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Gaillard L, Tjaberinga MC, Dremmen MHG, Mathijssen IMJ, Vrooman HA. Brain volume in infants with metopic synostosis: Less white matter volume with an accelerated growth pattern in early life. J Anat 2024. [PMID: 38417842 DOI: 10.1111/joa.14028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 01/30/2024] [Accepted: 02/05/2024] [Indexed: 03/01/2024] Open
Abstract
Metopic synostosis patients are at risk for neurodevelopmental disorders despite a negligible risk of intracranial hypertension. To gain insight into the underlying pathophysiology of metopic synostosis and associated neurodevelopmental disorders, we aimed to investigate brain volumes of non-syndromic metopic synostosis patients using preoperative MRI brain scans. MRI brain scans were processed with HyperDenseNet to calculate total intracranial volume (TIV), total brain volume (TBV), total grey matter volume (TGMV), total white matter volume (TWMV) and total cerebrospinal fluid volume (TCBFV). We compared global brain volumes of patients with controls corrected for age and sex using linear regression. Lobe-specific grey matter volumes were assessed in secondary analyses. We included 45 metopic synostosis patients and 14 controls (median age at MRI 0.56 years [IQR 0.36] and 1.1 years [IQR 0.47], respectively). We found no significant differences in TIV, TBV, TGMV or TCBFV in patients compared to controls. TWMV was significantly smaller in patients (-62,233 mm3 [95% CI = -96,968; -27,498], Holm-corrected p = 0.004), and raw data show an accelerated growth pattern of white matter in metopic synostosis patients. Grey matter volume analyses per lobe indicated increased cingulate (1378 mm3 [95% CI = 402; 2355]) and temporal grey matter (4747 [95% CI = 178; 9317]) volumes in patients compared to controls. To conclude, we found smaller TWMV with an accelerated white matter growth pattern in metopic synostosis patients, similar to white matter growth patterns seen in autism. TIV, TBV, TGMV and TCBFV were comparable in patients and controls. Secondary analyses suggest larger cingulate and temporal lobe volumes. These findings suggest a generalized intrinsic brain anomaly in the pathophysiology of neurodevelopmental disorders associated with metopic synostosis.
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Affiliation(s)
- L Gaillard
- Department of Plastic and Reconstructive Surgery and Hand Surgery, Erasmus MC-Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - M C Tjaberinga
- Department of Plastic and Reconstructive Surgery and Hand Surgery, Erasmus MC-Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - M H G Dremmen
- Department of Radiology and Nuclear Medicine, Erasmus MC-Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - I M J Mathijssen
- Department of Plastic and Reconstructive Surgery and Hand Surgery, Erasmus MC-Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - H A Vrooman
- Department of Radiology and Nuclear Medicine, Erasmus MC-Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands
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2
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Gaillard L. A Suture-specific Photo Score for Metopic Synostosis. J Craniofac Surg 2024; 35:75-79. [PMID: 37815380 PMCID: PMC10749672 DOI: 10.1097/scs.0000000000009773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 08/20/2023] [Indexed: 10/11/2023] Open
Abstract
Head shape assessments in children with metopic synostosis are a relevant outcome measure in addition to functional measures, such as neurocognitive outcomes, behavioral outcomes, and visual functioning outcomes. However, consensus on head shape assessments in children with metopic synostosis is lacking. The aim of this study is to develop a reproducible and reliable suture-specific photo score that can be used for cross-center comparison of phenotypical severity of metopic synostosis and evaluation of esthetic outcome of treatment later in childhood. We conducted a retrospective study among nonsyndromic metopic synostosis patients aged <18 years. Preoperative and postoperative photosets of patients with metopic synostosis from 6 expert centers were included. The photo score was discussed in the group of expert craniofacial plastic surgeons and pediatric neurosurgeons. Interrater reliability was determined with modified weighted Fleiss' kappa and intraclass correlation coefficients. Correlation between individual photo score items with overall phenotype was assessed using Spearman correlation analyses. The metopic synostosis photo score contained the following items: "wedging of the forehead", "hypotelorism", "temporal hollowing", "biparietal widening,"and an assessment of "overall phenotype". Items were scored on a 4-point ordinal scale ranging from normal to severe. We found moderate interrater reliability for all items, but substantial agreement for the summed scores. Correlation with overall phenotype was lowest for biparietal widening. To conclude, although agreement on individual photo score items was suboptimal, the agreement on the summed score was substantial, which indicates there is consensus on the overall severity of the metopic synostosis phenotype.
