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Osborn AJ, Lange O, Roberts RM. Attention Deficit/Hyperactivity Disorder in Individuals with Non-Syndromic Craniosynostosis: A Systematic Review and Meta-Analysis. Dev Neuropsychol 2024; 49:191-206. [PMID: 38801083 DOI: 10.1080/87565641.2024.2357801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 05/15/2024] [Indexed: 05/29/2024]
Abstract
It is not yet understood whether, and to what extent, craniosynostosis impacts the development of Attention Deficit/Hyperactivity Disorder (ADHD). This PRISMA compliant and PROSPERO pre-registered (ID: CRD42023458640) systematic review and meta-analysis examines the association of single-suture, non-syndromic craniosynostosis with ADHD and inattention/hyperactivity symptoms. Data from 17 independent studies (Nparticipants = 2,389; Mage = 7.3 years) were analyzed, taking into consideration suture location, surgical status, age, and measures administered, where feasible. Few differences were found between cases and controls, but some studies reported high symptom levels. Additional research is required utilizing larger sample sizes and more comprehensive assessment of ADHD.
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Affiliation(s)
- Amanda J Osborn
- School of Psychology, University of Adelaide, Adelaide, South Australia, Australia
| | - Olivia Lange
- School of Psychology, University of Adelaide, Adelaide, South Australia, Australia
| | - Rachel M Roberts
- School of Psychology, University of Adelaide, Adelaide, South Australia, Australia
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2
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Gong JH, Soliman L, Sobti N, Mehrzad R, Woo AS. Medical Malpractice Litigations Involving Infant Craniosynostosis and Deformational Plagiocephaly in the United States. Cleft Palate Craniofac J 2024; 61:1398-1403. [PMID: 36935634 DOI: 10.1177/10556656231165591] [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: 03/21/2023] Open
Abstract
OBJECTIVE To identify characteristics of malpractice litigations involving skull deformity in infants (craniosynostosis and deformational plagiocephaly). DESIGN Retrospective review of all lawsuits with jury verdicts or settlements involving infant skull deformity as the primary diagnosis using the Westlaw Legal Database. SETTING United States. PATIENTS, PARTICIPANTS Plaintiffs with skull deformity as the primary diagnosis. MAIN OUTCOME MEASURES Litigation outcome and indemnity payment amount. RESULTS From 1990 to 2019, 9 cases involving infant skull deformity met our inclusion/exclusion criteria. Among these cases, 8 (88.9%) cases resulted in indemnity payments to plaintiffs, totaling $30,430,000. Failure to diagnose (n = 4, 44.4%) and surgical negligence (n = 3, 33.3%) were the most common reasons for litigations. CONCLUSIONS There were a small number of malpractice lawsuits involving infant skull deformity over three decades. When cases go to court, physicians and hospitals have a high likelihood of judgment against them, frequently resulting in high indemnity payments.
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Affiliation(s)
- Jung Ho Gong
- Division of Plastic and Reconstructive Surgery, The Warren Alpert Medical School of Brown University, Providence, RI 02903, USA
| | - Luke Soliman
- Division of Plastic and Reconstructive Surgery, The Warren Alpert Medical School of Brown University, Providence, RI 02903, USA
| | - Nikhil Sobti
- Division of Plastic and Reconstructive Surgery, The Warren Alpert Medical School of Brown University, Providence, RI 02903, USA
| | - Raman Mehrzad
- Division of Plastic and Reconstructive Surgery, The Warren Alpert Medical School of Brown University, Providence, RI 02903, USA
| | - Albert S Woo
- Division of Plastic and Reconstructive Surgery, The Warren Alpert Medical School of Brown University, Providence, RI 02903, USA
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3
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Luo A, Gurses ME, Gecici NN, Kozel G, Lu VM, Komotar RJ, Ivan ME. Machine learning applications in craniosynostosis diagnosis and treatment prediction: a systematic review. Childs Nerv Syst 2024; 40:2535-2544. [PMID: 38647661 PMCID: PMC11269440 DOI: 10.1007/s00381-024-06409-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Accepted: 04/13/2024] [Indexed: 04/25/2024]
Abstract
Craniosynostosis refers to the premature fusion of one or more of the fibrous cranial sutures connecting the bones of the skull. Machine learning (ML) is an emerging technology and its application to craniosynostosis detection and management is underexplored. This systematic review aims to evaluate the application of ML techniques in the diagnosis, severity assessment, and predictive modeling of craniosynostosis. A comprehensive search was conducted on the PubMed and Google Scholar databases using predefined keywords related to craniosynostosis and ML. Inclusion criteria encompassed peer-reviewed studies in English that investigated ML algorithms in craniosynostosis diagnosis, severity assessment, or treatment outcome prediction. Three independent reviewers screened the search results, performed full-text assessments, and extracted data from selected studies using a standardized form. Thirteen studies met the inclusion criteria and were included in the review. Of the thirteen papers examined on the application of ML to the identification and treatment of craniosynostosis, two papers were dedicated to sagittal craniosynostosis, five papers utilized several different types of craniosynostosis in the training and testing of their ML models, and six papers were dedicated to metopic craniosynostosis. ML models demonstrated high accuracy in identifying different types of craniosynostosis and objectively quantifying severity using innovative metrics such as metopic severity score and cranial morphology deviation. The findings highlight the significant strides made in utilizing ML techniques for craniosynostosis diagnosis, severity assessment, and predictive modeling. Predictive modeling of treatment outcomes following surgical interventions showed promising results, aiding in personalized treatment strategies. Despite methodological diversities among studies, the collective evidence underscores ML's transformative potential in revolutionizing craniosynostosis management.
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Affiliation(s)
- Angela Luo
- Department of Neurosurgery, Miller School of Medicine, University of Miami, 1475 NW 12th Ave, Miami, FL, 33136, USA
| | - Muhammet Enes Gurses
- Department of Neurosurgery, Miller School of Medicine, University of Miami, 1475 NW 12th Ave, Miami, FL, 33136, USA.
| | | | - Giovanni Kozel
- Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Victor M Lu
- Department of Neurosurgery, Miller School of Medicine, University of Miami, 1475 NW 12th Ave, Miami, FL, 33136, USA
| | - Ricardo J Komotar
- Department of Neurosurgery, Miller School of Medicine, University of Miami, 1475 NW 12th Ave, Miami, FL, 33136, USA
| | - Michael E Ivan
- Department of Neurosurgery, Miller School of Medicine, University of Miami, 1475 NW 12th Ave, Miami, FL, 33136, USA
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4
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Swift CA, Weaver KJ, Shiflett JM, Humphries LS, Hoppe IC. Squamosal Craniosynostosis Associated with Rickets. Cleft Palate Craniofac J 2024; 61:1410-1414. [PMID: 37062955 DOI: 10.1177/10556656231170138] [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: 04/18/2023] Open
Abstract
Rickets results from defective bone mineralization, leading to skeletal deformities. Among those deformities, rickets has been associated with craniosynostosis, the premature closure of cranial sutures. Most of these patients have fusion of major sutures. Rarely, squamosal craniosynostosis in association with rickets has been described. Squamosal craniosynostosis is noted as lacking a definitive head abnormality and difficult visualization on standard imaging modalities, leading to poor recognition. Careful attention should be given to rickets patients to monitor for these unusual suture closures. Additionally, craniosynostosis could be a presenting feature of rickets, and further rickets evaluation of the patient is indicated.
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Affiliation(s)
| | - Kristin J Weaver
- Department of Neurosurgery, Division of Pediatric Neurosurgery, University of Mississippi Medical Center, Jackson, USA
| | - J Mason Shiflett
- Department of Neurosurgery, Division of Pediatric Neurosurgery, University of Mississippi Medical Center, Jackson, USA
| | - Laura S Humphries
- Department of Surgery, Division of Plastic Surgery, University of Mississippi Medical Center, Jackson, USA
| | - Ian C Hoppe
- Department of Surgery, Division of Plastic Surgery, University of Mississippi Medical Center, Jackson, USA
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5
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M K, Sathyabal VC, K P P, Chaurasia B. A call for the need of a new neurosurgical sub-speciality in the asian continent- neuroplastic surgery. Neurosurg Rev 2024; 47:290. [PMID: 38914698 DOI: 10.1007/s10143-024-02472-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Revised: 05/07/2024] [Accepted: 05/19/2024] [Indexed: 06/26/2024]
Affiliation(s)
- Kodeeswaran M
- Department of Neurosurgery, Government Kilpauk Medical College, 600010, Chennai, Tamil Nadu, India.
| | | | - Priyadharsan K P
- Department of Neurosurgery, Government Kilpauk Medical College, 600010, Chennai, Tamil Nadu, India
| | - Bipin Chaurasia
- Department of Neurosurgery, Neurosurgery Clinic, Birgunj, Nepal
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Gutierrez-Pineda F, Franklin BA, Punukollu A, Garcia GG, Duque OEM, Renteria HA, Perez JFP, Gonzalez IA. Efficacy and safety of sagittal synostosis surgery in older (> 12 months) patients: a systematic review and meta-analysis. Childs Nerv Syst 2024:10.1007/s00381-024-06472-y. [PMID: 38856746 DOI: 10.1007/s00381-024-06472-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Accepted: 05/23/2024] [Indexed: 06/11/2024]
Abstract
PURPOSE Sagittal synostosis is the most common isolated craniosynostosis. Surgical treatment of this synostosis has been extensively described in the global literature, with promising outcomes when it is performed in the first 12 months of life. However, in some cases, patients older than 12 months arrive at the craniofacial center with this synostosis. A comprehensive study on efficacy and perioperative outcomes has yet to be fully explored in this population. This systematic review and meta-analysis aimed to assess the available evidence of surgical outcomes for the treatment of sagittal synostosis among older patients to analyze the efficacy and safety of synostosis surgery in this unique population. METHODS PubMed, Embase, and Scopus were searched for studies published from inception to March 2024 reporting surgical outcomes of synostosis surgery in older patients (> 12 months) with isolated sagittal synostosis. The main outcome was the reoperation rate, with secondary endpoints including transfusion rates, aesthetic outcomes, and surgical complications. RESULTS Nine studies were included in the final analysis. The pooled proportion of the reoperation rate was 1%. The rate of excellent aesthetic results was 95%. The need for transfusion associated with the procedures was 86%, and finally, surgical complications attained a pooled ratio of 2%, indicating minimal morbidity associated with the surgical repair. CONCLUSION Sagittal synostosis surgery is a safe and effective procedure to perform in older patients; this meta-analysis suggests that open surgery confers a significant rate of excellent aesthetic results with a low reoperation rate and minimal complications associated with the intervention. Future research with direct comparisons among different techniques will validate the findings of this study, which will all contribute to the rigor of synostosis management.
