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Stanton EW, Manasyan A, Roohani I, Kondra K, Magee WP, Hammoudeh JA, Urata MM. A National Analysis of Craniosynostosis Demographic and Surgical Trends Over a 10-Year Period. J Craniofac Surg 2024:00001665-990000000-01732. [PMID: 38940557 DOI: 10.1097/scs.0000000000010434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 05/29/2024] [Indexed: 06/29/2024] Open
Abstract
The pathogenesis of craniosynostosis, characterized by the premature fusion of calvarial sutures, is multifaceted and often the result of an amalgamation of contributing factors. The current study seeks examine the possible contributors to craniosynostosis development and its surgical trends over time. A multicenter/national retrospective cohort study was conducted of patients who underwent surgical repair of craniosynostosis (n=11,279) between 2012 and 2021 identified in the American College of Surgeons National Surgical Quality Improvement Program Pediatric Data File. Main outcome measures included risk factors and trends relating to surgical repair of craniosynostosis. Nationwide reports of craniosynostosis in the NSQIP-P database have increased between 2012 and 2021 by 195%. The prevalence of craniosynostosis per overall cases has remained between 1.0% and 1.3%. There were predominantly more White male patients in the craniosynostosis cohort (P<0.001). Craniosynostosis patients had significantly greater birth weights, gestational ages, and were less likely to be premature (P<0.05). Linear regression demonstrated that operative time, anesthesia time, and length of stay significantly decreased over the study period (P<0.001). This national data analysis highlights trends in craniosynostosis repair indicating potential improvements in safety and patient outcomes over time. While these findings offer insights for health care professionals, caution is warranted in extrapolating beyond the data's scope. Future research should focus on diverse patient populations, compare outcomes across institutions, and employ prospective study designs to enhance the evidence base for craniosynostosis management. These efforts will help refine diagnostic and treatment strategies, potentially leading to better outcomes for patients.
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Affiliation(s)
- Eloise W Stanton
- Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine
| | - Artur Manasyan
- Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine
| | - Idean Roohani
- Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine
| | - Katelyn Kondra
- Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine
| | - William P Magee
- Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine
- Division of Oral and Maxillofacial Surgery, University of Southern California
- Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA
| | - Jeffrey A Hammoudeh
- Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine
- Division of Oral and Maxillofacial Surgery, University of Southern California
- Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA
| | - Mark M Urata
- Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine
- Division of Oral and Maxillofacial Surgery, University of Southern California
- Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA
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Abdali H, Anaraki AG, Mahdipour S. Craniosynostosis in Isfahan, Iran: A Cross-Sectional Study. J Maxillofac Oral Surg 2023; 22:879-885. [PMID: 38105844 PMCID: PMC10719191 DOI: 10.1007/s12663-022-01794-3] [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: 05/21/2021] [Accepted: 09/13/2022] [Indexed: 10/24/2022] Open
Abstract
Background Craniosynostosis is the premature closure of cranial sutures. According to the literature, several factors are related to this disorder. Due to the relatively high prevalence in Iran and a lack of related studies in this region, this study was designed to determine the characteristics of a group of these patients in this region. Methods This cross-sectional study was performed from 2016 to 2019 at two tertiary referral hospitals for children in Isfahan, Iran. Studied variables included: age, sex, birth weight, type of craniosynostosis, concurrent anomalies, parents' age, father's job, fetus position, maternal parity, history of maternal smoking during the pregnancy, use of fertility assistant treatments, and history of maternal endocrine disorders. Results We had 125 infants, including 82 (65.6%) males and 43 (34.4%) females. The most common type was metopic (29%). The most common concurrent disorder was congenital heart defects (43.2% of patients). The mean age of infants was 0.62SD0.59 years. Gender distribution showed a significant difference (p value = 0.006). While the metopic (n = 31) type was significantly more common in boys, the coronal type was female predominant (n = 14). The mean age of fathers was 33.08SD5.66 and mothers, was 29.02SD5.70 with no significant difference (p value = 0.669 and 0.149, respectively). Other evaluated factors also didn't show a significant difference. Conclusion Craniosynostosis is more prevalent in boys, especially the metopic type. Coronal type has a female predilection. The most common subtype is metopic. The most common concurrent congenital disorder is congenital heart defects.