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Kuehle R, Ringwald F, Bouffleur F, Hagen N, Schaufelberger M, Nahm W, Hoffmann J, Freudlsperger C, Engel M, Eisenmann U. The Use of Artificial Intelligence for the Classification of Craniofacial Deformities. J Clin Med 2023; 12:7082. [PMID: 38002694 PMCID: PMC10672418 DOI: 10.3390/jcm12227082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 10/27/2023] [Accepted: 11/02/2023] [Indexed: 11/26/2023] Open
Abstract
Positional cranial deformities are a common finding in toddlers, yet differentiation from craniosynostosis can be challenging. The aim of this study was to train convolutional neural networks (CNNs) to classify craniofacial deformities based on 2D images generated using photogrammetry as a radiation-free imaging technique. A total of 487 patients with photogrammetry scans were included in this retrospective cohort study: children with craniosynostosis (n = 227), positional deformities (n = 206), and healthy children (n = 54). Three two-dimensional images were extracted from each photogrammetry scan. The datasets were divided into training, validation, and test sets. During the training, fine-tuned ResNet-152s were utilized. The performance was quantified using tenfold cross-validation. For the detection of craniosynostosis, sensitivity was at 0.94 with a specificity of 0.85. Regarding the differentiation of the five existing classes (trigonocephaly, scaphocephaly, positional plagiocephaly left, positional plagiocephaly right, and healthy), sensitivity ranged from 0.45 (positional plagiocephaly left) to 0.95 (scaphocephaly) and specificity ranged from 0.87 (positional plagiocephaly right) to 0.97 (scaphocephaly). We present a CNN-based approach to classify craniofacial deformities on two-dimensional images with promising results. A larger dataset would be required to identify rarer forms of craniosynostosis as well. The chosen 2D approach enables future applications for digital cameras or smartphones.
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Affiliation(s)
- Reinald Kuehle
- Department of Oral and Maxillofacial Surgery, University of Heidelberg, 69120 Heidelberg, Germany; (F.B.); (J.H.); (C.F.)
| | - Friedemann Ringwald
- Institute of Medical Informatics, University of Heidelberg, 69120 Heidelberg, Germany; (F.R.)
| | - Frederic Bouffleur
- Department of Oral and Maxillofacial Surgery, University of Heidelberg, 69120 Heidelberg, Germany; (F.B.); (J.H.); (C.F.)
| | - Niclas Hagen
- Institute of Medical Informatics, University of Heidelberg, 69120 Heidelberg, Germany; (F.R.)
| | - Matthias Schaufelberger
- Institute of Biomedical Engineering, Karlsruhe Institute for Technology, 76131 Karlsruhe, Germany
| | - Werner Nahm
- Institute of Biomedical Engineering, Karlsruhe Institute for Technology, 76131 Karlsruhe, Germany
| | - Jürgen Hoffmann
- Department of Oral and Maxillofacial Surgery, University of Heidelberg, 69120 Heidelberg, Germany; (F.B.); (J.H.); (C.F.)
| | - Christian Freudlsperger
- Department of Oral and Maxillofacial Surgery, University of Heidelberg, 69120 Heidelberg, Germany; (F.B.); (J.H.); (C.F.)
| | - Michael Engel
- Department of Oral and Maxillofacial Surgery, University of Heidelberg, 69120 Heidelberg, Germany; (F.B.); (J.H.); (C.F.)
| | - Urs Eisenmann
- Institute of Medical Informatics, University of Heidelberg, 69120 Heidelberg, Germany; (F.R.)