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Affiliation(s)
- Felipe Gutierrez-Pineda
- Department of Neurosurgery, University of Antioquia, School of Medicine, Medellin, Colombia.
- Department of Neurosurgery, Colombian Neurological Institute, Medellin, Colombia.
| | | | | | - Gustavo Giraldo Garcia
- Department of Neurosurgery, University of Antioquia, School of Medicine, Medellin, Colombia
- Department of Neurosurgery, Hospital Pablo Tobon Uribe, Medellin, Colombia
| | - Oscar Eduardo Moreno Duque
- Department of Neurosurgery, University of Antioquia, School of Medicine, Medellin, Colombia
- Department of Neurosurgery, Colombian Neurological Institute, Medellin, Colombia
| | - Haiber Arias Renteria
- Department of Neurosurgery, University of Antioquia, School of Medicine, Medellin, Colombia
- Department of Neurosurgery, Colombian Neurological Institute, Medellin, Colombia
| | - Juan Felipe Pelaez Perez
- Department of Neurosurgery, University of Antioquia, School of Medicine, Medellin, Colombia
- Department of Neurosurgery, Colombian Neurological Institute, Medellin, Colombia
| | - Ignacio Alberto Gonzalez
- Department of Neurosurgery, University of Antioquia, School of Medicine, Medellin, Colombia
- Department of Neurosurgery, Hospital Pablo Tobon Uribe, Medellin, Colombia
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Mai R, Popov V, Mishina E, Osidak E. 3D printing in pediatric neurosurgery: experimental study of a novel approach using biodegradable materials. Childs Nerv Syst 2024; 40:1881-1888. [PMID: 38427108 DOI: 10.1007/s00381-024-06342-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 02/26/2024] [Indexed: 03/02/2024]
Abstract
PURPOSE 3D printing technologies have become an integral part of modern life, and the most routinely used materials in reconstructive surgery in children are biodegradable materials. The combination of these two technologies opens up new possibilities for the application of innovative methods in neurosurgery and a patient-centered approach in medical care. The aim of the study was to determine whether a physician without specialized programming and printing skills could independently create materials in a clinical setting for the treatment of patients. METHODS We conducted a preclinical study on 15 male Balb-C mice. Cylindrical materials made of polylactic acid (PLA) plastic were 3D printed. Sterilization of the obtained material was performed using a cold plasma sterilizer with hydrogen peroxide vapor and its plasma. The sterile material was implanted subcutaneously into the mice for 30 days, followed by histological examination. Using open-source software for modeling and printing, plates and screws made of PLA plastic were manufactured. The produced components were tested in the biomedical laboratory of the institute. RESULTS The histological material showed that no inflammatory changes were observed at the implantation site during the entire observation period. The cellular composition is mainly represented by macrophages and fibroblasts. There was a gradual resolution of the material and its replacement by native tissues. Research conducted to assess the effectiveness of material sterilization in a cold plasma sterilizer demonstrated its high bactericidal efficiency. CONCLUSION The method we developed for obtaining biodegradable plates and fixation elements on a 3D printer is easy to use and has demonstrated safety in a preclinical study on an animal model.
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Affiliation(s)
- Roni Mai
- Moscow Regional Scientific Research Clinical Institute M.F. Vladimirsky, Moscow, Russia.
| | - Vladimir Popov
- Moscow Regional Scientific Research Clinical Institute M.F. Vladimirsky, Moscow, Russia
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Nahass GR, Marques MA, Bou Zeid N, Zhao L, Alkureishi LWT. Normscan: open-source Python software to create average models from CT scans. Int J Comput Assist Radiol Surg 2024:10.1007/s11548-024-03185-0. [PMID: 38767767 DOI: 10.1007/s11548-024-03185-0] [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: 02/06/2024] [Accepted: 05/09/2024] [Indexed: 05/22/2024]
Abstract
PURPOSE Age-matched average 3D models facilitate both surgical planning and intraoperative guidance of cranial birth defects such as craniosynostosis. We aimed to develop an algorithm that accepts any number of CT scans as input and generates highly accurate, average models with minimal user input that are ready for 3D printing and clinical use. METHODS Using a compiled database of 'normal' pediatric computed tomography (CT) scans, we report Normscan, an open-source platform built in Python that allows users to generate normative models of CT scans through user-defined landmarks. We use the basion, nasion, and left and right porions as anatomical landmarks for initial correspondence and then register the models using the iterative closest points algorithm before downstream averaging. RESULTS Normscan is fast and easy to use via our user interface and also creates highly accurate average models of any number of input models. Additionally, it is highly repeatable, with coefficients of variance for the surface area and volume of the average model being less than 3% across ten independent trials. Average models can then be 3D printed and/or visualized in augmented reality. CONCLUSIONS Normscan provides an end-to-end pipeline for the creation of average models of skulls. These models can be used for the generation of databases of specific demographic anatomical models as well as for intraoperative guidance and surgical planning. While Normscan was designed for craniosynostosis repair, due to the modular nature of the algorithm, Normscan has many applications in other areas of surgical planning and research.
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Affiliation(s)
- George R Nahass
- Division of Plastic, Reconstructive, and Cosmetic Surgery, The Craniofacial Center, University of Illinois at Chicago, 811 S Paulina St., Chicago, IL, 60612, USA
- University of Illinois College of Medicine, Chicago, IL, 60612, USA
- Richard and Loan Hill Department of Biomedical Engineering, University of Illinois at Chicago, Chicago, IL, 60612, USA
| | - Mitchell A Marques
- Division of Plastic, Reconstructive, and Cosmetic Surgery, The Craniofacial Center, University of Illinois at Chicago, 811 S Paulina St., Chicago, IL, 60612, USA
- University of Illinois College of Medicine, Chicago, IL, 60612, USA
| | - Naji Bou Zeid
- Division of Plastic, Reconstructive, and Cosmetic Surgery, The Craniofacial Center, University of Illinois at Chicago, 811 S Paulina St., Chicago, IL, 60612, USA
| | - Linping Zhao
- Division of Plastic, Reconstructive, and Cosmetic Surgery, The Craniofacial Center, University of Illinois at Chicago, 811 S Paulina St., Chicago, IL, 60612, USA
| | - Lee W T Alkureishi
- Division of Plastic, Reconstructive, and Cosmetic Surgery, The Craniofacial Center, University of Illinois at Chicago, 811 S Paulina St., Chicago, IL, 60612, USA.
- Richard and Loan Hill Department of Biomedical Engineering, University of Illinois at Chicago, Chicago, IL, 60612, USA.
- Shriners Children's Chicago Hospital, Chicago, IL, 60707, USA.
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9
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Aksoğan Y, Kuzucu P, Soysal Acar AŞ, Şahin MB, Gücüyener K, Börcek AÖ. Evaluation of neurocognitive and social developments after craniosynostosis surgery. Childs Nerv Syst 2024; 40:1489-1499. [PMID: 38294493 DOI: 10.1007/s00381-024-06303-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 01/24/2024] [Indexed: 02/01/2024]
Abstract
OBJECTIVE The study focused on assessing the potential neurocognitive and social developmental issues in children with non-syndromic craniosynostosis (NSC) who received optimal surgical treatment. The primary objective was to determine whether NSC, even after optimal surgical treatment, could have negative effects on brain development. METHODS The study included a total of 73 pediatric patients aged between 2 and 6 years who had previously undergone surgery for NSC at the Gazi University Faculty of Medicine, Department of Neurosurgery. These patients were carefully matched with 107 healthy children who visited the outpatient clinic of the same department in terms of sociodemographic characteristics such as age, gender, and social status. To assess the neurocognitive and social development of the participants, the child psychologist administered a developmental scale to the child and his/her family via video conference. This scale was adapted from the Bayley-III Infant and Child Development Scale by the Gazi University Faculty of Medicine, Division of Pediatric Neurology. RESULTS The study found no social or gross motor developmental issues in patients who had undergone optimal surgical treatment for NSC. However, the risk of fine motor developmental deficiencies was 4.79 times higher than that of the normal population, and the risk of language developmental deficiencies was 5.75 times higher than that of the normal population. CONCLUSIONS Despite timely treatment of NSC, long-term neurocognitive and social development issues may arise in affected children. Therefore, it is crucial to monitor these patients after completing surgical treatment and thoroughly examine their development using a multidisciplinary approach.
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Affiliation(s)
- Yiğit Aksoğan
- Department of Neurosurgery, Bayburt State Hospital, Bayburt, Turkey.
| | - Pelin Kuzucu
- Division of Pediatric Neurosurgery, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Azime Ş Soysal Acar
- Department of Pediatric Health and Diseases, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Merve Büke Şahin
- Department of Public Health, Etimesgut District Health Directorate, Ankara, Turkey
| | - Kıvılcım Gücüyener
- Division of Pediatric Neurology, Gazi University, Faculty of Medicine, Ankara, Turkey
| | - Alp Ö Börcek
- Division of Pediatric Neurosurgery, Gazi University Faculty of Medicine, Ankara, Turkey
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Al-Murad BM, Radwan MA, Zaki IA, Soliman MM, Al-Shareef EM, Gaban AM, Al-Mukhlifi YM, Kefi FZ. Exploring Different Management Modalities of Nonsyndromic Craniosynostosis. Cureus 2024; 16:e60831. [PMID: 38910614 PMCID: PMC11190809 DOI: 10.7759/cureus.60831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2024] [Indexed: 06/25/2024] Open
Abstract
Craniosynostosis is an atypical skull shape characterized by the premature fusion of cranial sutures. It is one of the most common congenital anomalies encountered by craniofacial surgeons, with a prevalence of one in every 2000-2500 births. It is classified into two main types: syndromic and nonsyndromic. In syndromic, the patient presents with other abnormalities involving the trunk, face, or extremities. While in nonsyndromic the only anomy is the premature fusion, which usually involves one suture; the most common subtypes are unicoronal, sagittal, bicoronal, metopic, and lambdoid. As a consequence, premature fusion before its natural time restricts the space for the brain to grow, increases intracranial pressure, causes damage to the brain tissue, and affects the development of the child. This review comprehensively provides a detailed overview of nonsyndromic craniosynostosis and aims to highlight the importance of early and accurate diagnosis, and determining the most suitable intervention, whether surgical or conservative modalities. The optimal treatment approach produces the most favorable aesthetic and functional outcomes.