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Affiliation(s)
- Hossein Abdali
- Department of Surgery, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
- Craniofacial and Cleft Research Center, Al-Zahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Amin Ghanei Anaraki
- Department of Surgery, School of Medicine, Al-Zahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Samiye Mahdipour
- Scool of medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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Durham EL, Grey ZJ, Black L, Howie RN, Barth JL, Lee BS, Cray JJ. Sfrp4 expression in thyroxine treated calvarial cells. Life Sci 2022; 311:121158. [PMID: 36370870 PMCID: PMC9719041 DOI: 10.1016/j.lfs.2022.121158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 10/24/2022] [Accepted: 11/04/2022] [Indexed: 11/11/2022]
Abstract
AIMS Evidence suggests alterations of thyroid hormone levels can disrupt normal bone development. Most data suggest the major targets of thyroid hormones to be the Htra1/Igf1 pathway. Recent discovery by our group suggests involvement of targets WNT pathway, specifically overexpression of antagonist Sfrp4 in the presence of exogenous thyroid hormone. MAIN METHODS Here we aimed to model these interactions in vitro using primary and isotype cell lines to determine if thyroid hormone drives increased Sfrp4 expression in cells relevant to craniofacial development. Transcriptional profiling, bioinformatics interrogation, protein and function analyses were used. KEY FINDINGS Affymetrix transcriptional profiling found Sfrp4 overexpression in primary cranial suture derived cells stimulated with thyroxine in vitro. Interrogation of the SFRP4 promoter identified multiple putative binding sites for thyroid hormone receptors. Experimentation with several cell lines demonstrated that thyroxine treatment induced Sfrp4 expression, demonstrating that Sfrp4 mRNA and protein levels are not tightly coupled. Transcriptional and protein analyses demonstrate thyroid hormone receptor binding to the proximal promoter of the target gene Sfrp4 in murine calvarial pre-osteoblasts. Functional analysis after thyroxine hormone stimulation for alkaline phosphatase activity shows that pre-osteoblasts increase alkaline phosphatase activity compared to other cell types, suggesting cell type susceptibility. Finally, we added recombinant SFRP4 to pre-osteoblasts in combination with thyroxine treatment and observed a significant decrease in alkaline phosphatase positivity. SIGNIFICANCE Taken together, these results suggest SFRP4 may be a key regulatory molecule that prevents thyroxine driven osteogenesis. These data corroborate clinical findings indicating a potential for SFRP4 as a diagnostic or therapeutic target for hyperostotic craniofacial disorders.
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Affiliation(s)
- Emily L Durham
- Department of Oral Health Sciences, Medical University of South Carolina, Charleston, SC, USA; Department of Pediatrics, Division of Human Genetics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Zachary J Grey
- Department of Oral Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Laurel Black
- Department of Oral Health Sciences, Medical University of South Carolina, Charleston, SC, USA; Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - R Nicole Howie
- Department of Oral Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Jeremy L Barth
- Department of Regenerative Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Beth S Lee
- Department of Physiology and Cell Biology, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - James J Cray
- Department of Biomedical Education and Anatomy, College of Medicine, The Ohio State University, Columbus, OH, USA; Division of Biosciences, College of Dentistry, The Ohio State University, Columbus, OH, USA.
