathologic subarachnoid spaces' enlargement is present preoperatively and it also affects the postoperative evolution. Such observation highlights the importance of evaluating whether subarachnoid spaces are enlarged when planning a surgical correction in isolated sagittal suture synostosis.
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Affiliation(s)
- Francesca Nicolini
- Departement of Pediatric Neurosurgery, Craniofacial Unit, Necker Enfants Malades Hospital, APHP, Paris, France.,Operative Unit of Neurosurgery, Bellaria Hospital, Bologna, Italy
| | - Eric Arnaud
- Departement of Pediatric Neurosurgery, Craniofacial Unit, Necker Enfants Malades Hospital, APHP, Paris, France
| | - Kenichi Usami
- Departement of Pediatric Neurosurgery, Craniofacial Unit, Necker Enfants Malades Hospital, APHP, Paris, France
| | - Antonio Vecchione
- Department of Anesthesia, Necker Enfants Malades Hospital, APHP, Paris, France
| | - Francis Brunelle
- Department of Neuroradiology, Necker Enfants Malades Hospital, APHP, Paris, France
| | - Federico Di Rocco
- Departement of Pediatric Neurosurgery, Craniofacial Unit, Necker Enfants Malades Hospital, APHP, Paris, France
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Al-Namnam NM, Hariri F, Thong MK, Rahman ZA. Crouzon syndrome: Genetic and intervention review. J Oral Biol Craniofac Res 2018; 9:37-39. [PMID: 30202723 DOI: 10.1016/j.jobcr.2018.08.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2018] [Accepted: 08/24/2018] [Indexed: 12/16/2022] Open
Abstract
Crouzon syndrome exhibits considerable phenotypic heterogeneity, in the aetiology of which genetics play an important role. FGFR2 mediates extracellular signals into cells and the mutations in the FGFR2 gene cause this syndrome occurrence. Activated FGFs/FGFR2 signaling disrupts the balance of differentiation, cell proliferation, and apoptosis via its downstream signal pathways. However, very little is known about the cellular and molecular factors leading to severity of this phenotype. Revealing the molecular pathology of craniosynostosis will be a great value for genetic counselling, diagnosis, prognosis and early intervention programs. This mini-review summarizes the fundamental and recent scientific literature on genetic disorder of Crouzon syndrome and presents a graduated strategy for the genetic approach, diagnosis and the management of this complex craniofacial defect.
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Affiliation(s)
- N M Al-Namnam
- Department of Oral Biology, Faculty of Dentistry, University of MAHSA, 42610, Jenjarum, Selangor, Malaysia
| | - F Hariri
- Department of Oro-Maxillofacial Clinical Science, Faculty of Dentistry, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - M K Thong
- Department of Paediatrics, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Z A Rahman
- Department of Oro-Maxillofacial Clinical Science, Faculty of Dentistry, University of Malaya, 50603, Kuala Lumpur, Malaysia
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Image based simulation of the low dose computed tomography images suggests 13 mAs 120 kV suitability for non-syndromic craniosynostosis diagnosis without iterative reconstruction algorithms. Eur J Radiol 2018; 105:168-174. [DOI: 10.1016/j.ejrad.2018.06.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 05/03/2018] [Accepted: 06/10/2018] [Indexed: 11/18/2022]
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15
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Hariri F, Abdul Rahman ZA, Bahuri NFA, Azmi MN, Abdullah NA, Ganesan D. Crouzon Syndrome: A Case Series of Craniomaxillofacial Distraction Osteogenesis for Functional Rehabilitation. J Oral Maxillofac Surg 2018; 76:646.e1-646.e12. [DOI: 10.1016/j.joms.2017.11.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 10/20/2017] [Accepted: 11/17/2017] [Indexed: 12/12/2022]
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Mertens C, Wessel E, Berger M, Ristow O, Hoffmann J, Kansy K, Freudlsperger C, Bächli H, Engel M. The value of three-dimensional photogrammetry in isolated sagittal synostosis: Impact of age and surgical technique on intracranial volume and cephalic index─a retrospective cohort study. J Craniomaxillofac Surg 2017; 45:2010-2016. [PMID: 29066040 DOI: 10.1016/j.jcms.2017.09.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 07/29/2017] [Accepted: 09/18/2017] [Indexed: 12/01/2022] Open
Abstract