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Affiliation(s)
| | | | - Ibrahim A Zaki
- General Practice of Pediatrics, Batterjee Medical College, Jeddah, SAU
| | | | | | | | - Yara M Al-Mukhlifi
- Medical School, King Saud Bin Abdualziz University for Health and Sciences, Riyadh, SAU
| | - Fatma Z Kefi
- Medical School, Batterjee Medical College, Jeddah , SAU
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Lutz K, Röhrig A, Al-Hourani J, Kunze S, Forkosh J, Wermelinger J, Messing-Jünger M. Long-term results of minimally invasive strip craniectomy without helmet therapy for scaphocephaly - a single-centre experience. Neurosurg Rev 2024; 47:164. [PMID: 38630329 DOI: 10.1007/s10143-024-02406-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 03/25/2024] [Accepted: 04/09/2024] [Indexed: 04/19/2024]
Abstract
Scaphocephaly is the most common type of craniosynostosis and various surgical techniques are used for treatment. Due to late postoperative changes of the head shape, long-term outcome data is important for evaluating any new surgical technique. At our institution, minimally invasive strip craniectomy without regular helmet therapy is the standard treatment in scaphocephalic patients. Between October 2021 and February 2023, we retrospectively examined the skull shape of patients who underwent minimally invasive strip craniectomy for scaphocephaly using a 3D surface scan technique. The cephalic index (CI), the need for helmet therapy and additional cosmetic outcome parameters were investigated. We included 70 patients (72.5% male). The mean follow-up time was 46 (10-125) months and the mean CI was 75.7 (66.7-85.2). In 58 patients, the final cosmetic result was rated as "excellent/good" (mean CI: 76.3; 70.4-85.0), in 11 as "intermediate" (mean CI: 73.3; 66.7-77.6), and in one case as "unsatisfactory" (CI 69.3). The presence of a suboccipital protrusion was associated with a "less than good" outcome. The CI correlated significantly with the overall outcome, the presence of frontal bossing, and the interval between scan and surgery (age at scan). Minimally invasive strip craniectomy is an elegant and safe method to correct scaphocephaly. Our data show good cosmetic results in the long term even without regular postoperative helmet therapy.
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Affiliation(s)
- Katharina Lutz
- Neurosurgery Department, Inselspital, Bern University Hospital and University of Bern, Bern, 3010, Switzerland.
- Pediatric Neurosurgery, Asklepios Children's Hospital, 53757, Sankt Augustin, Germany.
| | - Andreas Röhrig
- Pediatric Neurosurgery, Asklepios Children's Hospital, 53757, Sankt Augustin, Germany
| | - Jasmin Al-Hourani
- Pediatric Neurosurgery, Asklepios Children's Hospital, 53757, Sankt Augustin, Germany
| | - Sandra Kunze
- Pediatric Neurosurgery, Asklepios Children's Hospital, 53757, Sankt Augustin, Germany
| | - Jana Forkosh
- Pediatric Neurosurgery, Asklepios Children's Hospital, 53757, Sankt Augustin, Germany
| | - Jonathan Wermelinger
- Neurosurgery Department, Inselspital, Bern University Hospital and University of Bern, Bern, 3010, Switzerland
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12
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Ma L, Zhou X, Yao S, Zhang X, Mao J, Vona B, Fan L, Lou S, Li D, Wang L, Pan Y. METTL3-dependent m 6A modification of PSEN1 mRNA regulates craniofacial development through the Wnt/β-catenin signaling pathway. Cell Death Dis 2024; 15:229. [PMID: 38509077 PMCID: PMC10954657 DOI: 10.1038/s41419-024-06606-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 03/07/2024] [Accepted: 03/11/2024] [Indexed: 03/22/2024]
Abstract
Craniofacial malformations, often associated with syndromes, are prevalent birth defects. Emerging evidence underscores the importance of m6A modifications in various bioprocesses such as stem cell differentiation, tissue development, and tumorigenesis. Here, in vivo, experiments with zebrafish models revealed that mettl3-knockdown embryos at 144 h postfertilization exhibited aberrant craniofacial features, including altered mouth opening, jaw dimensions, ethmoid plate, tooth formation and hypoactive behavior. Similarly, low METTL3 expression inhibited the proliferation and migration of BMSCs, HEPM cells, and DPSCs. Loss of METTL3 led to reduced mRNA m6A methylation and PSEN1 expression, impacting craniofacial phenotypes. Co-injection of mettl3 or psen1 mRNA rescued the level of Sox10 fusion protein, promoted voluntary movement, and mitigated abnormal craniofacial phenotypes induced by mettl3 knockdown in zebrafish. Mechanistically, YTHDF1 enhanced the mRNA stability of m6A-modified PSEN1, while decreased METTL3-mediated m6A methylation hindered β-catenin binding to PSEN1, suppressing Wnt/β-catenin signaling. Pharmacological activation of the Wnt/β-catenin pathway partially alleviated the phenotypes of mettl3 morphant and reversed the decreases in cell proliferation and migration induced by METTL3 silencing. This study elucidates the pivotal role of METTL3 in craniofacial development via the METTL3/YTHDF1/PSEN1/β-catenin signaling axis.
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Affiliation(s)
- Lan Ma
- Jiangsu Province Key Laboratory of Oral Diseases, Nanjing Medical University, Nanjing, China
| | - Xi Zhou
- Jiangsu Province Key Laboratory of Oral Diseases, Nanjing Medical University, Nanjing, China
- Department of Orthodontics, The Affiliated Stomatology Hospital of Nanjing Medical University, Nanjing, China
| | - Siyue Yao
- The Affiliated Stomatology Hospital of Suzhou Vocational Health College, Suzhou, China
| | - Xinyu Zhang
- Jiangsu Province Key Laboratory of Oral Diseases, Nanjing Medical University, Nanjing, China
- Department of Orthodontics, The Affiliated Stomatology Hospital of Nanjing Medical University, Nanjing, China
| | - Ji Mao
- Jiangsu Province Key Laboratory of Oral Diseases, Nanjing Medical University, Nanjing, China
- Department of Orthodontics, The Affiliated Stomatology Hospital of Nanjing Medical University, Nanjing, China
| | - Barbara Vona
- Institute of Human Genetics, University Medical Center Göttingen, Göttingen, Germany
- Institute for Auditory Neuroscience and Inner Ear Lab, University Medical Center Göttingen, Göttingen, Germany
| | - Liwen Fan
- Jiangsu Province Key Laboratory of Oral Diseases, Nanjing Medical University, Nanjing, China
- Department of Orthodontics, The Affiliated Stomatology Hospital of Nanjing Medical University, Nanjing, China
| | - Shu Lou
- Jiangsu Province Key Laboratory of Oral Diseases, Nanjing Medical University, Nanjing, China
- Department of Orthodontics, The Affiliated Stomatology Hospital of Nanjing Medical University, Nanjing, China
| | - Dandan Li
- Jiangsu Province Key Laboratory of Oral Diseases, Nanjing Medical University, Nanjing, China
- Department of Orthodontics, The Affiliated Stomatology Hospital of Nanjing Medical University, Nanjing, China
| | - Lin Wang
- Jiangsu Province Key Laboratory of Oral Diseases, Nanjing Medical University, Nanjing, China
- Department of Orthodontics, The Affiliated Stomatology Hospital of Nanjing Medical University, Nanjing, China
- Jiangsu Province Engineering Research Center of Stomatological Translational Medicine, Nanjing Medical University, Nanjing, China
| | - Yongchu Pan
- Jiangsu Province Key Laboratory of Oral Diseases, Nanjing Medical University, Nanjing, China.
- Department of Orthodontics, The Affiliated Stomatology Hospital of Nanjing Medical University, Nanjing, China.
- Jiangsu Province Engineering Research Center of Stomatological Translational Medicine, Nanjing Medical University, Nanjing, China.
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13
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Izumi S, Takezaki T, Takeshima Y, Hamasaki T, Mukasa A. A Case of Trigeminal Neuralgia in an Adult Patient With Lambdoid Synostosis. Cureus 2024; 16:e56918. [PMID: 38665710 PMCID: PMC11043020 DOI: 10.7759/cureus.56918] [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] [Accepted: 03/25/2024] [Indexed: 04/28/2024] Open
Abstract
Trigeminal neuralgia (TN) is characterized by sudden, brief intense pain in the distribution of the unilateral trigeminal nerve (TGN). Neurovascular compression (NVC) of the TGN is the most common cause of TN. Recent studies have suggested that a structural anomaly of the posterior cranial fossa might be involved in the development of TN, and several studies have documented the association between NVC-related TN and congenital posterior cranial deformities in adults. We present the case of a 56-year-old woman with NVC-related TN and unilateral lambdoid synostosis (ULS), along with a literature review, to investigate the relationship between TN and structural anomalies of the posterior fossa. This is the first report of TN in an adult with ULS. Mild and asymptomatic cases of lambdoid synostosis might have a higher incidence of NVC-related TN in association with posterior cranial fossa deformities.
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Affiliation(s)
- Shunsuke Izumi
- Neurosurgery, Kumamoto University Hospital, Kumamoto, JPN
| | | | - Yuki Takeshima
- Neurosurgery, Kumamoto University Hospital, Kumamoto, JPN
| | | | - Akitake Mukasa
- Neurosurgery, Kumamoto University Hospital, Kumamoto, JPN
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14
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Skadorwa T, Strzelecka J. QEEG findings in nonsyndromic sagittal craniosynostosis. Sci Rep 2024; 14:1301. [PMID: 38221524 PMCID: PMC10788330 DOI: 10.1038/s41598-024-51858-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 01/10/2024] [Indexed: 01/16/2024] Open
Abstract
Despite the undertaken treatment, children with nonsyndromic sagittal craniosynostosis (NSC) are burdened with problems with speech development, visuospatial and other cognitive deficits. The electroencephalographic assessment has not influenced the diagnostics and treatment strategy of craniosynostosis so far but the introduction of quantitative EEG (QEEG) protocols renewed an interest in the functional aspect of this disease. In this study we retrospectively assessed the QEEG records of 25 children with NSC aged 1-18 months (mean age 9.62 months) before and after surgery. In each case, the amplitude, interhemispheric (ICoh) and intrahemispheric (HCoh) coherence indices were calculated. Obtained data were compared to age-matched control group of 25 normocephalic children. Children with NSC presented significantly lower values of amplitudes and intrahemispheric coherence in occipital, posterior parietal and posterior temporal regions than normocephalic children. The values of amplitudes, ICoh and HCoh in pre- and postoperative QEEG records mostly remained unchanged, with a slight improvement in HCoh in centro-parietal area. These findings suggest that NSC children present their own QEEG profile. The operative treatment improves an intrahemispheric connectivity, but there still exists a significant difference in the occipitotemporal, frontotemporal and centro-frontal areas, which may be considered as a functional substrate of reported speech and neurocognitive problems. QEEG findings in nonsyndromic sagittal craniosynostosis.