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Franz-Odendaal TA, Bezuhly M. Clomiphene Citrate and Enclomiphene Hydrochloride Exposure Is Associated With Interfrontal Suture Fusion in Zebrafish. Plast Surg (Oakv) 2023; 31:383-389. [PMID: 37915340 PMCID: PMC10617459 DOI: 10.1177/22925503211057526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 09/24/2021] [Accepted: 09/30/2021] [Indexed: 11/03/2023] Open
Abstract
Background: The last several decades have witnessed an increase in metopic craniosynostosis incidence. Population-based studies suggest that pharmacological exposure in utero may be responsible. This study examined effects of the fertility drug clomiphene citrate (CC) on calvarial development in an established model for craniofacial development, the zebrafish Danio rerio. Results: Zebrafish larvae were exposed to clomiphene citrate or its isomer enclomiphene for five days at key points during calvarial development. Larvae were then raised to adulthood in normal rearing water. Zebrafish were analyzed using whole-mount skeletal staining. We observed differential effects on survivability, growth and suture formation depending on the treatment. Treatments with CC or enclomiphene at 5.5 mm SL led to increased fusion of the interfrontal suture (p < .01) compared to controls. Conclusions: Exposure to fertility drugs appears to affect development of the cranial vault, specifically the interfrontal suture, in zebrafish. Further research is required to identify the signaling mechanisms at play. This work suggests that fertility drug treatment may contribute to the increased incidence of metopic craniosynostosis observed globally.
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Affiliation(s)
- Tamara A. Franz-Odendaal
- Department of Biology, Mount Saint Vincent University, Mount Saint Vincent University, Halifax, Nova Scotia, Canada
| | - Michael Bezuhly
- Division of Plastic Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
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Xu S, Leclair NK, Angelo S, Paro M, Stoltz P, Anderson M, Martin JE, Hersh DS, Bookland MJ. Natural history of mild trigonocephalic deformities. J Neurosurg Pediatr 2023; 32:472-477. [PMID: 37548529 DOI: 10.3171/2023.6.peds23201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 06/06/2023] [Indexed: 08/08/2023]
Abstract
OBJECTIVE Ridging along the metopic suture line can be a common cause of concern for parents and has been theorized to represent a mild form of trigonocephaly, a cranial deformity associated with risks of negative cosmetic outcomes, if not surgically corrected. Yet the literature contains sparse reports of long-term cosmetic results or expectations for infants with isolated metopic ridging compared with those with severe trigonocephaly, or even what objective metrics discriminate isolated metopic ridging from severe trigonocephaly. Therefore, the authors' goals for this study were to 1) quantify the degree of frontal deformity among patients with metopic ridge, metopic craniosynostosis, and normocephalic head shapes; and 2) document the natural history of frontal deformities in isolated metopic ridge patients in the 1st year of life. METHODS This was a retrospective cohort study of patients with normocephalic head shapes, metopic ridges, and metopic craniosynostoses who presented at < 1 year of age to the Connecticut Children's neurosurgery clinic from January 2019 to December 2021. Data were collected regarding demographics and photograph-based craniometrics. RESULTS A total of 212 normocephalic, 34 metopic ridge, and 29 metopic craniosynostosis patients were included. Both the normocephalic and metopic ridge groups had a significantly higher anterior arc angle (AAA) value compared with the metopic craniosynostosis group (p < 0.0001). The AAA did not differ significantly among normocephalic patients and those with ridging. Over the course of 1 year of follow-up, patients with metopic ridging demonstrated a slight decrease in AAA values, but overall remained within the same range as normocephalic patients. CONCLUSIONS Photograph-based craniometrics suggest that metopic ridge patients with frontal bone angulations > 2.2 radians have a mild degree of frontal constriction that does not significantly worsen over the 1st year of life.