PURPOSE The aim of this study was to compare the outcome of intracranial volume (ICV) and cephalic index (CI) between two different techniques for surgical therapy of sagittal synostosis. MATERIAL AND METHODS Between 2011 and 2015, all patients scheduled for surgical therapy of sagittal synostosis were consecutively enrolled. All patients younger than 6 months underwent early extended strip craniectomy (ESC group), and patients older than 6 months underwent late modified pi-procedure (MPP group). To measure ICV and CI, data acquisition was performed via three-dimensional photogrammetry, 1 day before (T0) and between 10 and 12 weeks after surgery (T1). Results were compared with an age-matched reference group of healthy children. Perioperative parameters, as duration of surgery and the amount of blood loss of both surgical procedures were analyzed. RESULTS A total of 85 patients were enrolled. Of the patients, 48 underwent an extended strip craniotomy with parietal osteotomies and biparietal widening and 37 patients underwent a late modified pi-procedure. There was no significant difference between the ESC group and the MPP group regarding the efficacy of improving CI (p > 0.05). Both techniques were able to normalize CI and to improve head shape. ICV was normal compared to age-matched norm-groups with both techniques, pre- and postoperatively. However, duration of the surgical procedure and calculated blood loss were significantly lower in the ESC group (p < 0.05). CONCLUSION ESC and MPP were effective techniques to normalize cephalic index (CI) and improve head shape at their recommended time of surgery. Measurement of ICV and CI with 3D photogrammetry is a valid method to objectively evaluate patients before and after surgery without exposing pediatric patients to ionizing radiation.
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Affiliation(s)
- Christian Mertens
- Department of Cranio- and Maxillofacial Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Eline Wessel
- Department of Cranio- and Maxillofacial Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Moritz Berger
- Department of Cranio- and Maxillofacial Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Oliver Ristow
- Department of Cranio- and Maxillofacial Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Jürgen Hoffmann
- Department of Cranio- and Maxillofacial Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Katinka Kansy
- Department of Cranio- and Maxillofacial Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Christian Freudlsperger
- Department of Cranio- and Maxillofacial Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Heidrun Bächli
- Department of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Michael Engel
- Department of Cranio- and Maxillofacial Surgery, Heidelberg University Hospital, Heidelberg, Germany.
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Pogliani L, Zuccotti GV, Furlanetto M, Giudici V, Erbetta A, Chiapparini L, Valentini L. Cranial ultrasound is a reliable first step imaging in children with suspected craniosynostosis. Childs Nerv Syst 2017; 33:1545-1552. [PMID: 28578511 DOI: 10.1007/s00381-017-3449-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 05/02/2017] [Indexed: 12/17/2022]
Abstract
PURPOSE Skull radiography (SR) and Computed Tomography (CT) are still proposed as the first-line imaging choice for the diagnosis of craniosynostosis (CS) in children with abnormal head shape, but both techniques expose infants to ionizing radiation. Several studies shown that ultrasound may play an important role in the diagnosis of craniosynostosis. The aim of our study is to assess the diagnostic accuracy of cranial ultrasound scan (CUS) and confirm if it is a reliable first step imaging evaluation for the diagnosis of craniosynostosis in newborn. METHOD A cohort of 196 infants (122/74 males/females), with a mean age of 4 months, clinically suspected to have abnormal closure of cranial sutures, were firstly examined by CUS and then referred to neuroradiologists to perform volumetric CT scan if the suspicion of stenosis was ecographically confirmed; otherwise, a routine follow-up and physical treatment was performed, to observe the evolution of the head shape. RESULTS Of the 196 children studied by CUS, only two had inconclusive studies due to age limitation (>12 months). Thirty children were diagnosed with cranial synostosis at CUS and verified by CT; all the CUS results were confirmed, except two cases, that were revealed as false positives in the starting phase of the study. Twelve patients with very prominent head deformity and negative CUS underwent CT, which confirmed the CUS results in all of them; one case of closure of both temporal sutures, not studied by CUS, was documented by CT. All the 148 children with poor clinical suspicion and negative CUS underwent just a prolonged clinical follow-up. In all of them, a progressive normalization of head shape was observed, and the craniosynostosis was excluded on a clinical base. CONCLUSIONS CUS is a highly specific and sensitive imaging technique. In referral centers, expert hands can use it as a reliable first-step screening for infants younger than 1 year, suspected to have a craniosynostosis, thus avoiding unnecessary exposure to ionizing radiation. The "golden age" to obtain the best CUS results is under 6 months of life. Because the method is operator-dependent and there is a learning curve, a case centralization is advisable.