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Shlobin NA, Baticulon RE, Ortega CA, Du L, Bonfield CM, Wray A, Forrest CR, Dewan MC. Global Epidemiology of Craniosynostosis: A Systematic Review and Meta-Analysis. World Neurosurg 2022; 164:413-423.e3. [PMID: 35636659 DOI: 10.1016/j.wneu.2022.05.093] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 05/19/2022] [Accepted: 05/20/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Craniosynostosis leads to craniofacial deformity and may result in raised intracranial pressure, neurocognitive deficits, and psychosocial issues if left untreated. The global epidemiology of craniosynostosis is unknown. We conducted a meta-analysis to estimate global birth prevalence. METHODS PubMed, Embase, and Scopus were searched. Articles were screened by title and abstract and then full text. Meta-analysis of birth prevalence was conducted. Birth prevalence figures were combined with metrics detailing the number of births in 2019 to estimate the number of children worldwide born with craniosynostosis annually. RESULTS Of 1378 resultant articles, 24 studies were included, including 20 providing data for craniosynostosis overall and 9 for nonsyndromic craniosynostosis. World Health Organization regions of included studies were 9 (37.5%) European Region, 8 (33.3%) Region of the Americas, 4 (16.7%) Western Pacific region, 2 (8.3%) African Region, and 1 (4.2%) Eastern Mediterranean Region. Lower middle-income countries represented only 4% of study manuscripts. The overall birth prevalence of craniosynostosis was 5.9 per 10,000 live births (20 studies; 95% confidence interval [CI]: 3.9, 8.4; I2 = 100%). The birth prevalence of nonsyndromic craniosynostosis was 5.2 per 10,000 live births (9 studies; 95% CI: 3.4, 7.3; I2 = 98%). The number of children born globally with craniosynostosis in 2019 was estimated to be 84,665 (95% CI: 55,965, 120,540), including 72,857 (95% CI: 47,637, 120,280) with nonsyndromic craniosynostosis. CONCLUSIONS Craniosynostosis is a common condition that affects the neurocognitive and craniofacial skeletal development of children worldwide. Initiatives to scale up capacity for craniosynostosis epidemiologic research and clinical care are warranted, particularly in low- and middle-income countries.
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Affiliation(s)
- Nathan A Shlobin
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Ronnie E Baticulon
- Division of Neurosurgery, Department of the Neurosciences, Philippine General Hospital, University of the Philippines, Manila, Philippines
| | - Carlos A Ortega
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Liping Du
- Department of Biostatistics, Vanderbilt University, Nashville, Tennessee, USA
| | - Christopher M Bonfield
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Alison Wray
- Department of Neurosurgery, The Royal Children's Hospital, Melbourne, Australia
| | - Christopher R Forrest
- Division of Plastic and Reconstructive Surgery, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Michael C Dewan
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
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Stanton E, Urata M, Chen JF, Chai Y. The clinical manifestations, molecular mechanisms and treatment of craniosynostosis. Dis Model Mech 2022; 15:dmm049390. [PMID: 35451466 PMCID: PMC9044212 DOI: 10.1242/dmm.049390] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Craniosynostosis is a major congenital craniofacial disorder characterized by the premature fusion of cranial suture(s). Patients with severe craniosynostosis often have impairments in hearing, vision, intracranial pressure and/or neurocognitive functions. Craniosynostosis can result from mutations, chromosomal abnormalities or adverse environmental effects, and can occur in isolation or in association with numerous syndromes. To date, surgical correction remains the primary treatment for craniosynostosis, but it is associated with complications and with the potential for re-synostosis. There is, therefore, a strong unmet need for new therapies. Here, we provide a comprehensive review of our current understanding of craniosynostosis, including typical craniosynostosis types, their clinical manifestations, cranial suture development, and genetic and environmental causes. Based on studies from animal models, we present a framework for understanding the pathogenesis of craniosynostosis, with an emphasis on the loss of postnatal suture mesenchymal stem cells as an emerging disease-driving mechanism. We evaluate emerging treatment options and highlight the potential of mesenchymal stem cell-based suture regeneration as a therapeutic approach for craniosynostosis.
