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Pogliani LM, Zuccotti GV, Reggiori M, Erbetta A, Lacerenza M, Prada F, Furlanetto M, Vetrano IG, Valentini LG. Surface Cranial Ultrasound: The Natural Heir to X-Ray for the Screening of Skull Deformities in Infants. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2023; 44:503-511. [PMID: 35760078 DOI: 10.1055/a-1820-8101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE Volumetric tomography (3D-CT) is currently considered the gold standard for the diagnosis of craniosynostosis, but its use as the first-line examination for cranial deformities is a topic of debate, because of skull X-ray radiation and low sensitivity and specificity. Cranial ultrasound is an emerging noninvasive radiation-free alternative, but its diagnostic accuracy still needs confirmation. MATERIALS AND METHODS The present prospective study included 350 infants with skull deformities, who underwent cranial ultrasound as the first-line examination, followed by 3D-CT if the echography results was positive or unclear. If the results were negative, infants underwent physical treatment and follow-up. To evaluate ultrasound reliability, we focused on cases that underwent both the index test and the gold standard and performed a double-blind comparison of the echography and 3D-CT results. RESULTS Ultrasound documented patent sutures in 293 infants and 9 had inconclusive results. The 293 ultrasound-negative infants were followed clinically: all improved, except 28 that underwent 3D-CT. In all of these cases, 3D-CT confirmed the ultrasonography results (no false negatives). 48 infants showed premature suture closure and underwent 3D-CT: 47 were confirmed (true positive), 1 was false positive. The sensitivity was 100%, the specificity was 99.7%, the positive and negative predictive values were 97.9% and 100%, respectively, the accuracy was 99.7%, and the diagnostic test evaluation was conclusive. CONCLUSION The study documented the high sensitivity and specificity of echography for the diagnosis of craniosynostosis in a referral center, with better results being achieved before 6 months of age. Major limitations are the loss of diagnostic significance as the child grows and the learning curve needed. The advantages are avoidance of radiation and chance to evaluate the brain at the same time.
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Affiliation(s)
| | - Gian Vincenzo Zuccotti
- Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, Milan, Italy
- Pediatrics, Ospedale Luigi Sacco-Polo Universitario, Milan, Italy
| | | | - Alessandra Erbetta
- Neuroradiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | | | - Francesco Prada
- Neurosurgical Department, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
- Neurological Surgery, University of Virginia School of Medicine, Charlottesville, United States
| | - Marika Furlanetto
- Neurosurgical Department, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | | | - Laura Grazia Valentini
- Neurosurgical Department, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
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2
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Saracoglu A, Zengin SU, Ozturk N, Niftaliyev S, Harman F, Aykac Z. The outcomes of using high oxygen concentration in pediatric patients. J Clin Monit Comput 2021; 36:1341-1346. [PMID: 34705168 DOI: 10.1007/s10877-021-00765-2] [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: 08/07/2021] [Accepted: 10/05/2021] [Indexed: 11/24/2022]
Abstract
Oxygen reserve index, available as part of Masimo Rainbow SET pulse oximetry, is a noninvasive and continuous variable intended to provide insight into a patient's oxygen status in the moderate hyperoxic range (PaO2 > 100 and ≤ 200 mm Hg), defined as a patient's oxygen "reserve". When used in conjunction with pulse oximetry, ORi extends the knowledge on a patient's oxygen status providing clinically important information helping to prevent hyperoxemia and hypoxemia. There are limited data on patients undergoing craniosynostosis surgery. Our primary goal was to evaluate the effects of different concentrations of inspiratory oxygen (FiO2) on patient oxygenation status by monitoring ORi. Thirty patients scheduled for craniosynostosis were included in this observational cohort study. Patients were randomized into two equal groups: Group 1 received a fraction of inspired oxygen of 0.8 and group 2 received a FiO2 of 0.6 during induction of anaesthesia. In addition to standard haemodynamic variables with ORi were recorded at baseline 1 min, 5 min, 60 min, and 120 min after intubation. Postoperative complications, length of stay in the intensive care unit and hospital were recorded. In total, 14 patients were evaluated in each group. Gender, age, BMI, ASA scores were similar between groups (p > 0.05). In Group 1, ORi values were significantly higher when compared to group 2 at baseline (0.86 ± 0.21 vs 0.45 ± 0.32, p = 0.001), one minute (0.61 ± 0.24 vs 0.27 ± 0.21, p = 0.001), and 5 min (0.34 ± 0.31 vs 0.10 ± 0.13, p = 0.033). High inspired oxygen concentration during induction of anesthesia in pediatric patients is associated with higher levels of ORi. Therefore, ORi may provide the means to safely reduce the inspired oxygen fraction during inhalational induction in paediatric patients.