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Affiliation(s)
- L Pogliani
- Department of Paediatrics, University of Milan, Luigi Sacco Hospital, Via GB Grassi 74, Milan, Italy.
| | - G V Zuccotti
- Department of Pediatrics, University of Milan, Milan Children's Hospital V. Buzzi, Milan, Italy
| | - M Furlanetto
- Department of Neurosurgery C. Besta" Neurological Institute, Milan, Italy
| | - V Giudici
- Department of Pediatrics, University of Milan, Milan Children's Hospital V. Buzzi, Milan, Italy
| | - A Erbetta
- Service of Neuroradiology: "C. Besta" Neurological Institute, Milan, Italy
| | - L Chiapparini
- Service of Neuroradiology: "C. Besta" Neurological Institute, Milan, Italy
| | - L Valentini
- Department of Neurosurgery C. Besta" Neurological Institute, Milan, Italy
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18
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Hermann CD, Hyzy SL, Olivares-Navarrete R, Walker M, Williams JK, Boyan BD, Schwartz Z. Craniosynostosis and Resynostosis: Models, Imaging, and Dental Implications. J Dent Res 2016; 95:846-52. [PMID: 27076448 DOI: 10.1177/0022034516643315] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Craniosynostosis occurs in approximately 1 in 2,000 children and results from the premature fusion of ≥1 cranial sutures. If left untreated, craniosynostosis can cause numerous complications as related to an increase in intracranial pressure or as a direct result from cranial deformities, or both. More than 100 known mutations may cause syndromic craniosynostosis, but the majority of cases are nonsyndromic, occurring as isolated defects. Most cases of craniosynostosis require complex cranial vault reconstruction that is associated with a high risk of morbidity. While the first operation typically has few complications, bone rapidly regrows in up to 40% of children who undergo it. This resynostosis typically requires additional surgical intervention, which can be associated with a high incidence of life-threatening complications. This article reviews work related to the dental and maxillofacial implications of craniosynostosis and discusses clinically relevant animal models related to craniosynostosis and resynostosis. In addition, information is provided on the imaging modalities used to study cranial defects in animals and humans.
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Affiliation(s)
- C D Hermann
- School of Medicine, Emory University, Atlanta, GA, USA
| | - S L Hyzy
- Department of Biomedical Engineering, School of Engineering, Virginia Commonwealth University, Richmond, VA, USA
| | - R Olivares-Navarrete
- Department of Biomedical Engineering, School of Engineering, Virginia Commonwealth University, Richmond, VA, USA
| | - M Walker
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Tech and Emory University, Georgia Institute of Technology, Atlanta, GA, USA
| | - J K Williams
- Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - B D Boyan
- Department of Biomedical Engineering, School of Engineering, Virginia Commonwealth University, Richmond, VA, USA Wallace H. Coulter Department of Biomedical Engineering, Georgia Tech and Emory University, Georgia Institute of Technology, Atlanta, GA, USA
| | - Z Schwartz
- Department of Biomedical Engineering, School of Engineering, Virginia Commonwealth University, Richmond, VA, USA Department of Periodontics, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
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Seeberger R, Hoffmann J, Freudlsperger C, Berger M, Bodem J, Horn D, Engel M. Intracranial volume (ICV) in isolated sagittal craniosynostosis measured by 3D photocephalometry: A new perspective on a controversial issue. J Craniomaxillofac Surg 2016; 44:626-31. [PMID: 27017102 DOI: 10.1016/j.jcms.2016.01.023] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Revised: 12/18/2015] [Accepted: 01/27/2016] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND There are still controversies regarding the intracranial volumes in patients with isolated sagittal craniosynostosis compared to a healthy population. This study aimed to compare the intracranial volume of children with sagittal synostosis and scaphocephaly to an age- and gender-matched control cohort using three-dimensional (3D) photogrammetry. METHODS 62 boys and nine girls with sagittal craniosynostosis were included in this study. The intracranial volume was measured at the first clinical presentation. However, 3D photogrammetry was performed at children not younger than 3 months. The 3D photogrammetric data of 547 healthy boys and 287 healthy girls between the ages of 3-10 month was analyzed to establish an age- and gender-matched control group. RESULTS Male patients with sagittal synostosis showed a significantly reduced intracranial volume compared to the reference group. For female patients, the intracranial volume was slightly lower compared to the norm group, but not significantly. CONCLUSIONS Male children with sagittal synostosis showed significantly decreased intracranial volume between the age of 3 and 10 months compared to an age- and gender-matched control group. Female patients in the same age group presented a lower intracranial volume compared to the norm group. Measuring intracranial volume using 3D photogrammetry is a comparable and valuable alternative to CT scans that leads to a significant reduction of radiation exposure to the growing brain.