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Affiliation(s)
- Summer Xu
- 1School of Medicine, University of Connecticut Health Center, Farmington, Connecticut
| | - Nathan K Leclair
- 1School of Medicine, University of Connecticut Health Center, Farmington, Connecticut
| | - Sophia Angelo
- 1School of Medicine, University of Connecticut Health Center, Farmington, Connecticut
| | - Mitch Paro
- 1School of Medicine, University of Connecticut Health Center, Farmington, Connecticut
| | - Petronella Stoltz
- 2Division of Neurosurgery, Connecticut Children's, Hartford, Connecticut; and
| | - Megan Anderson
- 2Division of Neurosurgery, Connecticut Children's, Hartford, Connecticut; and
| | - Jonathan E Martin
- 2Division of Neurosurgery, Connecticut Children's, Hartford, Connecticut; and
- 3Department of Surgery, UConn School of Medicine, Farmington, Connecticut
| | - David S Hersh
- 2Division of Neurosurgery, Connecticut Children's, Hartford, Connecticut; and
- 3Department of Surgery, UConn School of Medicine, Farmington, Connecticut
| | - Markus J Bookland
- 2Division of Neurosurgery, Connecticut Children's, Hartford, Connecticut; and
- 3Department of Surgery, UConn School of Medicine, Farmington, Connecticut
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Magnet R, Bloch K, Taverne M, Melzi S, Geoffroy M, Khonsari RH, Ovsjanikov M. Assessing craniofacial growth and form without landmarks: A new automatic approach based on spectral methods. J Morphol 2023; 284:e21609. [PMID: 37458086 DOI: 10.1002/jmor.21609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 05/19/2023] [Accepted: 05/29/2023] [Indexed: 07/18/2023]
Abstract
We present a novel method for the morphometric analysis of series of 3D shapes, and demonstrate its relevance for the detection and quantification of two craniofacial anomalies: trigonocephaly and metopic ridges, using CT-scans of young children. Our approach is fully automatic, and does not rely on manual landmark placement and annotations. Our approach furthermore allows to differentiate shape classes, enabling successful differential diagnosis between trigonocephaly and metopic ridges, two related conditions characterized by triangular foreheads. These results were obtained using recent developments in automatic nonrigid 3D shape correspondence methods and specifically spectral approaches based on the functional map framework. Our method can capture local changes in geometric structure, in contrast to methods based, for instance, on global shape descriptors. As such, our approach allows to perform automatic shape classification and provides visual feedback on shape regions associated with different classes of deformations. The flexibility and generality of our approach paves the way for the application of spectral methods in quantitative medicine.
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Affiliation(s)
- Robin Magnet
- LIX, École Polytechnique, IP Paris, Palaiseau, France
| | - Kevin Bloch
- Laboratoire "Forme et Croissance du Crâne", Hôpital Necker-Enfants Malades, Assistance Publique Hôpitaux de Paris, Faculté de Médecine, Université Paris Cité, Paris, France
| | - Maxime Taverne
- Laboratoire "Forme et Croissance du Crâne", Hôpital Necker-Enfants Malades, Assistance Publique Hôpitaux de Paris, Faculté de Médecine, Université Paris Cité, Paris, France
| | - Simone Melzi
- Department of Informatics, Systems and Communication, University of Milano-Bicocca, Milan, Italy
| | - Maya Geoffroy
- Laboratoire "Forme et Croissance du Crâne", Hôpital Necker-Enfants Malades, Assistance Publique Hôpitaux de Paris, Faculté de Médecine, Université Paris Cité, Paris, France
| | - Roman H Khonsari
- Laboratoire "Forme et Croissance du Crâne", Hôpital Necker-Enfants Malades, Assistance Publique Hôpitaux de Paris, Faculté de Médecine, Université Paris Cité, Paris, France
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Agushi R, Scagnet M, Spacca B, Mura R, Grandoni M, Mussa F, Genitori L. Is endoscope-assisted strip craniectomy the future of metopic suture craniosynostosis treatment? An 11-year experience with 62 patients. J Neurosurg Pediatr 2023; 32:75-81. [PMID: 36964738 DOI: 10.3171/2023.2.peds22409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 02/14/2023] [Indexed: 03/26/2023]
Abstract
OBJECTIVE Endoscopic mini-invasive treatment for sporadic trigonocephaly is becoming a widely accepted surgical treatment. In most centers this treatment is performed in association with postoperative helmeting. The aim of the present study was to review and report the authors' 11-year experience of endoscope-assisted metopic suturectomy for treatment of 62 trigonocephaly patients without helmet use. METHODS For this retrospective study, clinical data of 62 consecutive pediatric patients (age 3-8 months) were obtained from the data bank of the "Anna Meyer" Children Hospital. These patients had been diagnosed with trigonocephaly (type II and III) and undergone surgery performed with a mini-invasive endoscopic technique during the period from January 2011 to January 2022. No helmet was used postoperatively in these patients, and they were evaluated through craniometric measurements, pre-/postoperative photographs, and parents' impressions, as well as thorough clinical examinations during follow-up appointments. RESULTS The mean patient follow-up period was 6 ± 1.3 years. The female/male ratio was 1:2; 52% of the patients presented with type II trigonocephaly and the remaining patients with type III. The mean age at surgery was 153 ± 44 days (5 ± 1.5 months, range 3-8 months). In 92% of the patients the surgical outcome was defined as good to excellent. However, 4 patients presented with an unsatisfactory outcome, including 1 patient with a CSF collection requiring surgical repair 2 months after the first surgery and 1 patient who developed infection of the surgical wound and needed a second surgery. In the latter patient the outcome was evaluated as satisfactory, and no sequelae regarding the infection were encountered during follow-up. CONCLUSIONS According to the authors' experience, endoscopic metopic suturectomy alone, without the use of a helmet, is a valid surgical option for trigonocephaly treatment, and its application can be considered in patients of older age groups (up to 8 months). Thus, in the right patient selection context, this technique represents the treatment of choice.