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Affiliation(s)
- Ayten Saracoglu
- Department of Anesthesiology and Intensive Care, Marmara University Pendik Training and Research Hospital, Fevzi Cakmak Mh. Muhsin Yazicioglu Cd., Pendik/Istanbul, Turkey.
| | - Seniyye Ulgen Zengin
- Department of Anesthesiology and Intensive Care, Marmara University Pendik Training and Research Hospital, Fevzi Cakmak Mh. Muhsin Yazicioglu Cd., Pendik/Istanbul, Turkey
| | - Nilufer Ozturk
- Department of Pediatry, Marmara University Pendik Training and Research Hospital, Istanbul, Turkey
| | - Seymur Niftaliyev
- Department of Neurosurgery, Marmara University Pendik Training and Research Hospital, Istanbul, Turkey
| | - Ferhat Harman
- Department of Neurosurgery, Marmara University Pendik Training and Research Hospital, Istanbul, Turkey
| | - Zuhal Aykac
- Department of Anesthesiology and Intensive Care, Marmara University Pendik Training and Research Hospital, Fevzi Cakmak Mh. Muhsin Yazicioglu Cd., Pendik/Istanbul, Turkey
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3
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Bozkurt S, Borghi A, van de Lande LS, Jeelani NUO, Dunaway DJ, Schievano S. Computational modelling of patient specific spring assisted lambdoid craniosynostosis correction. Sci Rep 2020; 10:18693. [PMID: 33122820 PMCID: PMC7596227 DOI: 10.1038/s41598-020-75747-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 10/19/2020] [Indexed: 11/25/2022] Open
Abstract
Lambdoid craniosynostosis (LC) is a rare non-syndromic craniosynostosis characterised by fusion of the lambdoid sutures at the back of the head. Surgical correction including the spring assisted cranioplasty is the only option to correct the asymmetry at the skull in LC. However, the aesthetic outcome from spring assisted cranioplasty may remain suboptimal. The aim of this study is to develop a parametric finite element (FE) model of the LC skulls that could be used in the future to optimise spring surgery. The skull geometries from three different LC patients who underwent spring correction were reconstructed from the pre-operative computed tomography (CT) in Simpleware ScanIP. Initially, the skull growth between the pre-operative CT imaging and surgical intervention was simulated using MSC Marc. The osteotomies and spring implantation were performed to simulate the skull expansion due to the spring forces and skull growth between surgery and post-operative CT imaging in MSC Marc. Surface deviation between the FE models and post-operative skull models reconstructed from CT images changed between ± 5 mm over the skull geometries. Replicating spring assisted cranioplasty in LC patients allow to tune the parameters for surgical planning, which may help to improve outcomes in LC surgeries in the future.
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Affiliation(s)
- Selim Bozkurt
- Institute of Cardiovascular Science, University College London, London, UK. .,University College London, Great Ormond Street Institute of Child Health, London, UK.