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Affiliation(s)
- R Seeberger
- Department of Oral and Cranio-Maxillofacial Surgery, University of Heidelberg, Germany
| | - J Hoffmann
- Department of Oral and Cranio-Maxillofacial Surgery, University of Heidelberg, Germany
| | - C Freudlsperger
- Department of Oral and Cranio-Maxillofacial Surgery, University of Heidelberg, Germany
| | - M Berger
- Department of Oral and Cranio-Maxillofacial Surgery, University of Heidelberg, Germany
| | - J Bodem
- Department of Oral and Cranio-Maxillofacial Surgery, University of Heidelberg, Germany
| | - D Horn
- Department of Oral and Cranio-Maxillofacial Surgery, University of Heidelberg, Germany
| | - M Engel
- Department of Oral and Cranio-Maxillofacial Surgery, University of Heidelberg, Germany.
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Rozovsky K, Udjus K, Wilson N, Barrowman NJ, Simanovsky N, Miller E. Cranial Ultrasound as a First-Line Imaging Examination for Craniosynostosis. Pediatrics 2016; 137:e20152230. [PMID: 26772661 DOI: 10.1542/peds.2015-2230] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/16/2015] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Radiography, typically the first-line imaging study for diagnosis of craniosynostosis, exposes infants to ionizing radiation. We aimed to compare the accuracy of cranial ultrasound (CUS) with radiography for the diagnosis or exclusion of craniosynostosis. METHODS Children aged 0 to 12 months who were assessed for craniosynostosis during 2011-2013 by using 4-view skull radiography and CUS of the sagittal, coronal, lambdoid, and metopic sutures were included in this prospective study. Institutional review board approval and parental informed consent were obtained. CUS and radiography were interpreted independently and blindly by 2 pediatric radiologists; conflicts were resolved in consensus. Sutures were characterized as closed, normal, or indeterminate. Correlation between CUS and radiography and interreader agreement were examined for each suture. RESULTS A total of 126 children (82 boys, 64.5%) ages 8 to 343 days were included. All sutures were normal on CUS and radiography in 115 patients (93.7%); craniosynostosis of 1 suture was detected in 8 (6.3%, 5 sagittal, 2 metopic, 1 coronal). In 3 cases the metopic suture was closed (n = 2) or indeterminate on CUS (n = 1) but normally closed on radiography. CUS sensitivity was 100%, specificity 98% (95% confidence interval 94%-100%). Reader agreement was 100% for sagittal, coronal, and lambdoid sutures (κ = 0.80); after consensus, disagreement remained on 3 metopic sutures. CONCLUSIONS In this series, CUS could be safely used as a first-line imaging tool in the investigation of craniosynostosis, reducing the need for radiographs in young children. Additional assessment may be required for accurate assessment of the metopic suture.
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Affiliation(s)
- Katya Rozovsky
- Department of Medical Imaging, and Department of Diagnostic Imaging, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | | | | | - Nicholas James Barrowman
- Research Institute, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada; and
| | - Natalia Simanovsky
- Department of Diagnostic Imaging, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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Siegenthaler MH. Methods to Diagnose, Classify, and Monitor Infantile Deformational Plagiocephaly and Brachycephaly: A Narrative Review. J Chiropr Med 2015; 14:191-204. [PMID: 26778933 DOI: 10.1016/j.jcm.2015.05.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Revised: 05/22/2015] [Accepted: 05/24/2015] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE The purpose of this study is to review the literature for possible methods in diagnosing, classifying, and monitoring deformational plagiocephaly and brachycephaly. METHODS A search was conducted on articles through February 2014 in PubMed (Medline) and Google Scholar. Articles were included if they met the following criteria: (1) they were written in English or German; (2) they involved humans; (3) they were published in the last 10 years; (4) they had a primary research question about all possible methods for diagnosing, classifying, and monitoring deformational plagiocephaly and brachycephaly; and (5) an abstract was available. RESULTS The search resulted in 58 articles. After the review, the number was reduced to 16. Of the 16 articles included, 9 were reliability studies on measurements of deformational plagiocephaly. Six measurement tools for diagnosing, classifying, and monitoring deformational plagiocephaly and brachycephaly were found: visual assessment, anthropometric measurements with a caliper, measurements with a flexicurve, plagiocephalometry, 3-dimensional photography, and radiological imaging. CONCLUSION This study found that visual assessment, flexicurve, anthropometric measurements with a caliper, and plagiocephalometry are useful measurements. At present, the plagiocephalometry and the anthropometric measurements with a caliper are more reliable methods than the visual assessment and the measurement with a flexicurve.