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Mologousis MA, Rork JF, Balkin DM, Berry JG, Liang MG. Metopic ridge presenting to pediatric dermatology and vascular anomalies clinics. Pediatr Dermatol 2023. [PMID: 37253677 DOI: 10.1111/pde.15371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 05/13/2023] [Indexed: 06/01/2023]
Abstract
Metopic ridge (MeR) is a midline osseous forehead prominence resulting from physiologic closure of the underlying metopic suture. This mass-like ridge can be mistaken for serious conditions such as a craniosynostosis or vascular anomaly, prompting concern and workup. We reviewed patients presenting for a forehead mass to Vascular Anomalies and Dermatology clinics and diagnosed with MeR to increase familiarity with this finding and to encourage MeR in the differential diagnosis of pediatric midline forehead masses.
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Affiliation(s)
- Mia A Mologousis
- Tufts University School of Medicine, Boston, Massachusetts, USA
- Department of Dermatology, Vascular Anomalies Center, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Jillian F Rork
- Dartmouth Geisel School of Medicine, Hanover, New Hampshire, USA
- Department of Dermatology, Dartmouth Hitchcock Medical Center, Manchester, New Hampshire, USA
| | - Daniel M Balkin
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Jay G Berry
- Harvard Medical School, Boston, Massachusetts, USA
- Complex Care, Division of General Pediatrics, Department of Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Marilyn G Liang
- Department of Dermatology, Vascular Anomalies Center, Boston Children's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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Pfaff MJ, Bruce MK, Erpenbeck S, Mittal A, Beiriger JW, Zhu X, Dvoracek L, Goldstein JA. A Three-Dimensional-Based Morphometric Analysis of a Standardized Overcorrection Technique for Fronto-Orbital Advancement in Metopic Craniosynostosis. Cleft Palate Craniofac J 2023; 60:268-273. [PMID: 34870484 DOI: 10.1177/10556656211062843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION The concept of "overcorrection" for trigonocephaly has been reported to achieve both anterior cranial fossa expansion and normalization of craniofacial form. The purpose of this study is to describe in detail a standardized technique to fronto-orbital advancement utilizing the concept of "overcorrection" and objectively evaluate intermediate results. METHODS This retrospective study included patients with isolated metopic synostosis who underwent surgery via the proposed surgical technique and age and sex-matched unaffected controls. Craniofacial morphometric analysis was performed on pre-, immediate post-, and intermediate postoperative (>2 years) three-dimensional (3D)-rendered computed tomographic (CT) scans and photographs. Key CT-based measurements included interzygomaticofrontal suture distance (IZFS), endocranial bifrontal angle (ECA), and temporal expansion. 3D photogrammetry was performed using established measurements and associated Z-scores converted. A Paired t-test and analysis of variance were performed when appropriate. RESULTS Forty-one patients were included. A comparison of pre- and immediate postoperative CT scans demonstrated statistically significant increases in all measurements. Subset analysis of 12 patients with intermediate follow-up (age: 39.6 ± 3.6 months) demonstrated significant differences from preoperative values except for IZFS, which decreased from immediate postoperative values and was smaller than age- and sex-matched controls. 3D photogrammetry demonstrated a mean Z-score above the norm for frontal breath. 3D photogrammetry is also positively correlated with CT-based measurements. CONCLUSIONS This standardized "overcorrection" approach for trigonocephaly can provide the appropriate changes to maintain a normal ECA despite a reduction in bifrontal width over time. 3D photogrammetry positively correlated with CT-based measurements and may provide useful information when following patients clinically. Long-term follow-up assessment to determine the necessary degree of overcorrection at skeletal mature is needed.