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Affiliation(s)
- Eloise Stanton
- Center for Craniofacial Molecular Biology, University of Southern California, Los Angeles, CA 90033, USA
- Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
| | - Mark Urata
- Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, CA 90033, USA
| | - Jian-Fu Chen
- Center for Craniofacial Molecular Biology, University of Southern California, Los Angeles, CA 90033, USA
| | - Yang Chai
- Center for Craniofacial Molecular Biology, University of Southern California, Los Angeles, CA 90033, USA
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The Effect of Using In Vitro Fertilization (IVF) on Increasing the Prevalence of Craniosynostosis. J Craniofac Surg 2021; 33:26-28. [PMID: 34545049 DOI: 10.1097/scs.0000000000008188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Craniosynostosis, a malformation caused by premature closure of one or more cranial sutures, is a rare congenital disability usually of unknown cause; however, it is often associated with assisted reproductive technology. Given the increasing prevalence of craniosynostosis and the use of the in vitro fertilization (IVF) method, the authors evaluated the association between IVF and the prevalence of craniosynostosis. METHODS This retrospective study reviewed records of patients with nonsyndromic craniosynostosis who underwent surgery in Mofid Hospital, a tertiary children's hospital affiliated to Shahid Beheshti University of Medical Sciences, between 2010 and 2019. RESULTS A total of 200 patients aged one month to 7 years old, were evaluated. Out of 200 patients, 43% were plagiocephalic, 39% trigonocephalic, 8.5% scaphocephalic, 8% brachiocephalic, and 1.5% were mixed. Nine (4.5%) patients had received clomiphene citrate. Eight (4%) mothers had become pregnant under IVF, and they all had used clomiphene citrate for ovulation stimulation. No use of artificial insemination was reported. Of the eight patients whose mother had become pregnant through IVF, three were trigonocephalic, and five were plagiocephalic. CONCLUSIONS Without a control group, we are not able report the statistical results confirming or denying a link between craniosynostosis and infertility treatment. However, 4% prevalence of IVF use among craniosynostosis patients is significant. Further studies with a broader statistical community are suggested in this regard.
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Abdelhamid K, Konci R, ElHawary H, Gorgy A, Smith L. Advanced parental age: Is it contributing to an increased incidence of non-syndromic craniosynostosis? A review of case-control studies. J Oral Biol Craniofac Res 2020; 11:78-83. [PMID: 33376670 DOI: 10.1016/j.jobcr.2020.11.016] [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] [Received: 09/05/2020] [Revised: 10/17/2020] [Accepted: 11/24/2020] [Indexed: 11/30/2022] Open
Abstract
Background Craniosynostosis (CS) is a congenital birth defect characterized by the premature fusion of one or several calvarial suture(s). CS could lead to serious complications, such as intracranial hypertension and neurodevelopmental impairment. There is an increasing trend in the prevalence of CS - 75% of which are of non-syndromic type (NSCS). In parallel, there is a steady rise in the average maternal age. The goal of this paper was to review the literature to clearly identify any associations between parental age and NSCS. This review was performed and reported in compliance with PRISMA guidelines. Methods The PUBMED and EMBASE databases were systematically searched, and all studies that observed the relationship between maternal and/or paternal age on NSCS were included. The articles were then assessed for methodological quality using the Newcastle-Ottawa Scale (NOS). The effect of advanced maternal and/or paternal age on the incidence of NSCS was identified by the prevalence ratios reported at a confidence interval of 95%. Results Six retrospective case-control studies, reporting on a total of 3267 cases of NSCS were included in this review. While there were some inconsistencies in the findings of the different studies, the majority reported a positive correlation between advanced maternal and/or paternal age and an increased incidence of NSCS. Conclusion This review identified an association between advanced parental age and an increased incidence of NSCS.