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Radiological assessment of skull base changes in children with syndromic craniosynostosis: role of “minor” sutures. Neuroradiology 2014; 56:865-75. [DOI: 10.1007/s00234-014-1392-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Accepted: 06/05/2014] [Indexed: 10/25/2022]
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Mendoza CS, Safdar N, Okada K, Myers E, Rogers GF, Linguraru MG. Personalized assessment of craniosynostosis via statistical shape modeling. Med Image Anal 2014; 18:635-46. [DOI: 10.1016/j.media.2014.02.008] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2013] [Revised: 02/11/2014] [Accepted: 02/22/2014] [Indexed: 01/31/2023]
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Anderson PJ, Yong R, Surman TL, Rajion ZA, Ranjitkar S. Application of three-dimensional computed tomography in craniofacial clinical practice and research. Aust Dent J 2014; 59 Suppl 1:174-85. [DOI: 10.1111/adj.12154] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- PJ Anderson
- Australian Craniofacial Unit; Women's and Children's Hospital; North Adelaide South Australia Australia
- School of Dentistry; The University of Adelaide; South Australia Australia
- School of Dental Sciences, Health Campus; Universiti Sains Malaysia; Kota Bharu Kelantan Malaysia
| | - R Yong
- School of Dentistry; The University of Adelaide; South Australia Australia
| | - TL Surman
- Australian Craniofacial Unit; Women's and Children's Hospital; North Adelaide South Australia Australia
- School of Dentistry; The University of Adelaide; South Australia Australia
| | - ZA Rajion
- School of Dental Sciences, Health Campus; Universiti Sains Malaysia; Kota Bharu Kelantan Malaysia
| | - S Ranjitkar
- School of Dentistry; The University of Adelaide; South Australia Australia
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Saponaro G, Bernardo S, Di Curzio P, Basile E, Rastelli E, Martini S, Vinci V, Saldari M, Manganaro L, Cascone P. Cranial sutures ultrasonography as a valid diagnostic tool in isolated craniosynostoses: a pilot study. EUROPEAN JOURNAL OF PLASTIC SURGERY 2013. [DOI: 10.1007/s00238-013-0898-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Badve CA, K MM, Iyer RS, Ishak GE, Khanna PC. Craniosynostosis: imaging review and primer on computed tomography. Pediatr Radiol 2013; 43:728-42; quiz 725-7. [PMID: 23636536 DOI: 10.1007/s00247-013-2673-6] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2012] [Revised: 02/05/2013] [Accepted: 02/07/2013] [Indexed: 12/29/2022]
Abstract
Craniosynostosis is encountered in the pediatric population in isolated or syndromic forms. The resulting deformity depends on the number and type of sutures involved and, in multi-sutural synostosis, the order of suture fusion. Primary craniosynostosis needs to be differentiated from the secondary variety and positional or deformational mimics. Syndromic craniosynostoses are associated with other craniofacial deformities. Evaluation with 3-D CT plays an important role in accurate diagnosis and management; however, implementation of appropriate CT techniques is essential to limit the radiation burden in these children. In this article, the authors briefly review the classification, embryopathogenesis and epidemiology and describe in detail the radiologic appearance and differential diagnoses of craniosynostosis.
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Affiliation(s)
- Chaitra A Badve
- Department of Radiology, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, USA.