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Affiliation(s)
- Tymon Skadorwa
- Department of Pediatric Neurosurgery, Bogdanowicz Memorial Hospital for Children, 4/24 Nieklanska St., 03924, Warsaw, Poland.
- Department of Descriptive and Clinical Anatomy, Medical University of Warsaw, 5 Chalubinskiego St., 02004, Warsaw, Poland.
| | - Jolanta Strzelecka
- Department of Pediatric Neurology, Medical University of Warsaw, 63A Żwirki i Wigury St., 02091, Warsaw, Poland
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15
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Vaja H, Patel SN, Vadher A, Patel M, Patel MB, Shah J. A unique presentation of Crouzon-like syndrome: Complex craniosynostosis in the absence of genetic mutations or familial predisposition - A case report. Surg Neurol Int 2023; 14:422. [PMID: 38213431 PMCID: PMC10783658 DOI: 10.25259/sni_424_2023] [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: 05/17/2023] [Accepted: 11/10/2023] [Indexed: 01/13/2024] Open
Abstract
Background Crouzon syndrome is a rare genetic disorder characterized by premature fusion of skull sutures during skull development, resulting in various craniofacial abnormalities and complex craniosynostosis is a condition in which more than one such sutures of the skull fuse prematurely. Case Description Herein, we present a case of a 5-year-old male diagnosed with Crouzon-like syndrome and complex craniosynostosis involving multiple cranial sutures, including metopic, sagittal, coronal (right and left), and lambdoid sutures, and without any identifiable mutations on karyotyping. The patient underwent successful surgical intervention with a satisfactory outcome, highlighting the importance of early diagnosis and intervention to prevent or minimize associated neurological manifestations and craniofacial abnormalities. Conclusion Our case report underscores the involvement of multiple cranial sutures in complex craniosynostosis and the absence of identifiable mutations or family history of similar craniofacial abnormalities, providing important insights into the diagnosis and management of this condition.
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Affiliation(s)
- Hariom Vaja
- Department of Medicine, Byramjee Jeejeebhoy Medical College and Civil Hospital, Ahmedabad, Gujarat, India
| | - Shubham Nayankumar Patel
- Department of Medicine, Byramjee Jeejeebhoy Medical College and Civil Hospital, Ahmedabad, Gujarat, India
| | - Abhishek Vadher
- Department of Medicine, Government Hospital Palsana, Palsana, Gujarat, India
| | - Masum Patel
- Department of Medicine, Byramjee Jeejeebhoy Medical College and Civil Hospital, Ahmedabad, Gujarat, India
| | - Megh Bhaveshkumar Patel
- Department of Medicine, Byramjee Jeejeebhoy Medical College and Civil Hospital, Ahmedabad, Gujarat, India
| | - Jaimin Shah
- Department of Neurosurgery, Byramjee Jeejeebhoy Medical College and Civil Hospital, Ahmedabad, Gujarat, India
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16
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Hodapp M, Hing AV, Gallagher E, Blessing M, Cunningham ML. Isolated frontosphenoidal craniosynostosis: An argument for genetic testing. Am J Med Genet A 2023; 191:2651-2655. [PMID: 37421219 DOI: 10.1002/ajmg.a.63348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 06/22/2023] [Accepted: 06/28/2023] [Indexed: 07/10/2023]
Abstract
Isolated frontosphenoidal craniosynostosis (IFSC) is a rare congenital defect defined as premature fusion of the frontosphenoidal suture in the absence of other suture fusion. Until now, IFSC was regarded as a phenomenon with an unclear genetic etiology. We have identified three cases with IFSC with underlying syndromic diagnoses that were attributable to pathogenic mutations involving FGFR3 and MN1, as well as 22q11.2 deletion syndrome. These findings suggest a genetic predisposition to IFSC may exist, thereby justifying the recommendation for genetic evaluation and testing in this population. Furthermore, due to improved imaging resolution, cases of IFSC are now readily identified. With the identification of IFSC with underlying genetic diagnoses, in combination with significant improvements in imaging resolution, we recommend genetic evaluation in children with IFSC.
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Affiliation(s)
- Matthew Hodapp
- University of Nevada, Las Vegas School of Medicine, Las Vegas, Nevada, USA
| | - Anne V Hing
- Seattle Children's Craniofacial Center, Seattle Children's Hospital, Seattle, Washington, USA
- Department of Pediatrics, University of Washington, Seattle, Washington, USA
| | - Emily Gallagher
- Seattle Children's Craniofacial Center, Seattle Children's Hospital, Seattle, Washington, USA
- Department of Pediatrics, University of Washington, Seattle, Washington, USA
| | - Matthew Blessing
- Seattle Children's Craniofacial Center, Seattle Children's Hospital, Seattle, Washington, USA
- Department of Pediatrics, University of Washington, Seattle, Washington, USA
| | - Michael L Cunningham
- Seattle Children's Craniofacial Center, Seattle Children's Hospital, Seattle, Washington, USA
- Department of Pediatrics, University of Washington, Seattle, Washington, USA
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17
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Qamar A, Bangi SF, Barve R. Artificial Intelligence Applications in Diagnosing and Managing Non-syndromic Craniosynostosis: A Comprehensive Review. Cureus 2023; 15:e45318. [PMID: 37846266 PMCID: PMC10577020 DOI: 10.7759/cureus.45318] [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] [Accepted: 09/15/2023] [Indexed: 10/18/2023] Open
Abstract
Craniosynostosis is characterised by the premature fusion of one or more cranial sutures, resulting in an abnormal head shape. The management of craniosynostosis requires early diagnosis, surgical intervention, and long-term monitoring. With the advancements in artificial intelligence (AI) technologies, there is great potential for AI to assist in various aspects of managing craniosynostosis. The main aim of this article is to review available literature describing the current uses of AI in craniosynostosis. The main applications highlighted include diagnosis, surgical planning, and outcome prediction. Many studies have demonstrated the accuracy of AI in differentiating subtypes of craniosynostosis using machine learning (ML) algorithms to classify craniosynostosis based on simple photographs. This demonstrates its potential to be used as a screening tool and may allow patients to monitor disease progression reducing the need for CT scanning. ML algorithms can also analyse CT scans to aid in the accurate and efficient diagnosis of craniosynostosis, particularly when training junior surgeons. However, the lack of sufficient data currently limits this clinical application. Virtual surgical planning for cranial vault remodelling using prefabricated cutting guides has been shown to allow more precise reconstruction by minimising the subjectivity of the clinicians' assessment. This was particularly beneficial in reducing operating length and preventing the need for blood transfusions. Despite the potential benefits, there are numerous challenges associated with implementing AI in craniosynostosis. The integration of AI in craniosynostosis holds significant promise for improving the management of craniosynostosis. Further collaboration between clinicians, researchers, and AI experts is necessary to harness its full potential.
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Affiliation(s)
- Amna Qamar
- Surgery, John Radcliffe Hospital, Oxford, GBR
| | - Shifa F Bangi
- Medicine and Surgery, University Hospitals of Leicester, Leicester, GBR
| | - Rajas Barve
- General Surgery, Bedford Hospital, Bedford, GBR
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18
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Kaasalainen T, Männistö V, Mäkelä T, Suojanen J, Nuorala A, Heliövaara A, Leikola J. Postoperative computed tomography imaging of pediatric patients with craniosynostosis: radiation dose and image quality comparison between multi-slice computed tomography and O-arm cone-beam computed tomography. Pediatr Radiol 2023; 53:1704-1712. [PMID: 36967418 PMCID: PMC10359214 DOI: 10.1007/s00247-023-05644-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 03/08/2023] [Accepted: 03/09/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND When postoperative multi-slice computed tomography (MSCT) imaging of patients with craniosynostosis is used, it is usually performed a few days after surgery in a radiology department. This requires additional anesthesia for the patient. Recently, intraoperative mobile cone-beam CT (CBCT) devices have gained popularity for orthopedic and neurosurgical procedures, which allows postoperative CT imaging in the operating room. OBJECTIVE This single-center retrospective study compared radiation dose and image quality of postoperative imaging performed using conventional MSCT scanners and O-arm CBCT. MATERIALS AND METHODS A total of 104 pediatric syndromic and non-syndromic patients who were operated on because of single- or multiple-suture craniosynostosis were included in this study. The mean volumetric CT dose index (CTDIvol) and dose-length product (DLP) values of optimized craniosynostosis CT examinations (58 MSCT and 46 CBCT) were compared. Two surgeons evaluated the subjective image quality. RESULTS CBCT resulted in significantly lower CTDIvol (up to 14%) and DLP (up to 33%) compared to MSCT. Multi-slice CT image quality was considered superior to CBCT scans. However, all scans were considered to be of sufficient quality for diagnosis. CONCLUSION The O-arm device allowed for an immediate postoperative CBCT examination in the operating theater using the same anesthesia induction. Radiation exposure was lower in CBCT compared to MSCT scans, thus further encouraging the use of O-arms. Cone-beam CT imaging with an O-arm is a feasible method for postoperative craniosynostosis imaging, yielding less anesthesia to patients, lower health costs and the possibility to immediately evaluate results of the surgical operation.