| | - Alessandro Borghi
- University College London, Great Ormond Street Institute of Child Health, London, UK.,Craniofacial Unit, Great Ormond Street Hospital for Children, London, UK
| | - Lara S van de Lande
- University College London, Great Ormond Street Institute of Child Health, London, UK.,Craniofacial Unit, Great Ormond Street Hospital for Children, London, UK
| | - N U Owase Jeelani
- University College London, Great Ormond Street Institute of Child Health, London, UK.,Craniofacial Unit, Great Ormond Street Hospital for Children, London, UK
| | - David J Dunaway
- University College London, Great Ormond Street Institute of Child Health, London, UK.,Craniofacial Unit, Great Ormond Street Hospital for Children, London, UK
| | - Silvia Schievano
- University College London, Great Ormond Street Institute of Child Health, London, UK.,Craniofacial Unit, Great Ormond Street Hospital for Children, London, UK
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Evaluation of the underlying causes of papilledema in children. Can J Ophthalmol 2019; 54:653-658. [PMID: 31836094 DOI: 10.1016/j.jcjo.2019.02.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 01/26/2019] [Accepted: 02/18/2019] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The purpose of this retrospective study was to identify the types and relative frequencies of intracranial disorders in pediatric patients who present with papilledema. DESIGN Retrospective case series. PARTICIPANTS AND METHODS This study was conducted in 2 pediatric ophthalmology clinics, both providing community-based care in a large inner-city urban center in the U.S. Pediatric patients aged between 0 and 16 years diagnosed with papilledema and who had an underlying etiology identified were included in the study. Patient demographic data, ophthalmologic examination findings, and diagnostic work-up results were identified from clinical records. RESULTS The mean age of 38 study patients (19 female, 19 male) was 8.6 ± 4.8 years. Of the 38 patients, 16 (42.1%) had idiopathic intracranial hypertension (IIH) as the underlying cause of the papilledema, 7 (18.4%) had a craniosynostosis disorder, 6 (15.8%) had intracranial tumours, 2 (5.3%) had primary hydrocephalus, and 1 (2.6%) patient each had transverse sinus thrombosis related to sinusitis, hypertensive crisis, subdural hematoma, intracranial abscess, Lyme disease, presumed neurosarcoidosis, and acute disseminated encephalomyelitis. Of the 6 intracranial tumours, 2 (33.3%) presented in the sellar/parasellar region, 2 (33.3%) in the posterior fossa, and 2 (33.3%) were in cortical locations. CONCLUSION Clinicians should have a high index of suspicion for IIH and brain tumours in children presenting with papilledema. Patients with craniosynostosis should have routine eye examinations to monitor for asymptomatic papilledema. Understanding the relative incidence of etiologies for papilledema highlights the urgency of appropriate work-up and the need to consider low-frequency etiologies.
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Andersen JB, Moberg JY, Spelman T, Magyari M. Pregnancy Outcomes in Men and Women Treated With Teriflunomide. A Population-Based Nationwide Danish Register Study. Front Immunol 2018; 9:2706. [PMID: 30532753 PMCID: PMC6266987 DOI: 10.3389/fimmu.2018.02706] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 11/01/2018] [Indexed: 11/13/2022] Open
Abstract
Background: The majority of persons diagnosed with multiple sclerosis (MS) experience their first MS symptoms in the reproductive age. Teriflunomide (TFL, Aubagio), was first released in Denmark for relapsing-remitting MS in December 2013. TFL treatment is contraindicated in women of childbearing potential who are not using reliable contraception. TFL can be transmitted via semen and a low risk of male-mediated embryo-fetal toxicity is described. Objective: To report pregnancy outcomes of TFL-treated women and partners to TFL-treated men: gestation week. Methods: Prospective cohort study comparing pregnancy outcomes of TFL-treated men and women, matched on age at conception, 1:4 with controls from the general population. Data on TFL-treated patients treated 1st of January 2014-31st of December 2016 for at least 30 consecutive days prior to conception, and with conception occurring latest 2 years after treatment discontinuation were extracted from The Danish Multiple Sclerosis Registry and merged with several national reproductive registries. Logistic regression was used to analyse the association between TFL exposure and any adverse event. Results: A total of 31 pregnancies were recorded, 13 women and 18 of partners to a TFL-treated man. All 18 partners of TFL-treated men completed their pregnancies: livebirth (18), gestation time >37 weeks (17), gestation time 33-36 weeks (1), normal birth weight (18), spontaneous and elective abortion (0), congenital malformation (plagiocephali) (1), normal delivery (14), induced delivery (2), cesarean section (2), Apgar score ≥7 (18). Among the 13 pregnancies in women exposed to TFL: elective abortion (11), spontaneous abortion (0), livebirth (2), gestation time >37 weeks (2), normal birth weight (2), congenital malformations (0), normal delivery (1), induced delivery (1), Apgar score ≥7 (2). The TFL group was associated with a 22% reduction in the odds of any adverse event relative to controls, although this association was not significant (OR 0.78; 95% CI 0.16-3.72, p = 0.753). Conclusion: Pregnancy outcomes were consistent with those of the general population. The malformation reported of the partner to a TFL-treated man is comparable to the rate of plagiocephaly reported in Denmark.