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Optimised low-dose multidetector CT protocol for children with cranial deformity. Eur Radiol 2013; 23:2279-87. [DOI: 10.1007/s00330-013-2806-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Revised: 01/11/2013] [Accepted: 01/20/2013] [Indexed: 10/27/2022]
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Alizadeh H, Najmi N, Mehdizade M, Najmi N. Diagnostic accuracy of ultrasonic examination in suspected craniosynostosis among infants. Indian Pediatr 2013. [DOI: 10.1007/s13312-013-0029-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Raised Intracranial Pressure Is Frequent in Untreated Nonsyndromic Unicoronal Synostosis and Does Not Correlate with Severity of Phenotypic Features. Plast Reconstr Surg 2012; 130:690e-697e. [DOI: 10.1097/prs.0b013e318267d5ae] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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30
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Engel M, Castrillón-Oberndorfer G, Hoffmann J, Orakcioglu B, Rohde S, Seeberger R, Freudlsperger C. Chiari malformation in nonsyndromal single craniosynostosis--much ado about nothing? Acta Neurochir (Wien) 2012; 154:1803-7. [PMID: 22790904 DOI: 10.1007/s00701-012-1439-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Accepted: 06/21/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND The significance of Chiari malformation in nonsyndromal-isolated craniosynostosis is still not well documented. Hence, in the present study we investigated the incidence of Chiari malformation in a larger series of patients with nonsyndromic-isolated single-suture craniosynostosis over a 9-year period using preoperative magnetic resonance imaging (MRI). METHODS Of 215 children who had undergone surgery for nonsyndromic-isolated craniosynostosis, 89 cases (41.4 %) had MRI prior to surgery. All MRIs were screened for Chiari malformation. RESULTS Only one patient (1.1 %) with isolated lambdoid synostosis showed Chiari malformation preoperatively, which was defined as a cerebellar tonsillar descent greater than 5 mm below the foramen magnum. However, no clinical symptoms were associated with Chiari malformation in this patient. CONCLUSIONS As Chiari malformation is more likely to be associated with syndromic craniosynostosis, nonsyndromic bilateral coronal synostosis, or synostosis of the lambdoid suture, a general use of MRI as a screening tool for Chiari malformation should not be recommended for patients with nonsyndromic-isolated craniosynostosis who lack clinical symptoms.
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Di Rocco C, Paternoster G, Caldarelli M, Massimi L, Tamburrini G. Anterior plagiocephaly: epidemiology, clinical findings,diagnosis, and classification. A review. Childs Nerv Syst 2012; 28:1413-22. [PMID: 22872257 DOI: 10.1007/s00381-012-1845-2] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2012] [Accepted: 06/14/2012] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Anterior plagiocephaly due to the early unilateral fusion of the coronal suture is associated to a clinical phenotype characterized by the unilateral flattening of the frontal bone and the orbit and by the distortion and maldevelopment of adjacent cranial and facial bones. Homolateral anterior displacement of the ear and contralateral deviation of the nasal pyramid and mandible are other prominent clinical features. The differential diagnosis includes a variety of conditions characterized by facial asymmetry, namely, due to muscular alterations, anomalies of the visual function, congenital anomalies of the cervical spine and craniovertebral junction, abnormal pregnancy, and birth injuries. Anterior plagiocephaly is the direct cause of oculomotor anomalies, with a characteristic strabismus, and of progressive asymmetrical maldevelopment of the face, craniovertebral junction, and cervical spine. METHODS The medical literature was reviewed in regard to the epidemiology, clinical features, and radiological findings. Different categorization of the affected infants in specific subtypes according to the severity of the condition was analyzed. The aim was to contribute to a practical clinical classification to be utilized for the surgical indication and for predicting the prognosis according to the severity of the condition at presentation. CONCLUSIONS Anterior plagiocephaly represents the most challenging simple suture craniosynostosis. The clinical differential diagnosis with other forms of cranial asymmetry is possible on the grounds of mere clinical findings. A classification system is necessary not only for the establishment of surgical planning but also to predict the late cosmetic and functional outcomes.
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Affiliation(s)
- Concezio Di Rocco
- Paediatric Neurosurgery, Catholic University Medical School, A. Gemelli Hospital, L.go A. Gemelli 8, 00168, Rome, Italy
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Nagaraja S, Anslow P, Winter B. Craniosynostosis. Clin Radiol 2012; 68:284-92. [PMID: 22939693 DOI: 10.1016/j.crad.2012.07.005] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2011] [Revised: 06/17/2012] [Accepted: 07/09/2012] [Indexed: 12/20/2022]
Abstract
Craniosynostosis is a complex condition, characterized by the premature fusion of one of more of the cranial sutures. They can be seen individually or as part of multisystem syndromes. This review uses computed tomography (CT) with three-dimensional reconstructions to help describe some of the types and classifications of craniosynostosis, as well as describing some of the associations and the management of craniosynostosis.