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Affiliation(s)
- Touko Kaasalainen
- HUS Diagnostic Center, Radiology, University of Helsinki and Helsinki University Hospital, P.O. Box 340, 00290, Helsinki, Finland.
| | - Ville Männistö
- Department of Oral and Maxillofacial Surgery, Lahti Central Hospital, Päijät-Häme Joint Authority for Health and Wellbeing, Lahti, Finland
| | - Teemu Mäkelä
- HUS Diagnostic Center, Radiology, University of Helsinki and Helsinki University Hospital, P.O. Box 340, 00290, Helsinki, Finland
- Department of Physics, University of Helsinki, Helsinki, Finland
| | - Juho Suojanen
- Department of Oral and Maxillofacial Surgery, Lahti Central Hospital, Päijät-Häme Joint Authority for Health and Wellbeing, Lahti, Finland
- Cleft Palate and Craniofacial Center, Department of Plastic Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Antton Nuorala
- Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Arja Heliövaara
- Cleft Palate and Craniofacial Center, Department of Plastic Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Junnu Leikola
- Cleft Palate and Craniofacial Center, Department of Plastic Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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19
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YAPIJAKIS CHRISTOS, PACHIS NIKOLAOS, SOTIRIADOU TRIANTAFYLLIA, VAILA CHRISTINA, MICHOPOULOU VASILIKI, VASSILIOU STAVROS. Molecular Mechanisms Involved in Craniosynostosis. In Vivo 2023; 37:36-46. [PMID: 36593018 PMCID: PMC9843758 DOI: 10.21873/invivo.13052] [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: 06/20/2022] [Revised: 11/07/2022] [Accepted: 11/16/2022] [Indexed: 01/03/2023]
Abstract
Craniosynostosis refers to the early fusion of one or many cranial sutures, causing craniofacial abnormalities observed in 1:2,500 births worldwide. In most cases (85%), craniosynostosis is presented as sporadic anomaly (non-syndromic craniosynostosis), while in other cases (15%) as part of syndromes (syndromic craniosynostosis). Patients with syndromic disorder usually have more severe symptoms compared to those with single suture synostosis. Most common syndromes of craniosynostosis include Pfeiffer, Apert, Crouzon, Jackson-Weiss, Muenke and Boston type MSX2-related syndrome. The main gene mutations in craniosynostosis involve FGFR1, FGFR2, FGFR3, TWIST1 and MSX2, which encode key factors influencing cranial bone morphogenesis. The main therapeutic approaches are surgical as discussed in this review, and the type of therapy depends on the graveness of the incident.
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Affiliation(s)
- CHRISTOS YAPIJAKIS
- Unit of Orofacial Genetics, 1st Department of Pediatrics, School of Medicine, National Kapodistrian University of Athens, "Agia Sophia" Children’s Hospital, Athens, Greece,Department of Molecular Genetics, "Cephalogenetics" Center, Athens, Greece,Department of Oral Maxillofacial Surgery, School of Medicine, National Kapodistrian University of Athens, Attikon Hospital, Athens, Greece
| | - NIKOLAOS PACHIS
- Unit of Orofacial Genetics, 1st Department of Pediatrics, School of Medicine, National Kapodistrian University of Athens, "Agia Sophia" Children’s Hospital, Athens, Greece,Department of Molecular Genetics, "Cephalogenetics" Center, Athens, Greece
| | - TRIANTAFYLLIA SOTIRIADOU
- Unit of Orofacial Genetics, 1st Department of Pediatrics, School of Medicine, National Kapodistrian University of Athens, "Agia Sophia" Children’s Hospital, Athens, Greece
| | - CHRISTINA VAILA
- Department of Molecular Genetics, "Cephalogenetics" Center, Athens, Greece
| | | | - STAVROS VASSILIOU
- Department of Oral Maxillofacial Surgery, School of Medicine, National Kapodistrian University of Athens, Attikon Hospital, Athens, Greece
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20
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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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21
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Sguinzi RM, Aissaoui S, Genevay-Infante M, Breguet R, Charbonnet P, Francis K, Kini R, Bühler L. Retroperitoneal liposarcoma and craniosynostosis: possible genomic relationship, case report, and literature review. Funct Integr Genomics 2022; 23:8. [PMID: 36538187 DOI: 10.1007/s10142-022-00924-x] [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: 10/17/2022] [Revised: 11/04/2022] [Accepted: 11/16/2022] [Indexed: 12/24/2022]
Abstract
Based on a case report, this review explores the genomic landscape for patients with liposarcomas and possible relationships with gene mutations related to craniosynostosis. We describe the case of a 40-year-old man, known for a surgical correction of craniosynostosis before the age of 1 year, who underwent a radical resection of a voluminous retroperitoneal liposarcoma; histopathological analysis revealed a low-grade well-differentiated, mostly sclerosing, liposarcoma. A genetic analysis searching for mutations in blood DNA was performed and did not detect any specific mutation. A literature review was also conducted. Several tumors related to syndromic and non-syndromic craniosynostosis are mentioned in the literature; no specific link with retroperitoneal liposarcoma is established but the FGFR3 mutation is detected in dedifferentiated liposarcomas. To date, no case has been reported in the literature demonstrating a genetic relationship between craniosynostosis and low-grade differentiated retroperitoneal liposarcoma. We conclude that further studies for gene complex mutations should be conducted to show a possible genetic relationship between retroperitoneal liposarcoma and craniosynostosis.
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Affiliation(s)
| | - Souria Aissaoui
- Genetic Consultation, Genesupport - Centre du Sein, Geneva, Switzerland
| | | | | | | | | | - Riad Kini
- Vesenaz Medical Center, Geneva, Switzerland
| | - Leo Bühler
- Department of Surgery, Cantonal Hospital Fribourg, Fribourg, Switzerland.,Hirslanden Clinic Grangettes, Geneva, Switzerland.,Vesenaz Medical Center, Geneva, Switzerland
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22
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Ivanov VP, Sakhno LP, Shchetinina AM, Kim AV, Trushcheleva SV. Early diagnosis and surgical treatment of craniosynostoses. ROSSIYSKIY VESTNIK PERINATOLOGII I PEDIATRII (RUSSIAN BULLETIN OF PERINATOLOGY AND PEDIATRICS) 2022. [DOI: 10.21508/1027-4065-2022-67-5-62-67] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Craniosynostosis is a craniofacial anomaly, characterized by premature fusion of one or more of the cranial sutures. Each suture and their combination correspond to a special type of deformation.Purpose. The study aimed at indicating the difficulties of early diagnostics of various forms of the craniosynostosis and evaluating the quality of treatment of patients with this disease depending on their age.Material and methods. A survey of parents with craniosynostosis who were treated at the Almazov National Medical Research Centre in 2018–2019 was conducted. The parents of 107 patients were surveyed. The main objectives of our research were: to evaluate the timeliness of diagnosis of craniosynostosis at primary health care at patient’s place of residence; to compare the methods of diagnosis verification and to present the results of the parents’ subjective assessment of the results of surgical treatment at the early and long-term postoperative period.Results. The median age of children when they were diagnosed with craniosystosis was 5 months, the median age of patients when they underwent a surgical treatment was 16 months. The median duration of the catamnesis was 6 months. We revealed that the preliminary diagnosis was established by a neurologist and pediatrician only in 21% of cases. Only at 28% of cases, children were directed to neurosurgeon, who confirm the diagnosis. In 38 (35.3%) cases, patient’s parents independently sought medical advice. The diagnosis was verified by the results of the computer tomography in 55% of patients. on because primary care specialists due to the lack of primary care specialists’ awareness about the diagnosis of craniosynostoses and attempts at long-term monitoring and conservative treatment. The timeliness of detection of craniosynostosis in the newborn period and in the|first month of life can significantly improve the cosmetic and functional outcomes of the disease.
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Affiliation(s)
| | - L. P. Sakhno
- Saint Petersburg State Pediatric Medical University
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23
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Sickle Cell Disease Association with Premature Suture Fusion in Young Children. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2022; 10:e4620. [PMID: 36312905 PMCID: PMC9612952 DOI: 10.1097/gox.0000000000004620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 08/26/2022] [Indexed: 11/13/2022]
Abstract
Sickle cell disease (SCD) leads to the formation of an atypical hemoglobin tetramer with reduced capacity to carry oxygen. Although correlation between SCD and craniosynostosis (CS) has been mentioned, these are mostly small series or case reports. This article aimed to study any correlation between these entities in a large pediatric population. Methods We retrospectively reviewed head CT scans of SCD patients from 0 to 8 years of age who required a CT for issues unrelated to their head shape between 2012 and 2020. We excluded patients with known history of CS or any CS-related syndrome, hydrocephalus, shunt placement, history of cranial surgery, or any reported cerebral or cranial shape abnormality. Results Ninety-four CT scans were analyzed. The mean age at imaging was 4.48 ± 2.30 years. CS prevalence in this cohort was 19.1%. Analysis between independent variables and patients with +CS showed that SCD-associated vasculopathy, first-degree relatives with SCD, and the use of folic acid had a statistically significant association with CS development. Conclusions Approximately 20% of pediatric patients with SCD developed CS. This association was higher in those patients who had a family history of SCD, used folic acid, and had SCD-associated vasculopathy. While the clinical impact of these findings needs more extensive study, centers that manage patients with SCD should be aware of the relatively high concordance of these diagnoses, vigilantly monitor head shape and growth parameters, and understand the potential risks associated with unidentified or untreated CS.
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24
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Ahmadpour S, Foghi K. A rare case of the scaphocephalic skull of an adult male. EGYPTIAN JOURNAL OF FORENSIC SCIENCES 2022. [DOI: 10.1186/s41935-022-00303-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Scaphocephaly is a craniofacial anomaly where the skull is disproportionately long and narrow. Premature closure of the sagittal suture is thought to be at the core of the etiopathology for scaphocephaly.
Case presentation
The skull is a well-preserved skull found in an antiquated graveyard at Parkand village Daregaz, Iran, with no visible signs of surgical manipulation. The craniofacial indices were measured. The maximum cranial length was 200 mm, and the measured length of nasion-bregma was 140mm, whereas most of the measurements were less than the normal scaphocephalic indices. Another morphological finding was the flattening of the frontal bone.
Conclusions
The cranial vault morphometry and morphology of the presented case fit the scalp. In addition to the characteristics of scaphocephaly, the presented skull was of a rare trait, frontal flattening, which has not been reported before.