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Affiliation(s)
- Miles J Pfaff
- 6619Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center, Pediatric Plastic Surgery, Pittsburgh, PA, USA
| | - Madeleine K Bruce
- 6619Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center, Pediatric Plastic Surgery, Pittsburgh, PA, USA
| | - Sarah Erpenbeck
- 6619Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center, Pediatric Plastic Surgery, Pittsburgh, PA, USA
| | - Aditya Mittal
- 6619Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center, Pediatric Plastic Surgery, Pittsburgh, PA, USA
| | - Justin W Beiriger
- 6619Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center, Pediatric Plastic Surgery, Pittsburgh, PA, USA
| | - Xiao Zhu
- 6619Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center, Pediatric Plastic Surgery, Pittsburgh, PA, USA
| | - Lucas Dvoracek
- 6619Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center, Pediatric Plastic Surgery, Pittsburgh, PA, USA
| | - Jesse A Goldstein
- 6619Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center, Pediatric Plastic Surgery, Pittsburgh, PA, USA
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10
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Chiang SN, Peterson EC, Lauzier DC, McEvoy SD, Skolnick GB, Naidoo SD, Smyth MD, Patel KB. Impact of age at endoscopic metopic synostosis repair on anthropometric outcomes. J Neurosurg Pediatr 2022; 30:595-601. [PMID: 36577049 DOI: 10.3171/2022.8.peds22214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 08/15/2022] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Endoscopic strip craniectomy for metopic craniosynostosis relies on rapid growth and postoperative helmeting for correction. Endoscopic repair is generally performed before patients reach 4 months of age, and outcomes in older patients have yet to be quantified. Here, the authors examined a cohort of patients treated with endoscopic repair before or after 4 months of age to determine aesthetic outcomes of delayed repairs. METHODS Data from eligible patients were retrospectively assessed and aggregated in a dedicated metopic synostosis database. Inclusion criteria were radiographically confirmed metopic synostosis and endoscopic treatment. Patients were dichotomized into two groups: those younger than 4 months and those 4 months or older at the time of repair. The frontal width and interfrontal divergence angle (IFDA) were measured on reconstructed CT images. These measurements, alongside operative time, estimated blood loss, and transfusion rates, were compared between groups using the Student t-test or chi-square test. RESULTS The study population comprised 28 patients treated before 4 months of age and 8 patients treated at 4-6 months of age. Patient sex and perioperative complications did not differ by age group. Older age at repair was not significantly associated with 1-year postoperative IFDA (140° ± 4.2° vs 142° ± 5.0°, p = 0.28) or frontal width (84 ± 5.2 vs 83 ± 4.4 mm, p = 0.47). CONCLUSIONS One-year postoperative IFDA and frontal width do not differ significantly between patients treated before and after 4 months of age. Further study with longer follow-up is necessary to confirm the longevity of these results at skeletal maturity.
