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Licci M, Paasche A, Szathmari A, Beuriat PA, Mottolese C, Guzman R, Di Rocco F. Predictive Value of Sonographic Parameters on the Effects of Cranial Molding Helmet Therapy in Infants with Positional Plagiocephaly. Diagnostics (Basel) 2024; 14:1407. [PMID: 39001297 PMCID: PMC11240944 DOI: 10.3390/diagnostics14131407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Revised: 06/02/2024] [Accepted: 06/17/2024] [Indexed: 07/16/2024] Open
Abstract
Positional plagiocephaly is a deformational cranial flattening frequently treated in pediatric neurosurgical practice. Positional maneuvers and orthotic helmet therapy are preferred therapeutic options for moderate-to-severe forms. Treatment response seems to be age-dependent. Nevertheless, predictive data are vague, and cost-efficiency might be a limiting factor for treatment. The purpose of this study was to investigate the early predictive value of sonographic parameters on the efficacy of orthotic helmet therapy through the assessment of changes in skull shape and correlation of the parameters with caliper cephalometry values and with age. A consecutive cohort of 49 patients < 10 months of age, undergoing orthotic helmet therapy for positional plagiocephaly, was recruited prospectively. The authors routinely assessed the patency of the lambdoid sutures by ultrasound and the following additional skull parameters were measured: suture width, adjacent full bone thickness, adjacent cortical bone thickness and occipital angle. Caliper cephalometric values, as well as demographic and clinical data were collected. Retrospective data analysis showed an inverse relation between both cortical and full skull bone thickness and early treatment efficacy, defined by a reduction in the occipital angle. The improvement of sonographic parameters correlated with the development of cranial caliper cephalometry values. In conclusion, the sonographic assessment of skull bone thickness is a safe and cost-effective tool to predict the early efficacy of orthotic helmet therapy in positional plagiocephaly and might, therefore, help the clinician to foresee the potential evolution of the deformity.
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Affiliation(s)
- Maria Licci
- Department of Pediatric Neurosurgery, French Referral Center for Craniosynostosis, Hôpital Femme Mère-Enfant, Hospices Civils de Lyon University of Lyon, INSERM 1033, 69500 Bron, Lyon, France
- Department of Neurosurgery, Division of Pediatric Neurosurgery, University Hospital and University Children's Hospital of Basel, 4031 Basel, Switzerland
| | - Agnes Paasche
- Department of Pediatric Neurosurgery, French Referral Center for Craniosynostosis, Hôpital Femme Mère-Enfant, Hospices Civils de Lyon University of Lyon, INSERM 1033, 69500 Bron, Lyon, France
| | - Alexandru Szathmari
- Department of Pediatric Neurosurgery, French Referral Center for Craniosynostosis, Hôpital Femme Mère-Enfant, Hospices Civils de Lyon University of Lyon, INSERM 1033, 69500 Bron, Lyon, France
| | - Pierre-Aurélien Beuriat
- Department of Pediatric Neurosurgery, French Referral Center for Craniosynostosis, Hôpital Femme Mère-Enfant, Hospices Civils de Lyon University of Lyon, INSERM 1033, 69500 Bron, Lyon, France
| | - Carmine Mottolese
- Department of Pediatric Neurosurgery, French Referral Center for Craniosynostosis, Hôpital Femme Mère-Enfant, Hospices Civils de Lyon University of Lyon, INSERM 1033, 69500 Bron, Lyon, France
| | - Raphael Guzman
- Department of Neurosurgery, Division of Pediatric Neurosurgery, University Hospital and University Children's Hospital of Basel, 4031 Basel, Switzerland
| | - Federico Di Rocco
- Department of Pediatric Neurosurgery, French Referral Center for Craniosynostosis, Hôpital Femme Mère-Enfant, Hospices Civils de Lyon University of Lyon, INSERM 1033, 69500 Bron, Lyon, France
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Nakamura N, Harada A, Maeno K, Kyutoku S, Ueda K. A Case of Bilateral Lambdoid and Sagittal Synostosis Diagnosed with Skull Fracture after Vacuum-assisted Delivery: A Case Report and Literature Review. NMC Case Rep J 2024; 11:157-161. [PMID: 38974117 PMCID: PMC11224651 DOI: 10.2176/jns-nmc.2023-0279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 03/21/2024] [Indexed: 07/09/2024] Open
Abstract
Craniosynostosis (CS) can develop in the fetal period, but it is difficult to diagnose prenatally. In this case, a 3-month-old female baby developed extensive subgaleal hematoma and severe anemia after vacuum-assisted delivery. Her computed tomography showed bilateral lambdoid and sagittal synostosis (BLSS) with a depressed fracture of the right parietal bone. She was referred to our hospital for treatment of the CS. At 4 months of age, she underwent bilateral lambda and sagittal suturectomy and foramen magnum decompression. CS may result in trauma at delivery, because CS disturbs fetal head molding during delivery and disrupts passage through the birth canal. In particular, the risk of severe peripartum trauma is thought to increase in cases of CS with multiple suture fusions, such as those observed in BLSS, due to the strong inhibition of this process of passage through the birth canal. Therefore, if the delivery is abnormally prolonged or if the infant has a massive subgaleal hematoma, it is important to perform evaluations for CS after birth.