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25
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Roland H, Brown A, Rousselot A, Freeman N, Wieting JM, Bergman S, Mondal D. Osteopathic Manipulative Treatment Decreases Hospital Stay and Healthcare Cost in the Neonatal Intensive Care Unit. MEDICINES (BASEL, SWITZERLAND) 2022; 9:49. [PMID: 36286582 PMCID: PMC9607199 DOI: 10.3390/medicines9100049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 09/08/2022] [Accepted: 09/12/2022] [Indexed: 06/16/2023]
Abstract
Osteopathic manipulative treatment (OMT) is used in both inpatient and outpatient settings. Evidence suggests that OMT can reduce both patients' recovery time and the financial cost of their acute medical treatment and rehabilitation. Multiple studies from neonatal intensive care units (NICUs) are presented in this article that demonstrate infants treated with OMT recover faster, are discharged earlier, and have lower healthcare costs than their non-OMT-treated counterparts. Data clearly show that adjunctive OMT facilitates feeding coordination in newborns, such as latching, suckling, swallowing, and breathing, and increases long-term weight gain and maintenance, which reduces hospital length of stay (LOS). Osteopathic techniques, such as soft tissue manipulation, balanced ligamentous tension, myofascial release, and osteopathic cranial manipulation (OCM), can reduce regurgitation, vomiting, milky bilious, or bloody discharge and decrease the need for constipation treatment. OMT can also be effective in reducing the complications of pneumonia in premature babies. Studies show the use of OCM and lymphatic pump technique (LPT) reduces the occurrence of both aspiration and environmentally acquired pneumonia, resulting in significantly lower morbidity and mortality in infants. Based on published findings, it is determined that OMT is clinically effective, cost efficient, a less invasive alternative to surgery, and a less toxic choice to pharmacologic drugs. Therefore, routine incorporation of OMT in the NICU can be of great benefit in infants with multiple disorders. Future OMT research should aim to initiate clinical trial designs that include randomized controlled trials with larger cohorts of infants admitted to the NICU. Furthermore, a streamlined and concerted effort to elucidate the underlying molecular mechanisms associated with the beneficial effects of OMT will aid in understanding the significant value of incorporating OMT into optimal patient care.
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Affiliation(s)
- Hannah Roland
- DeBusk College of Osteopathic Medicine, Lincoln Memorial University, 9737 Cogdill Road, Knoxville, TN 37932, USA
| | - Amanda Brown
- DeBusk College of Osteopathic Medicine, Lincoln Memorial University, 9737 Cogdill Road, Knoxville, TN 37932, USA
| | - Amy Rousselot
- DeBusk College of Osteopathic Medicine, Lincoln Memorial University, 9737 Cogdill Road, Knoxville, TN 37932, USA
| | - Natalie Freeman
- DeBusk College of Osteopathic Medicine, Lincoln Memorial University, 9737 Cogdill Road, Knoxville, TN 37932, USA
| | - J. Michael Wieting
- DeBusk College of Osteopathic Medicine, Lincoln Memorial University, 6965 Cumberland Gap Parkway, Harrogate, TN 37752, USA
| | - Stephen Bergman
- DeBusk College of Osteopathic Medicine, Lincoln Memorial University, 6965 Cumberland Gap Parkway, Harrogate, TN 37752, USA
| | - Debasis Mondal
- DeBusk College of Osteopathic Medicine, Lincoln Memorial University, 9737 Cogdill Road, Knoxville, TN 37932, USA
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Manrique M, Mantilla-Rivas E, Rana MS, Crowder H, Oh N, Oh AK, Keating RF, Rogers GF. Normocephalic sagittal craniosynostosis in young children is common and unrecognized. Childs Nerv Syst 2022; 38:1549-1556. [PMID: 35716184 DOI: 10.1007/s00381-022-05533-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 04/16/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Sagittal craniosynostosis (SC) is usually diagnosed during early childhood by the presence of scaphocephaly. Recently, our group found 3.3% of children under 5 years of age with normocephalic sagittal craniosynostosis (NSC) using computed tomography (CT) scans. This paper aims to validate our preliminary findings using a larger cohort of patients, and analyze factors associated with incidental NSC. METHODS A retrospective review of head CT scans in patients aged 0 to 71 months who presented to the emergency department of our tertiary care institution between 2008 and 2020 was completed. Patients with syndromes associated with craniosynostosis (CS), history of hydrocephalus, or other brain/cranial abnormalities were excluded. Two craniofacial surgeons reviewed the CT scans to evaluate the presence and extent of CS. Demographic information, gestational age, past medical and family history, medications, and chief complaint were recorded as covariates, and differences between patients with and without CS were analyzed. Furthermore, comparison of the prevalence of CS across age groups was studied. Additional analysis exploring association between independent covariates and the presence of CS was performed in two sub-cohorts: patients ≤ 24 months of age and patients > 24 months of age. RESULTS A total of 870 scans were reviewed. SC was observed in 41 patients (4.71% - 25 complete, 16 incomplete), all with a normal cranial index (width/length > 0.7). The prevalence of SC increased up to 36 months of age, then plateaued through 72 months of age. Patients under 2 years of age with family history of neurodevelopmental disease had 49.32 (95% CI [4.28, 567.2]) times higher odds of developing CS. Sub-cohort of patients above 24 months of age showed no variable independently predicted developing CS. CONCLUSION NSC in young children is common. While the impact of this condition is unknown, the correlation with family history of neurodevelopmental disease is concerning.
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Affiliation(s)
- M Manrique
- Division of Plastic and Reconstructive Surgery, Children's National Hospital, DC, 20010, Washington, USA
| | - E Mantilla-Rivas
- Division of Plastic and Reconstructive Surgery, Children's National Hospital, DC, 20010, Washington, USA
| | - M S Rana
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Hospital, Washington, DC, USA
| | - H Crowder
- Division of Plastic and Reconstructive Surgery, Children's National Hospital, DC, 20010, Washington, USA
| | - N Oh
- Division of Plastic and Reconstructive Surgery, Children's National Hospital, DC, 20010, Washington, USA
| | - A K Oh
- Division of Plastic and Reconstructive Surgery, Children's National Hospital, DC, 20010, Washington, USA
| | - R F Keating
- Department of Neurosurgery, Children's National Hospital, Washington, DC, USA
| | - G F Rogers
- Division of Plastic and Reconstructive Surgery, Children's National Hospital, DC, 20010, Washington, USA.
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Wei X, Huang G, Gui B, Xie B, Chen S, Fan X, Chen Y. Phenotypic variability of syndromic craniosynostosis caused by c.833G > T in FGFR2: Clinical and genetic evaluation of eight patients from a five-generation family. Mol Genet Genomic Med 2022; 10:e1901. [PMID: 35235708 PMCID: PMC9000941 DOI: 10.1002/mgg3.1901] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 11/28/2021] [Accepted: 02/02/2022] [Indexed: 01/25/2023] Open
Abstract
Objective Craniosynostosis is the result of the early fusion of cranial sutures. Syndromic craniosynostosis includes but not limited by Crouzon syndrome and Pfeiffer syndrome. Considerable phenotypic overlap exists among these syndromes and mutations in FGFR2 may cause different syndromes. This study aims to investigate the explanation of the phenotypic variability via clinical and genetic evaluation for eight patients in a large pedigree. Methods For each patient, comprehensive physical examination, cranial plain CT scan with three‐dimensional CT reconstruction (3D‐CT), and eye examinations were conducted. Whole exome sequencing was applied for genetic diagnosis of the proband. Variants were analyzed and interpreted following the ACMG/AMP guidelines. Sanger sequencing was performed to reveal genotypes of all the family members. Results A pathogenic variant in the FGFR2 gene, c.833G > T (p.C278F), was identified and proved to be co‐segregate with the disease. Some symptoms of head, hearing, vision, mouth, teeth expressed differently by affected individuals. Nonetheless, all the eight patients manifested core symptoms of Crouzon syndrome without abnormality in the limbs, which could exclude diagnosis of Pfeiffer syndrome. Conclusion We have established clinical and genetic diagnosis of Crouzon syndrome for eight patients in a five‐generation Chinese family. Variability of clinical features among these familial patients was slighter than that in previously reported sporadic cases.
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Affiliation(s)
- Xianda Wei
- Center for Medical Genetics and Genomics, The Second Affiliated Hospital of Guangxi Medical University, Nanning, China.,The Guangxi Health Commission Key Laboratory of Medical Genetics and Genomics, The Second Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Guori Huang
- The Guangxi Health Commission Key Laboratory of Medical Genetics and Genomics, The Second Affiliated Hospital of Guangxi Medical University, Nanning, China.,Department of Pediatrics, The Second Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Baoheng Gui
- Center for Medical Genetics and Genomics, The Second Affiliated Hospital of Guangxi Medical University, Nanning, China.,The Guangxi Health Commission Key Laboratory of Medical Genetics and Genomics, The Second Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Bobo Xie
- Center for Medical Genetics and Genomics, The Second Affiliated Hospital of Guangxi Medical University, Nanning, China.,The Guangxi Health Commission Key Laboratory of Medical Genetics and Genomics, The Second Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Shaoke Chen
- The Guangxi Health Commission Key Laboratory of Medical Genetics and Genomics, The Second Affiliated Hospital of Guangxi Medical University, Nanning, China.,Department of Pediatrics, The Second Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Xin Fan
- The Guangxi Health Commission Key Laboratory of Medical Genetics and Genomics, The Second Affiliated Hospital of Guangxi Medical University, Nanning, China.,Department of Pediatrics, The Second Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Yujun Chen
- The Guangxi Health Commission Key Laboratory of Medical Genetics and Genomics, The Second Affiliated Hospital of Guangxi Medical University, Nanning, China.,Department of Pediatrics, The Second Affiliated Hospital of Guangxi Medical University, Nanning, China
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Bouaré F, Noureldine MHA, Hajhouji F, Ghannane H, Jallo GI, Ait Benali S. Complex craniosynostosis in the context of Carpenter's syndrome. Childs Nerv Syst 2022; 38:831-835. [PMID: 34244844 DOI: 10.1007/s00381-021-05288-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 07/06/2021] [Indexed: 10/20/2022]
Abstract
Carpenter's syndrome or acrocephalopolysyndactyly type II is a rare genetic autosomal recessive disease, with an incidence estimated at 1 per 1 million births. Common findings of a brachydactyly, polysyndactyly, and a trefoil-like skull with extreme brachycephaly due to fusion of the bilateral coronal, sagittal and lambdoid sutures. We report a 12-month-old male who was referred to our care for evaluation of a craniofacial deformity-a trefoil-like skull, flattened and receding forehead, bulging of temporal bones, hypertelorism, exorbitism, and polysyndactyly in the upper and lower limbs and psychomotor delay. Head computed tomography (CT) with 3D reconstruction revealed craniosynostosis with fusion of the coronal, metopic, and sagittal sutures. Correction of the craniofacial deformity was performed with satisfactory aesthesis of the craniofacial bones at 2 years of follow-up. Early correction of craniofacial deformity in Carpenter's syndrome is usually safe within 6 to 12 months. Venous drainage abnormalities and ectatic emissary veins can lead to significant bleeding and may be detected on MR angiography. Significant skull weakening may lead to bony fragmentation while creating cranial flaps and is best evaluated with 3D CT imaging. Taking these pitfalls into consideration decreases the chances of aborting the surgery and may lead to better overall outcomes.