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Affiliation(s)
- Kenzy Abdelhamid
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Rea Konci
- Department of Obstetrics and Gynecology, McGill University, Montreal, Quebec, Canada
| | - Hassan ElHawary
- Division of Plastic and Reconstructive Surgery, McGill University, Montreal, Quebec, Canada
| | - Andrew Gorgy
- Department of Surgery, McGill University, Montreal, Quebec, Canada
| | - Lee Smith
- The Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, Cambridge, UK
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Nonsyndromic Craniosynostosis Is Associated with Increased Risk for Psychiatric Disorders. Plast Reconstr Surg 2020; 146:355-365. [PMID: 32740588 DOI: 10.1097/prs.0000000000007009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Craniosynostosis is one of the most common craniofacial malformations demanding surgical treatment in infancy. Data on overall psychiatric morbidity among children with nonsyndromic craniosynostosis remain limited. This study investigated the risk of psychiatric disorders in nonsyndromic craniosynostosis. METHODS The authors reviewed a register-based cohort of all individuals born with nonsyndromic craniosynostosis in Sweden between 1973 to 1986 and 1997 to 2012 (n = 1238). The nonsyndromic craniosynostosis cohort was compared with a matched community cohort (n = 12,380) and with unaffected full siblings (n = 1485). The authors investigated the risk of psychiatric disorders, suicide attempts, and suicides by using Cox regression adjusted for perinatal and somatic factors, season and birth year, sex, parental socioeconomic factors, and parental psychiatric disorders. RESULTS Children with nonsyndromic craniosynostosis had a higher risk of any psychiatric disorder (adjusted Cox-derived hazard ratio, 1.70; 95 percent CI, 1.43 to 2.02), including intellectual disability (adjusted Cox-derived hazard ratio, 4.96; 95 percent CI, 3.20 to 7.70), language disorders (adjusted Cox-derived hazard ratio, 2.36; 95 percent CI, 1.57 to 3.54), neurodevelopmental disorders (adjusted Cox-derived hazard ratio, 1.30; 95 percent CI, 1.01 to 1.69), and other psychiatric disorders (adjusted Cox-derived hazard ratio, 1.43; 95 percent CI, 1.11 to 1.85). Full siblings with nonsyndromic craniosynostosis were more likely, in the crude analyses, to be diagnosed with any psychiatric disorder, including intellectual disability, language disorders, and neurodevelopmental disorders compared with nonaffected siblings. The higher risk for any psychiatric disorder and intellectual disability remained after adjusting for confounders. CONCLUSIONS Children with nonsyndromic craniosynostosis demonstrated higher risks of any psychiatric disorder compared with children without nonsyndromic craniosynostosis. This risk cannot fully be explained by familial influences (i.e., genetic or environmental factors). CLINICAL QUESTION/LEVEL OF EVIDENCE Risk, III.
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Characterization of Perinatal Risk Factors and Complications Associated With Nonsyndromic Craniosynostosis. J Craniofac Surg 2019; 30:334-338. [PMID: 30358747 DOI: 10.1097/scs.0000000000004997] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Certain intrauterine risk factors are known to increase the risk of premature cranial suture fusion and may cause complications during birth. Some of these risk factors may be modifiable. Therefore, the authors sought to characterize the institutional patterns of prenatal risk factors and perinatal complications in nonsyndromic craniosynostosis patients compared to normal births from the surrounding area to identify areas for possible intervention or prevention. METHODS The medical records of all infants with nonsyndromic craniosynostosis and full birth records born at Duke University Health System from 2006 to 2017 were retrospectively reviewed. Maternal comorbidities, prenatal risk factors, and perinatal complications were collected. The North Carolina State Center for Health Statistics was queried for perinatal statistics from Durham county and the Northeastern Perinatal Care Region to represent a control cohort of normal births from the same time period and region. The primary outcome investigated was the incidence of prenatal risk factors and complications at birth associated with premature fusion of cranial sutures. RESULTS Eighty births with nonsyndromic craniosynostosis were included in this study. The majority of these patients were males (61.7%) and born via cesarean section (55.0%). Intrauterine growth restriction occurred in 10.0% and head trauma during delivery occurred in 2.5%. Twinning (14.8% vs 3.6%, P < 0.0001), cesarean births (55.5% vs 30.0%, P < 0.0001), and breech presentation (17.3% vs 3.2%, P < 0.0001) were significantly more common in craniosynostosis patients. Prenatally, mothers of craniosynostosis infants had higher incidence of gestational diabetes (13.5% vs 5.0%, P < 0.0001) and oligohydramnios (6.1% vs 1.3%, P < 0.0001) compared to regional controls. CONCLUSION This study demonstrates that premature suture fusion is associated with prenatal risk factors such as gestational diabetes and oligohydramnios. Continued research into potentially modifiable prenatal risk factors and more refined prenatal diagnostic tools has the potential to reduce both the incidence of premature suture fusion and the sequelae of birth complications in this population.