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Affiliation(s)
- Sarah N Chiang
- 1Division of Plastic and Reconstructive Surgery, Department of Surgery
| | - Erin C Peterson
- 1Division of Plastic and Reconstructive Surgery, Department of Surgery
| | - David C Lauzier
- 2Department of Neurological Surgery; and
- 3Mallinckrodt Institute of Radiology, Washington University School of Medicine in St. Louis, Missouri
| | | | - Gary B Skolnick
- 1Division of Plastic and Reconstructive Surgery, Department of Surgery
| | - Sybill D Naidoo
- 1Division of Plastic and Reconstructive Surgery, Department of Surgery
| | | | - Kamlesh B Patel
- 1Division of Plastic and Reconstructive Surgery, Department of Surgery
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11
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Elawadly A, Smith L, Borghi A, Abdelaziz KI, Silva AHD, Dunaway DJ, Jeelani NUO, Ong J, James G. Correction of trigonocephaly after endoscopic strip craniectomy with postoperative helmet orthosis therapy: a 3D stereophotogrammetric study. J Neurosurg Pediatr 2022; 30:68-77. [PMID: 35364591 DOI: 10.3171/2022.2.peds21546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 02/07/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Endoscopic strip craniectomy with postoperative helmet orthosis therapy (ESCH) has emerged as a less invasive alternative to fronto-orbital remodeling for correction of trigonocephaly. However, there is no standardized objective method for monitoring morphological changes following ESCH. Such a method should be reproducible and avoid the use of ionizing radiation and general anesthesia for diagnostic imaging. The authors analyzed a number of metrics measured using 3D stereophotogrammetry (3DSPG) following ESCH, an imaging alternative that is free of ionizing radiation and can be performed on awake children. METHODS 3DSPG images obtained at two time points (perisurgical and 1-year follow-up [FU]) of children with metopic synostosis who had undergone ESCH were analyzed and compared to 3DSPG images of age-matched control children without craniofacial anomalies. In total, 9 parameters were measured, the frontal angle and anteroposterior volume in addition to 7 novel parameters: anteroposterior area ratio, anteroposterior width ratios 1 and 2, and right and left anteroposterior diagonal ratios 30 and 60. RESULTS Six eligible patients were identified in the operated group, and 15 children were in the control group. All 9 parameters differed significantly between perisurgical and age-matched controls, as well as from perisurgical to FU scans. Comparison of FU scans of metopic synostosis patients who underwent surgery to scans of age-matched controls without metopic synostosis revealed that all parameters were statistically identical, with the exception of the right anteroposterior diagonal ratio 30, which was not fully corrected in the treated patients. The left anterior part of the head showed the most change in surface area maps. CONCLUSIONS In this pilot study, ESCH showed satisfactory results at 1 year, with improvements in all measured parameters compared to perisurgical results and normalization of 8 of 9 parameters compared to an age-matched control group. The results indicate that these parameters may be useful for craniofacial units for monitoring changes in head shape after ESCH for trigonocephaly and that 3DSPG, which avoids the use of anesthesia and ionizing radiation, is a satisfactory monitoring method.
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Affiliation(s)
- Ahmed Elawadly
- 1Craniofacial Unit, Great Ormond Street Hospital, London
- 2Great Ormond Street Institute of Child Health, University College London, United Kingdom
- 3Neurosurgery Department, Aswan University, Aswan, Egypt
- 4Department of Neurosurgery, Great Ormond Street Hospital, London, United Kingdom
| | - Luke Smith
- 1Craniofacial Unit, Great Ormond Street Hospital, London
- 2Great Ormond Street Institute of Child Health, University College London, United Kingdom
| | - Alessandro Borghi
- 2Great Ormond Street Institute of Child Health, University College London, United Kingdom
| | | | - Adikarige Haritha Dulanka Silva
- 1Craniofacial Unit, Great Ormond Street Hospital, London
- 4Department of Neurosurgery, Great Ormond Street Hospital, London, United Kingdom
| | - David J Dunaway
- 1Craniofacial Unit, Great Ormond Street Hospital, London
- 2Great Ormond Street Institute of Child Health, University College London, United Kingdom
| | - Noor Ul Owase Jeelani
- 1Craniofacial Unit, Great Ormond Street Hospital, London
- 2Great Ormond Street Institute of Child Health, University College London, United Kingdom
- 4Department of Neurosurgery, Great Ormond Street Hospital, London, United Kingdom
| | - Juling Ong
- 1Craniofacial Unit, Great Ormond Street Hospital, London
- 2Great Ormond Street Institute of Child Health, University College London, United Kingdom
| | - Greg James
- 1Craniofacial Unit, Great Ormond Street Hospital, London
- 2Great Ormond Street Institute of Child Health, University College London, United Kingdom
- 4Department of Neurosurgery, Great Ormond Street Hospital, London, United Kingdom
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12
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Gover A, Khatib N, Beloosesky R, Bronshtein M. Fetal Trigonocephaly (Strawberry Skull) in Early Pregnancy. J Ultrasound Med 2022; 41:505-509. [PMID: 33769585 DOI: 10.1002/jum.15707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 03/09/2021] [Accepted: 03/13/2021] [Indexed: 06/12/2023]
Abstract
Trigonocephaly was previously described prenatally in association with severe abnormalities, mostly observed after 18 weeks of gestation. We describe our experience with this finding in early pregnancy, between 14 and 17 weeks of gestation. Our series includes 18 cases of trigonocephaly with several etiologies; trisomy 18, de novo translocation, thanatophoric dysplasia, and open spina bifida without hydrocephalus. Two fetuses had no other significant abnormalities and a spontaneous normalization of the skull shape was observed on follow-up. Both had normal genetic testing and postnatal outcome. These two cases represent a new phenomenon of an isolated transient form with normal outcome.