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Affiliation(s)
- Fah Bouaré
- Department of Neurosurgery, Arrazi Hospital VI University HospitalCadi Ayyad Université, Ibn Sina Avenue, Mohammed, BP2360, PrincipalMarrakesh, Morocco
| | - Mohammad Hassan A Noureldine
- Department of Neurosurgery and Brain Repair, University of South Florida Morsani College of Medicine, Tampa, FL, USA.
| | - Farouk Hajhouji
- Department of Neurosurgery, Arrazi Hospital VI University HospitalCadi Ayyad Université, Ibn Sina Avenue, Mohammed, BP2360, PrincipalMarrakesh, Morocco
| | - Houssine Ghannane
- Department of Neurosurgery, Arrazi Hospital VI University HospitalCadi Ayyad Université, Ibn Sina Avenue, Mohammed, BP2360, PrincipalMarrakesh, Morocco
| | - George I Jallo
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Johns Hopkins All Children's Hospital, Saint Petersburg, Florida, USA
| | - Said Ait Benali
- Department of Neurosurgery, Arrazi Hospital VI University HospitalCadi Ayyad Université, Ibn Sina Avenue, Mohammed, BP2360, PrincipalMarrakesh, Morocco
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29
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Reardon T, Fiani B, Kosarchuk J, Parisi A, Shlobin NA. Management of Lambdoid Craniosynostosis: A Comprehensive and Systematic Review. Pediatr Neurosurg 2022; 57:1-16. [PMID: 34864743 DOI: 10.1159/000519175] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 08/20/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Craniosynostosis is a condition characterized by the premature fusion of 2 or more skull bones. Craniosynostosis of the lambdoid suture is one of the rarest forms, accounting for 1-4% of all craniosynostoses. Documented cases are separated into simple (single suture), complex (bilateral), and associated with adjacent synostoses ("Mercedes Benz" Pattern) or syndromes (i.e., Crouzon, Sathre-Chotzen, Antley-Bixler). This condition can manifest phenotypic deformities and neurological sequelae that can lead to impaired cognitive function if improperly treated or left undiagnosed. Preferred surgical techniques have varied over time but all maintain the common goals of establishing proper head shape and preventing of complications that could contribute to aforementioned sequelae. SUMMARY This comprehensive review highlights demographic distributions, embryological development, pathogenesis, clinical presentation, neurological sequelae, radiologic findings, surgical techniques, surgical outcomes, and postoperative considerations of patients with lambdoid craniosynostosis presentation. In addition, a systematic review was conducted to explore the operative management of lambdoid craniosynostosis using PubMed, Embase, and Scopus databases, with 38 articles included after screening. Key Messages: Due to a low volume of published cases, diagnosis and treatment can vary. Large overlap in presentation can occur in patients that display lambdoid craniosynostosis and posterior plagiocephaly, furthering the need for comprehensive analysis. Possessing the knowledge and tools to properly assess patients with lambdoid craniosynostosis will allow for more precise care and improved outcomes.
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Affiliation(s)
- Taylor Reardon
- Kentucky College of Osteopathic Medicine, Pikeville, Kentucky, USA
| | - Brian Fiani
- Desert Regional Medical Center, Palm Springs, California, USA
| | | | | | - Nathan A Shlobin
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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30
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Skadorwa T, Wierzbieniec O. The foramen magnum in scaphocephaly. Childs Nerv Syst 2022; 38:2163-2170. [PMID: 35931858 PMCID: PMC9617951 DOI: 10.1007/s00381-022-05624-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 07/23/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE The foramen magnum (FM) presents various alterations in craniosynostoses, such as brachycephaly or Crouzon syndrome. However, to date, no study has been devoted to its morphology and morphometry in scaphocephaly, which is the most common of cranial deformities resulting from premature fusion of cranial sutures. METHODS We assessed the morphology and morphometry of FM using preoperative thin-cut CT scans of 107 children with non-syndromic sagittal craniosynostosis aged 1-12 months (mean age 5.38 months). A series of sagittal and transverse dimensions were taken and the FM area was calculated in each case. Obtained data were compared to the age-matched control group of 101 normocephalic children. RESULTS Dolichotrematous type of FM was dominant in the scaphocephaly group and observed in 63/107 cases (58.9%). The mean FM area in the scaphocephaly group was 519.64 mm2 and was significantly smaller compared to the control group (p = 0.0011). The transverse diameter and anterior sagittal diameter were also significantly smaller (p = 0.0112 and p = 0.0003, respectively). CONCLUSION The area of FM in scaphocephaly is smaller compared to normal individuals. This is associated with a significant reduction of the width of FM in children with sagittal craniosynostosis. FM in scaphocephaly is larger than in other reported series of children with brachycephaly or Crouzon syndrome.
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Affiliation(s)
- Tymon Skadorwa
- Department of Pediatric Neurosurgery, Bogdanowicz Memorial Hospital for Children, 4/24 Nieklanska St, 03924, Warsaw, Poland. .,Department of Descriptive and Clinical Anatomy, The Medical University of Warsaw, 5 Chalubinskiego St, 02004, Warsaw, Poland.
| | - Olga Wierzbieniec
- grid.13339.3b0000000113287408Department of Descriptive and Clinical Anatomy, The Medical University of Warsaw, 5 Chalubinskiego St, 02004 Warsaw, Poland
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31
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黄 宏, 魏 洁, 张 德, 周 学. [Research Progress of Fibroblast Growth Factor 8's Role in the Regulation of Bone Development and Homeostasis]. SICHUAN DA XUE XUE BAO. YI XUE BAN = JOURNAL OF SICHUAN UNIVERSITY. MEDICAL SCIENCE EDITION 2022; 53:54-57. [PMID: 35048600 PMCID: PMC10408843 DOI: 10.12182/20220160509] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Indexed: 06/14/2023]
Abstract
The proper development and the homeostasis maintenance of bones are important prerequisites for the normal functioning of the human body. Bone developmental deformities or homeostasis disorders, such as Kashin-Beck disease, craniosynostosis, cleft palate and osteoarthritis, severely affect the life of patients, causing significant stress to the family and the society. Fibroblast growth factor 8 (FGF8) plays multiple functions through the course of the life of organisms. Abnormal expression of FGF8 may cause disorders of bone homeostasis and developmental abnormalities of bones. More and more studies have found that FGF8 may play an important role in bone development and may become a potential therapeutic target. Herein, we reviewed the role of FGF8 in a variety of skeletal abnormalities, intending to provide new perspectives for the prevention and treatment of related diseases in the future.
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Affiliation(s)
- 宏灿 黄
- 口腔疾病研究国家重点实验室 国家口腔疾病临床医学研究中心 四川大学华西口腔医院 牙体牙髓病科 (成都 610041)State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, and Department of Dental and Endodontic Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - 洁雅 魏
- 口腔疾病研究国家重点实验室 国家口腔疾病临床医学研究中心 四川大学华西口腔医院 牙体牙髓病科 (成都 610041)State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, and Department of Dental and Endodontic Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - 德茂 张
- 口腔疾病研究国家重点实验室 国家口腔疾病临床医学研究中心 四川大学华西口腔医院 牙体牙髓病科 (成都 610041)State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, and Department of Dental and Endodontic Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - 学东 周
- 口腔疾病研究国家重点实验室 国家口腔疾病临床医学研究中心 四川大学华西口腔医院 牙体牙髓病科 (成都 610041)State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, and Department of Dental and Endodontic Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
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32
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Gulati S, N M S. Craniosynostosis: A pediatric neurologist’s perspective. J Pediatr Neurosci 2022; 17:S54-S60. [DOI: 10.4103/jpn.jpn_25_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 03/12/2022] [Indexed: 11/04/2022] Open
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33
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Arenas MA, Jaimovich S, Perez Garrido N, Del Pino M, Viterbo G, Marino R, Fano V. Hereditary hypophosphatemic rickets and craniosynostosis. J Pediatr Endocrinol Metab 2021; 34:1105-1113. [PMID: 34147045 DOI: 10.1515/jpem-2021-0042] [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: 01/19/2021] [Accepted: 06/02/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Craniosynostosis is an underdiagnosed complication associated with hypophosphatemic rickets. The study aims to describe the clinical and auxological characteristic of children with hypophosphatemic rickets and craniosynostosis, describe the usual treatment, and compare the characteristics with those of children without craniosynostosis. METHODS AND PATIENTS An observational and retrospective cohort study was conducted. Clinical notes and cranial images were reviewed. Out of 96 children, only the 50 patients who had skull images were included. RESULTS Out of 50 patients, 26 (15 males) had craniosynostosis (52%). No differences were observed in birth size, age, height, body proportions, alkaline phosphatase, serum phosphate, or percent tubular reabsorption of phosphate at first appointment among children with or without craniosynostosis. Among patients with craniosynostosis, dolichocephaly was prevalent. The sagittal suture was affected in all patients with craniosynostosis, with 19 of 26 children (73%) affected with isolated scaphocephaly. Pan-sutural craniosynostosis was present in 7 children (27%). None of the children had microcephaly, 7 of them presented macrocephaly and, in the remaining subjects, head circumference was normal. Five patients had undergone at least 1 cranial remodeling surgery. One patient with craniosynostosis was diagnosed with a Chiari I malformation. Molecular characterization of PHEX gene was performed in 14 cases. CONCLUSIONS Craniosynostosis is an underdiagnosed complication of hypophosphatemic rickets. Many patients with normal head size and growth may go undiagnosed, thus it is important to consider this association for early diagnosis and possible surgical treatment. A multidisciplinary approach is necessary for a correct long-term follow-up.