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Lattanzi W, Barba M, Di Pietro L, Boyadjiev SA. Genetic advances in craniosynostosis. Am J Med Genet A 2017; 173:1406-1429. [PMID: 28160402 DOI: 10.1002/ajmg.a.38159] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Revised: 12/30/2016] [Accepted: 01/06/2017] [Indexed: 12/22/2022]
Abstract
Craniosynostosis, the premature ossification of one or more skull sutures, is a clinically and genetically heterogeneous congenital anomaly affecting approximately one in 2,500 live births. In most cases, it occurs as an isolated congenital anomaly, that is, nonsyndromic craniosynostosis (NCS), the genetic, and environmental causes of which remain largely unknown. Recent data suggest that, at least some of the midline NCS cases may be explained by two loci inheritance. In approximately 25-30% of patients, craniosynostosis presents as a feature of a genetic syndrome due to chromosomal defects or mutations in genes within interconnected signaling pathways. The aim of this review is to provide a detailed and comprehensive update on the genetic and environmental factors associated with NCS, integrating the scientific findings achieved during the last decade. Focus on the neurodevelopmental, imaging, and treatment aspects of NCS is also provided.
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Affiliation(s)
- Wanda Lattanzi
- Institute of Anatomy and Cell Biology, Università Cattolica del Sacro Cuore, Rome, Italy.,Latium Musculoskeletal Tıssue Bank, Rome, Italy
| | - Marta Barba
- Institute of Anatomy and Cell Biology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Lorena Di Pietro
- Institute of Anatomy and Cell Biology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Simeon A Boyadjiev
- Division of Genomic Medicine, Department of Pediatrics, Davis Medical Center, University of California, Sacramento, California
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Effects of In Utero Thyroxine Exposure on Murine Cranial Suture Growth. PLoS One 2016; 11:e0167805. [PMID: 27959899 PMCID: PMC5154521 DOI: 10.1371/journal.pone.0167805] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 11/21/2016] [Indexed: 01/05/2023] Open
Abstract
Large scale surveillance studies, case studies, as well as cohort studies have identified the influence of thyroid hormones on calvarial growth and development. Surveillance data suggests maternal thyroid disorders (hyperthyroidism, hypothyroidism with pharmacological replacement, and Maternal Graves Disease) are linked to as much as a 2.5 fold increased risk for craniosynostosis. Craniosynostosis is the premature fusion of one or more calvarial growth sites (sutures) prior to the completion of brain expansion. Thyroid hormones maintain proper bone mineral densities by interacting with growth hormone and aiding in the regulation of insulin like growth factors (IGFs). Disruption of this hormonal control of bone physiology may lead to altered bone dynamics thereby increasing the risk for craniosynostosis. In order to elucidate the effect of exogenous thyroxine exposure on cranial suture growth and morphology, wild type C57BL6 mouse litters were exposed to thyroxine in utero (control = no treatment; low ~167 ng per day; high ~667 ng per day). Thyroxine exposed mice demonstrated craniofacial dysmorphology (brachycranic). High dose exposed mice showed diminished area of the coronal and widening of the sagittal sutures indicative of premature fusion and compensatory growth. Presence of thyroid receptors was confirmed for the murine cranial suture and markers of proliferation and osteogenesis were increased in sutures from exposed mice. Increased Htra1 and Igf1 gene expression were found in sutures from high dose exposed individuals. Pathways related to the HTRA1/IGF axis, specifically Akt and Wnt, demonstrated evidence of increased activity. Overall our data suggest that maternal exogenous thyroxine exposure can drive calvarial growth alterations and altered suture morphology.