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Affiliation(s)
- Natsuki Nakamura
- Department of Pediatric Neurosurgery, Takatsuki General Hospital, Takatsuki, Osaka, Japan
| | - Atsuko Harada
- Department of Pediatric Neurosurgery, Takatsuki General Hospital, Takatsuki, Osaka, Japan
| | - Kazushige Maeno
- Department of Neurosurgery, Takatsuki General Hospital, Takatsuki, Osaka, Japan
| | - Shigeo Kyutoku
- Division of Reconstructive Plastic Surgery, Nara City Hospital, Nara, Nara, Japan
| | - Koichi Ueda
- Department of Plastic and Reconstructive Surgery, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka, Japan
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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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Satanin LA, Dzhandzhgava NN, Evteev AA, Chernikova NA, Sakharov AV, Ivanov AL, Tere VA, Roginsky VV. [Difficulties in differential diagnosis of sagittal synostosis (scaphocephaly)]. ZHURNAL VOPROSY NEIROKHIRURGII IMENI N. N. BURDENKO 2023; 87:74-82. [PMID: 37650279 DOI: 10.17116/neiro20238704174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
Craniosynostosis is characterized by congenital absence or premature closure of skull sutures. The most common form of craniosynostosis is synostosis of sagittal suture followed by scaphocephaly. There are some head deformities similar to scaphocephaly such as positional and constitutional dolichocephaly, etc. These patients have no sagittal suture synostosis. However, there are difficulties in differential diagnosis between these deformities and scaphocephaly. OBJECTIVE To develop differential diagnostic criteria between dolichocephalic head deformities and true scaphocephaly following sagittal synostosis. MATERIAL AND METHODS The study included 33 patients with dolichocephaly (25 (75.8%) boys and 8 (24.2%) girls) between December 2013 and August 2022. The inclusion criterion was available CT or ultrasound data confirming or excluding sagittal synostosis. Age of patients was 8.62±7.71 (1.77-36) months. We analyzed anamnestic, clinical and radiological data. Radiological data was compared with diagnostic findings in 20 patients with scaphocephaly. Both groups were comparable in age, gender and cranial index. RESULTS We present clinical and radiological signs, as well as algorithm for differential diagnosis between scaphocephaly and dolichocephaly. CONCLUSION There are objective difficulties in differential diagnosis between scaphocephaly following sagittal synostosis and dolichocephalic head deformities. In most cases, we cannot establish the cause of congenital forms of dolichocephaly. The most likely causes may be pre- and postnatal compressive and positional effects. Ultrasound of skull sutures is preferable for differential diagnosis between these abnormalities. Correction of dolichocephaly can be carried out according to aesthetic indications with individual cranial orthoses.
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Affiliation(s)
- L A Satanin
- Burdenko Neurosurgical Center, Moscow, Russia
| | - N N Dzhandzhgava
- Kulakov Research Center for Obstetrics, Gynecology and Perinatology, Moscow, Russia
| | - A A Evteev
- Lomonosov Moscow State University, Research Institute and Museum of Anthropology, Moscow, Russia
| | | | | | - A L Ivanov
- Central Research Institute of Dentistry and Maxillofacial Surgery, Moscow, Russia
| | - V A Tere
- Burdenko Neurosurgical Center, Moscow, Russia
| | - V V Roginsky
- Central Research Institute of Dentistry and Maxillofacial Surgery, Moscow, Russia
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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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Acuña J, Adhikari S. Point-of-care Ultrasound to Distinguish Subgaleal and Cephalohematoma: Case Report. Clin Pract Cases Emerg Med 2021; 5:198-201. [PMID: 34437004 PMCID: PMC8143819 DOI: 10.5811/cpcem.2021.3.51375] [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] [Received: 12/29/2020] [Accepted: 03/05/2021] [Indexed: 11/24/2022] Open
Abstract
Introduction Cephalohematomas generally do not pose a significant risk to the patient and resolve spontaneously. Conversely, a subgaleal hematoma is a rare but more serious condition. While it may be challenging to make this diagnostic distinction based on a physical examination alone, the findings that differentiate these two conditions can be appreciated on point-of-care ultrasound (POCUS). We describe two pediatric patient cases where POCUS was used to distinguish between a subgaleal hematoma and a cephalohematoma. Case Reports We describe one case of a 14-month-old male brought to the pediatric emergency department (PED) with concern for head injury. A POCUS examination revealed a large fluid collection that did not cross the sagittal suture. Thus, the hematoma was more consistent with a cephalohematoma and less compatible with a subgaleal hematoma. Given these findings, further emergent imaging was deferred in the PED and the patient was kept for observation. In the second case an 8-week-old male presented with suspected swelling over the right parietal region. A POCUS examination was performed, which demonstrated an extensive, simple fluid collection that extended across the suture line, making it more concerning for a subgaleal hematoma. Given the heightened suspicion for a subgaleal hematoma, the patient was admitted for further imaging and evaluation. Conclusion Point-of-care ultrasound can be used to help differentiate between a subgaleal hematoma and a cephalohematoma to risk-stratify patients and determine the need for further imaging.
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Affiliation(s)
- Josie Acuña
- University of Arizona, Department of Emergency Medicine, Tucson, Arizona
| | - Srikar Adhikari
- University of Arizona, Department of Emergency Medicine, Tucson, Arizona
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Garcia-Ballestas E, Martinez-Perez R, Agrawal A, Moscote-Salazar LR. Re: Severe skull deformity in a child with shunted hydrocephalus. Br J Neurosurg 2020; 35:799. [PMID: 32397823 DOI: 10.1080/02688697.2020.1764496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
| | - Rafael Martinez-Perez
- Department of Neurosurgery, Wexner Medical Center, The Ohio State university, Columbus, OH, USA
| | - Amit Agrawal
- All India Institute of Medical Sciences. Saket Nagar. Bhopal 462020. Madhya Pradesh (India)
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