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Affiliation(s)
- S Nagaraja
- Department of Neuroradiology, John Radcliffe Hospitals, Headington, Oxford, UK
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Trigonocephaly: Results after surgical correction of nonsyndromatic isolated metopic suture synostosis in 54 cases. J Craniomaxillofac Surg 2012; 40:347-53. [DOI: 10.1016/j.jcms.2011.05.010] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2010] [Revised: 03/24/2011] [Accepted: 05/25/2011] [Indexed: 11/22/2022] Open
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Abstract
Nonsyndromic craniosynostosis is more commonly encountered than syndromic cases in pediatric craniofacial surgery. Affected children display characteristic phenotypes according to the suture or sutures involved. Restricted normal growth of the skull can lead to increased intracranial pressure and changes in brain morphology, which in turn may contribute to neurocognitive deficiency. Management has primarily focused on surgical correction of fused sutures prior to 12 months of age to optimize correction of the deformity and to ameliorate the effects of increased intracranial pressure. However, emphasis has recently shifted to better understanding the pathogenesis of neurocognitive impairment observed in these children, along with genetic mutations that contribute to premature suture fusion. Such understanding will provide opportunities for earlier and more specific neurocognitive interventions and for the development of targeted genetic therapy to prevent pathologic suture fusion. The authors review the common types of nonsyndromic craniosynostosis and the epidemiological, genetic, and neurodevelopmental details that are currently known from the literature. In addition, they present the rationale for surgical correction, offer suggestions for timing of intervention, and present some nuances of techniques that they find important in producing consistent results.
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Affiliation(s)
- Rebecca M. Garza
- Division of Plastic and Reconstructive Surgery, Stanford University, Stanford, California
| | - Rohit K. Khosla
- Division of Plastic and Reconstructive Surgery, Stanford University, Stanford, California
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Value of preoperative imaging in the diagnostics of isolated metopic suture synostosis: a risk-benefit analysis. J Plast Reconstr Aesthet Surg 2012; 65:1246-51. [PMID: 22534123 DOI: 10.1016/j.bjps.2012.03.038] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2011] [Revised: 02/07/2012] [Accepted: 03/26/2012] [Indexed: 12/28/2022]
Abstract
Radiographic evaluation including plain radiographies and computed tomographic (CT) scans are considered as a necessary tool for diagnosis of craniosynostosis. As recently concerns about harmful effects of ionising radiation in children have been raised, some authors have suggested the use of magnetic resonance imaging (MRI) as a helpful alternative in preoperative imaging of patients with isolated metopic synostosis. Besides confirming the diagnosis of trigonocephaly, MRI is the superior technique for the evaluation of underlying brain anomalies. However, if the benefit of preoperative imaging justifies possible side effects is still discussed controversially. Hence, this study investigated the value of preoperative imaging for the diagnosis of isolated synostosis of the metopic suture compared to a sole clinical examination. In a series of 63 cases with isolated metopic craniosynostosis operated at the Department of Oral and Maxillofacial Surgery, 48 (76.2%) patients received additional radiography or MRI investigation, while in 15 (23.8%) patients the diagnosis was based on clinical examinations only. In all patients, diagnosis was confirmed intra-operatively by a fused metopic suture. CT scans with three-dimensional reconstruction (12.5%) or plain radiographs (39.6%) did not provide any additional benefit for the diagnosis or the surgical treatment. In 23 patients (47.9%), MRI showed the typical soft-tissue alterations like triangular brain deformation in the frontal area. Besides these findings, no brain or other underlying anomalies were diagnosed which had required any additional treatment. The incidence of underlying brain abnormalities in isolated metopic synostosis seemed not to be different from that of the general population. As the characteristic clinical manifestations were sufficient for an accurate diagnosis of isolated metopic synostosis, and with respect to the biological effects of ionising radiation and risks of sedation especially in infants, preoperative imaging should be reduced to a minimum.