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Durham EL, Howie RN, Black L, Bennfors G, Parsons TE, Elsalanty M, Yu JC, Weinberg SM, Cray JJ. Effects of thyroxine exposure on the Twist 1 +/- phenotype: A test of gene-environment interaction modeling for craniosynostosis. ACTA ACUST UNITED AC 2016; 106:803-813. [PMID: 27435288 DOI: 10.1002/bdra.23543] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 06/06/2016] [Accepted: 06/08/2016] [Indexed: 12/16/2022]
Abstract
BACKGROUND Craniosynostosis, the premature fusion of one or more of the cranial sutures, is estimated to occur in 1:1800 to 2500 births. Genetic murine models of craniosynostosis exist, but often imperfectly model human patients. Case, cohort, and surveillance studies have identified excess thyroid hormone as an agent that can either cause or exacerbate human cases of craniosynostosis. METHODS Here we investigate the influence of in utero and in vitro exogenous thyroid hormone exposure on a murine model of craniosynostosis, Twist 1 +/-. RESULTS By 15 days post-natal, there was evidence of coronal suture fusion in the Twist 1 +/- model, regardless of exposure. With the exception of craniofacial width, there were no significant effects of exposure; however, the Twist 1 +/- phenotype was significantly different from the wild-type control. Twist 1 +/- cranial suture cells did not respond to thyroxine treatment as measured by proliferation, osteogenic differentiation, and gene expression of osteogenic markers. However, treatment of these cells did result in modulation of thyroid associated gene expression. CONCLUSION Our findings suggest the phenotypic effects of the genetic mutation largely outweighed the effects of thyroxine exposure in the Twist 1 +/- model. These results highlight difficultly in experimentally modeling gene-environment interactions for craniosynostotic phenotypes. Birth Defects Research (Part A) 106:803-813, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Emily L Durham
- Department of Oral Health Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - R Nicole Howie
- Department of Oral Health Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Laurel Black
- Department of Oral Health Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Grace Bennfors
- Department of Oral Health Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Trish E Parsons
- Center for Craniofacial and Dental Genetics, Department of Oral Biology, School of Dental Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Mohammed Elsalanty
- Departments of Oral Biology, Cellular Biology and Anatomy, Orthopaedic Surgery and Oral and Maxillofacial Surgery, Augusta University, Augusta, Georgia.,Institute for Regenerative and Reparative Medicine, Augusta University, Augusta, Georgia
| | - Jack C Yu
- Institute for Regenerative and Reparative Medicine, Augusta University, Augusta, Georgia.,Department of Surgery, Division of Plastic Surgery, Augusta University, Augusta, Georgia
| | - Seth M Weinberg
- Center for Craniofacial and Dental Genetics, Department of Oral Biology, School of Dental Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - James J Cray
- Department of Oral Health Sciences, Medical University of South Carolina, Charleston, South Carolina.
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13
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Affiliation(s)
- Farshid Farzaneh
- Shariati Hospital, Tehran University of Medical Science, Tehran, Iran; ,Children's Hospital Medical Center, Tehran University of Medical Science, Tehran, Iran
| | - Ehsan Moradi
- Shariati Hospital, Tehran University of Medical Science, Tehran, Iran; ,Children's Hospital Medical Center, Tehran University of Medical Science, Tehran, Iran
| | - Zohreh Habibi
- Shariati Hospital, Tehran University of Medical Science, Tehran, Iran; ,Children's Hospital Medical Center, Tehran University of Medical Science, Tehran, Iran
| | - Farideh Nejat
- Shariati Hospital, Tehran University of Medical Science, Tehran, Iran; ,Children's Hospital Medical Center, Tehran University of Medical Science, Tehran, Iran
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14
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Esmaeli A, Nejat F, Habibi Z, El Khashab M. Secondary bicoronal synostosis after metopic craniosynostosis surgical reconstruction. J Pediatr Neurosci 2015; 9:242-5. [PMID: 25624927 PMCID: PMC4302544 DOI: 10.4103/1817-1745.147578] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Re-synostosis after standard surgical procedures for nonsyndromic craniosynostosis is a rare event, which can occur at the same suture or rarely in adjacent sutures. Here, we report 2 patients with primary metopic craniosynostosis who developed bicoronal synostosis in previously opened sutures several months after surgery.
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Affiliation(s)
- Arash Esmaeli
- Department of Neurosurgery, Children's Hospital Medical Center, Tehran University of Medical Science, Tehran, Iran
| | - Farideh Nejat
- Department of Neurosurgery, Children's Hospital Medical Center, Tehran University of Medical Science, Tehran, Iran
| | - Zohreh Habibi
- Department of Neurosurgery, Children's Hospital Medical Center, Tehran University of Medical Science, Tehran, Iran
| | - Mostafa El Khashab
- Department of Neurosurgery, Hackensack University Medical Center, New Jersey, USA
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