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Affiliation(s)
- Johanna Balslev Andersen
- Danish Multiple Sclerosis Registry, Department of Neurology, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Julie Yoon Moberg
- Danish Multiple Sclerosis Registry, Department of Neurology, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Tim Spelman
- Danish Multiple Sclerosis Registry, Department of Neurology, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Melinda Magyari
- Danish Multiple Sclerosis Registry, Department of Neurology, Copenhagen University Hospital, Rigshospitalet, Denmark
- Department of Neurology, Danish Multiple Sclerosis Center, Copenhagen University Hospital, Rigshospitalet, Denmark
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Tu L, Porras AR, Oh A, Lepore N, Mastromanolis M, Tsering D, Paniagua B, Enquobahrie A, Keating R, Rogers GF, Linguraru MG. Radiation-free quantification of head malformations in craniosynostosis patients from 3D photography. PROCEEDINGS OF SPIE--THE INTERNATIONAL SOCIETY FOR OPTICAL ENGINEERING 2018; 10575:105751U. [PMID: 31379400 PMCID: PMC6679651 DOI: 10.1117/12.2295374] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
The evaluation of cranial malformations plays an essential role both in the early diagnosis and in the decision to perform surgical treatment for craniosynostosis. In clinical practice, both cranial shape and suture fusion are evaluated using CT images, which involve the use of harmful radiation on children. Three-dimensional (3D) photography offers non-invasive, radiation-free, and anesthetic-free evaluation of craniofacial morphology. The aim of this study is to develop an automated framework to objectively quantify cranial malformations in patients with craniosynostosis from 3D photography. We propose a new method that automatically extracts the cranial shape by identifying a set of landmarks from a 3D photograph. Specifically, it registers the 3D photograph of a patient to a reference template in which the position of the landmarks is known. Then, the method finds the closest cranial shape to that of the patient from a normative statistical shape multi-atlas built from 3D photographs of healthy cases, and uses it to quantify objectively cranial malformations. We calculated the cranial malformations on 17 craniosynostosis patients and we compared them with the malformations of the normative population used to build the multi-atlas. The average malformations of the craniosynostosis cases were 2.68 ± 0.75 mm, which is significantly higher (p<0.001) than the average malformations of 1.70 ± 0.41 mm obtained from the normative cases. Our approach can support the quantitative assessment of surgical procedures for cranial vault reconstruction without exposing pediatric patients to harmful radiation.
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Affiliation(s)
- Liyun Tu
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children’s National Health System, Washington DC, USA
| | - Antonio R. Porras
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children’s National Health System, Washington DC, USA
| | - Albert Oh
- Division of Plastic and Reconstructive Surgery, Children’s National Health System, Washington DC, USA
| | - Natasha Lepore
- CIBORG Lab, Children’s Hospital Los Angeles and University of Southern California, Los Angeles, CA, USA
| | - Manuel Mastromanolis
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children’s National Health System, Washington DC, USA
| | - Deki Tsering
- Division of Neurosurgery, Children’s National Health System, Washington DC, USA
| | | | | | - Robert Keating
- Division of Neurosurgery, Children’s National Health System, Washington DC, USA
| | - Gary F. Rogers
- Division of Plastic and Reconstructive Surgery, Children’s National Health System, Washington DC, USA
| | - Marius George Linguraru
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children’s National Health System, Washington DC, USA
- Departments of Radiology and Pediatrics, School of Medicine and Health Sciences, George Washington University, Washington DC, USA
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