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Panigrahi I. Craniosynostosis genetics: The mystery unfolds. INDIAN JOURNAL OF HUMAN GENETICS 2011; 17:48-53. [PMID: 22090712 PMCID: PMC3214317 DOI: 10.4103/0971-6866.86171] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Craniosynsostosis syndromes exhibit considerable phenotypic and genetic heterogeneity. Sagittal synostosis is common form of isolated craniosynostosis. The sutures involved, the shape of the skull and associated malformations give a clue to the specific diagnosis. Crouzon syndrome is one of the most common of the craniosynostosis syndromes. Apert syndrome accounts for 4.5% of all craniosynostoses and is one of the most serious of these syndromes. Most syndromic craniosynostosis require multidisciplinary management. The following review provides a brief appraisal of the various genes involved in craniosynostosis syndromes, and an approach to diagnosis and genetic counseling.
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Affiliation(s)
- Inusha Panigrahi
- Department of Pediatrics, Genetic and Metabolic Unit, Advanced Pediatric Center, PGIMER, Chandigarh, India
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Ursitti F, Fadda T, Papetti L, Pagnoni M, Nicita F, Iannetti G, Spalice A. Evaluation and management of nonsyndromic craniosynostosis. Acta Paediatr 2011; 100:1185-94. [PMID: 21457300 DOI: 10.1111/j.1651-2227.2011.02299.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
UNLABELLED Craniosynostosis (craniostenosis) is premature fusion of the sutures of the cranial vault. Several factors can affect the growth of the cranial vault during embryonic life and after birth, leading to different types of craniosynostosis; these can be classified on the basis of the specific sutures that are fused. Prognosis is improved by early diagnosis, and it is important to establish the correct approach to these patients on the basis of clinical and neuroradiological investigation. The first priority is to identify the type of craniosynostosis and to distinguish between the types that require surgical intervention and those that do not. We report on the different forms of nonsyndromic craniosynostosis, their clinical and neuroradiological diagnoses, and surgical strategies. CONCLUSION The aim of this review is to provide to paediatricians a correct diagnostic approach and management of children affected from nonsyndromic craniosynostosis, for which a careful physical, ophthalmological and neurological examination is fundamental, whereas brain Computed tomography and magnetic resonance imaging are necessary for patients in which the diagnosis is uncertain or for cases of syndromic craniosynostosis.
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Affiliation(s)
- F Ursitti
- Department of Pediatrics, Child Neurology Division, University of Sapienza, Rome, Italy
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Khanna PC, Thapa MM, Iyer RS, Prasad SS. Pictorial essay: The many faces of craniosynostosis. Indian J Radiol Imaging 2011; 21:49-56. [PMID: 21431034 PMCID: PMC3056371 DOI: 10.4103/0971-3026.76055] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Craniosynostosis is a common condition in the pediatric age group, which may either be isolated or may present as part of a craniofacial syndrome. This pictorial review illustrates the underlying mechanisms and pathophysiology of craniosynostosis, the various types of craniosynostoses, common craniofacial syndromes and the role of imaging in their diagnosis and management.
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Affiliation(s)
- Paritosh C Khanna
- Department of Radiology, Seattle Children's Hospital/University of Washington School of Medicine, Seattle, Washington, USA
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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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Kirmi O, Lo SJ, Johnson D, Anslow P. Craniosynostosis: a radiological and surgical perspective. Semin Ultrasound CT MR 2010; 30:492-512. [PMID: 20099636 DOI: 10.1053/j.sult.2009.08.002] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Craniosynostosis is the premature fusion of the cranial sutures. It is identified early in life either due to cosmetic deformity or due to more serious functional complications. Isolated forms of craniosynostosis are much more common and less challenging in their management than their syndromic counterpart. Modern multislice computed tomography and 3D reconstructions have revolutionized surgical planning and follow-up. We review the radiological features of the craniosynostoses, complications, and associated conditions that may alter patient management. Common surgical techniques and postoperative appearances are illustrated in the article.
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Affiliation(s)
- Olga Kirmi
- Department of Radiology, John Radcliffe Hospital, Oxford, United Kingdom.
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Davutoglu M, Okur N, Karabiber H, Guler E, Garipardic M, Bodovoglu T. Craniosynostosis Associated with Lacunar
Skull: Three-Dimensional Computed
Tomography Features. ELECTRONIC JOURNAL OF GENERAL MEDICINE 2010. [DOI: 10.29333/ejgm/82829] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Effectiveness of ultrasonographic evaluation of the cranial sutures in children with suspected craniosynostosis. Eur Radiol 2008; 19:687-92. [DOI: 10.1007/s00330-008-1193-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2008] [Revised: 08/23/2008] [Accepted: 09/15/2008] [Indexed: 10/21/2022]
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