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Affiliation(s)
- María Alejandra Arenas
- Department of Growth and Development, Garrahan Hospital, City of Buenos Aires, Argentina
| | - Sebastián Jaimovich
- Department of Neurosurgery, Garrahan Hospital, City of Buenos Aires, Argentina
| | - Natalia Perez Garrido
- Department of Laboratory of Molecular Endocrinology, Garrahan Hospital, City of Buenos Aires, Argentina
| | - Mariana Del Pino
- Department of Growth and Development, Garrahan Hospital, City of Buenos Aires, Argentina
| | - Gisela Viterbo
- Department of Endocrinology, Garrahan Hospital, City of Buenos Aires, Argentina
| | - Roxana Marino
- Department of Laboratory of Molecular Endocrinology, Garrahan Hospital, City of Buenos Aires, Argentina
| | - Virginia Fano
- Department of Growth and Development, Garrahan Hospital, City of Buenos Aires, Argentina
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34
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Paprocka J, Nowak M, Nieć M, Janik I, Rydzanicz M, Robert Ś, Klaniewska M, Rutkowska K, Płoski R, Jezela-Stanek A. Case Report: Blepharophimosis and Ptosis as Leading Dysmorphic Features of Rare Congenital Malformation Syndrome With Developmental Delay - New Cases With TRAF7 Variants. Front Med (Lausanne) 2021; 8:708717. [PMID: 34513876 PMCID: PMC8428514 DOI: 10.3389/fmed.2021.708717] [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] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 07/27/2021] [Indexed: 12/18/2022] Open
Abstract
Germline variants in tumor necrosis factor receptor-associated factor 7 (TRAF7) gene have recently been described in about 50 patients with developmental delay and cardiac, facial, and digital anomalies (CAFDADD). We aimed to depict further the clinical and genetic spectrum associated with TRAF7 germline variants in two additional patients, broaden the mutational spectrum, and support the characteristic clinical variety to facilitate the diagnostics of the syndrome among physician involved in the evaluation of patients with developmental delay/congenital malformations.
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Affiliation(s)
- Justyna Paprocka
- Department of Pediatric Neurology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | - Magdalena Nowak
- Students' Scientific Society, Department of Pediatric Neurology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | - Maria Nieć
- Students' Scientific Society, Department of Pediatric Neurology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | - Izabela Janik
- Students' Scientific Society, Department of Pediatric Neurology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | | | - Śmigiel Robert
- Department of Paediatrics, Division of Propaedeutic of Paediatrics and Rare Disorders, Wroclaw Medical University, Wroclaw, Poland
| | - Magdalena Klaniewska
- Department of Paediatrics, Division of Propaedeutic of Paediatrics and Rare Disorders, Wroclaw Medical University, Wroclaw, Poland
| | - Karolina Rutkowska
- Department of Medical Genetics, Medical University of Warsaw, Warsaw, Poland
| | - Rafał Płoski
- Department of Medical Genetics, Medical University of Warsaw, Warsaw, Poland
| | - Aleksandra Jezela-Stanek
- Department of Genetics and Clinical Immunology, National Institute of Tuberculosis and Lung Diseases, Warsaw, Poland
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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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Smartphone-assisted Augmented Reality in Craniofacial Surgery. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3743. [PMID: 34414055 PMCID: PMC8367041 DOI: 10.1097/gox.0000000000003743] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 06/09/2021] [Indexed: 12/28/2022]
Abstract
Augmented reality (AR), a blending of both the physical and digital worlds, can be a valid tool for surgeons wishing to plan interventions and attain symmetry. The use of technology has enabled physicians to achieve desirable results. In this article, we describe a method that uses smartphone's simple AR utilities for convenient, cost effective, and time saving perioperative planning. Methods Images of preoperative computed tomography, along with 3D reconstructed scans were uploaded to a smartphone and used in an affordable application (Camera Lucida) to superimpose the loaded pictures over the smartphone camera. In one case, a 3D computed tomography scan of the skull was mirrored to help guide fronto-orbital advancement, and in another case the loaded 3D reconstructed computed tomography scan was used to prioritize areas of scalp coverage in a complicated case of craniosynostosis with major scalp wound dehiscence. Discussion Adaptation of AR to assist in the field of craniofacial surgery has been introduced before in several studies that reported the use of computer-based guidance for cranial reshaping. The majority of these reports used sophisticated modalities, combining advanced image registration and tracking with specialized equipment. The utility of smartphone AR for cranial vault reconstruction provided good accuracy when visualizing fronto-orbital advancement and remodeling, together with in depth prioritization of areas in need of soft tissue reconstruction. Conclusion Smartphone AR adaptation proved to be a very convenient tool assisting in the planning of different craniofacial conditions that are time saving and do not incur any additional fees beyond those of the surgery.
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Non-Surgical Touch-Up with Hyaluronic Acid Fillers Following Facial Reconstructive Surgery. APPLIED SCIENCES-BASEL 2021. [DOI: 10.3390/app11167507] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The use of hyaluronic acid (HA) injectable fillers has become increasingly widespread in facial recontouring and rejuvenation. We report our experiences to emphasize the role of HA fillers as tools beyond aesthetic treatments in cases of post-surgical facial sequelae. HA fillers are generally used for aesthetic rejuvenation, but one potential new horizon could be their application in trauma, reconstructive, and craniofacial surgery. This study was conducted retrospectively, evaluating medical reports of patients treated at the Maxillofacial Surgery Unit, University of Campania “Luigi Vanvitelli”, Naples, for lip incompetence, trauma, oncological, reconstructive, and craniosynostosis surgery sequelae. Visual analog scale (VAS) evaluation was performed to assess patient satisfaction. No major complications (i.e., impending necrosis or visual loss) were reported. Bruising and swelling was reported for 48 h after lip injection. At the immediate VAS evaluation, 67% of the patients were “extremely satisfied” and 33% “satisfied”. In those 33%, VAS scores changed to “extremely satisfied” at 6–9 weeks and 3–6 months of VAS evaluation (contextually to improvement in tissue flexibility, elasticity, and aesthetic appearance). Results indicate that this minimally invasive approach achieves a high level of aesthetic enhancement, improving patient satisfaction. The concept of HA filler applications could be a frontier that may be applicable to other areas of reconstructive facial plastic surgery.
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Soldozy S, Yağmurlu K, Akyeampong DK, Burke R, Morgenstern PF, Keating RF, Black JS, Jane JA, Syed HR. Three-dimensional printing and craniosynostosis surgery. Childs Nerv Syst 2021; 37:2487-2495. [PMID: 33779807 DOI: 10.1007/s00381-021-05133-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Accepted: 03/15/2021] [Indexed: 12/15/2022]
Abstract
OVERVIEW The goal of this study was to review the current application and status of three-dimensional printing for craniosynostosis surgery. METHODS A literature review was performed using the PubMed/MEDLINE databases for studies published between 2010 and 2020. All studies demonstrating the utilization of three-dimensional printing for craniosynostosis surgery were included. RESULTS A total of 15 studies were ultimately selected. This includes studies demonstrating novel three-dimensional simulation and printing workflows, studies utilizing three-dimensional printing for surgical simulation, as well as case reports describing prior experiences. CONCLUSION The incorporation of three-dimensional printing into the domain of craniosynostosis surgery has many potential benefits. This includes streamlining surgical planning, developing patient-specific template guides, enhancing residency training, as well as aiding in patient counseling. However, the current state of the literature remains in the validation stage. Further study with larger case series, direct comparisons with control groups, and prolonged follow-up times is necessary before more widespread implementation is justified.
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Affiliation(s)
- Sauson Soldozy
- Department of Neurological Surgery, University of Virginia Health System, P.O. Box 800212, Charlottesville, VA, 22908, USA
| | - Kaan Yağmurlu
- Department of Neurological Surgery, University of Virginia Health System, P.O. Box 800212, Charlottesville, VA, 22908, USA
| | - Daniel K Akyeampong
- Department of Plastic Surgery, University of Virginia Health System, Charlottesville, VA, USA
| | - Rebecca Burke
- Department of Neurological Surgery, University of Virginia Health System, P.O. Box 800212, Charlottesville, VA, 22908, USA
| | - Peter F Morgenstern
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Robert F Keating
- Department of Neurosurgery, Children's National Medical Center, Washington, DC, USA
| | - Jonathan S Black
- Department of Plastic Surgery, University of Virginia Health System, Charlottesville, VA, USA
| | - John A Jane
- Department of Neurological Surgery, University of Virginia Health System, P.O. Box 800212, Charlottesville, VA, 22908, USA
| | - Hasan R Syed
- Department of Neurological Surgery, University of Virginia Health System, P.O. Box 800212, Charlottesville, VA, 22908, USA.
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Najjar O, AbouChebel N, Zeeni C, Najjar MW. Outcomes following Craniosynostosis Surgery at a Tertiary Care Center in the Middle East. Pediatr Neurosurg 2021; 56:239-247. [PMID: 33882504 DOI: 10.1159/000515637] [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: 01/07/2021] [Accepted: 03/03/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Despite advancements in craniosynostosis surgery, open surgical approaches remain crucial for the management of infants >6 months of age and in those with complex synostosis. The clinical features of craniosynostosis remain poorly characterized in the Middle East. This study sought to assess the clinical features and outcomes of infants undergoing craniosynostosis surgery at a tertiary care center in Lebanon. METHODS A retrospective review was performed of all patients who underwent craniosynostosis surgery from December 2006 to December 2018 at the American University of Beirut Medical Center, Lebanon. Clinicodemographic characteristics, complications, and recurrence outcomes were recorded and evaluated using descriptive statistics. RESULTS Thirty-five infants met the inclusion criteria, with a mean age of 9.0 ± 4.0 months. The most common site of suture involvement was metopic (28.6%), followed by unilateral coronal (25.7%), sagittal (20.0%), bicoronal (8.6%), and multiple sites (17.1%). Five patients (14.3%) had syndromic synostosis. Median estimated blood loss was 200 mL, and median volume of transfused packed red blood cells was 180 mL. Two patients (5.7%) experienced postoperative complications, including postoperative blood transfusion (n = 1)and wire protrusion requiring removal (n = 1). Three patients (8.6%) required reoperation: 2 (5.7%) for resynostosis and 1 for traumatic fracture repair. Caregivers of all patients reported high satisfaction with cosmetic outcomes 4 weeks postoperatively. CONCLUSIONS With appropriate perioperative precautions, open craniosynostosis surgery can be performed with minimal complications, low recurrence rates, and satisfactory cosmetic outcomes. Additional population-level data are needed to better characterize craniosynostosis patterns and outcomes in the Middle East.
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Affiliation(s)
- Omar Najjar
- The Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Naji AbouChebel
- Division of Orthodontics and Dentofacial Orthopedics, Department of Otolaryngology, Head and Neck Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Carine Zeeni
- Department of Anesthesiology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Marwan W Najjar
- Division of Neurosurgery, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
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Kloth K, Bierhals T, Johannsen J, Harms FL, Juusola J, Johnson MC, Grange DK, Kutsche K. Biallelic variants in SMAD6 are associated with a complex cardiovascular phenotype. Hum Genet 2019; 138:625-634. [DOI: 10.1007/s00439-019-02011-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 04/03/2019] [Indexed: 01/10/2023]
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