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Affiliation(s)
- Ayala Gover
- Neonatal Intensive Care Unit, Carmel Medical Center, Haifa, Israel
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Nizar Khatib
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel
| | - Ron Beloosesky
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel
| | - Moshe Bronshtein
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel
- Faculty of Social Welfare & Health Sciences, University of Haifa, Haifa, Israel
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13
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Mohamed AM, Kamel AK, Eid MM, Eid OM, Mekkawy M, Hussein SH, Zaki MS, Esmail S, Afifi HH, El-Kamah GY, Otaify GA, El-Awady HA, Elaidy A, Essa MY, El-Ruby M, Ashaat EA, Hammad SA, Mazen I, Abdel-Salam GMH, Aglan M, Temtamy S. Chromosome 9p terminal deletion in nine Egyptian patients and narrowing of the critical region for trigonocephaly. Mol Genet Genomic Med 2021; 9:e1829. [PMID: 34609792 PMCID: PMC8606205 DOI: 10.1002/mgg3.1829] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 05/22/2021] [Accepted: 09/07/2021] [Indexed: 11/30/2022] Open
Abstract
Background This study aimed to delineate the clinical phenotype of patients with 9p deletions, pinpoint the chromosomal breakpoints, and identify the critical region for trigonocephaly, which is a frequent finding in 9p terminal deletion. Methods We investigated a cohort of nine patients with chromosome 9p terminal deletions who all displayed developmental delay, intellectual disability, hypotonia, and dysmorphic features. Of them, eight had trigonocephaly, seven had brain anomalies, seven had autistic manifestations, seven had fair hair, and six had a congenital heart defect (CHD). Results Karyotyping revealed 9p terminal deletion in all patients, and patients 8 and 9 had additional duplication of other chromosomal segments. We used six bacterial artificial chromosome (BAC) clones that could identify the breakpoints at 17–20 Mb from the 9p terminus. Array CGH identified the precise extent of the deletion in six patients; the deleted regions ranged from 16 to 18.8 Mb in four patients, patient 8 had an 11.58 Mb deletion and patient 9 had a 2.3 Mb deletion. Conclusion The gene deletion in the 9p24 region was insufficient to cause ambiguous genitalia because six of the nine patients had normal genitalia. We suggest that the critical region for trigonocephaly lies between 11,575 and 11,587 Mb from the chromosome 9p terminus. To the best of our knowledge, this is the minimal critical region reported for trigonocephaly in 9p deletion syndrome, and it warrants further delineation.
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Affiliation(s)
- Amal M Mohamed
- Division of Human Genetics and Genome Research, Department of Human Cytogenetics, National Research Centre, Cairo, Egypt
| | - Alaa K Kamel
- Division of Human Genetics and Genome Research, Department of Human Cytogenetics, National Research Centre, Cairo, Egypt
| | - Maha M Eid
- Division of Human Genetics and Genome Research, Department of Human Cytogenetics, National Research Centre, Cairo, Egypt
| | - Ola M Eid
- Division of Human Genetics and Genome Research, Department of Human Cytogenetics, National Research Centre, Cairo, Egypt
| | - Mona Mekkawy
- Division of Human Genetics and Genome Research, Department of Human Cytogenetics, National Research Centre, Cairo, Egypt
| | - Shymaa H Hussein
- Division of Human Genetics and Genome Research, Department of Human Cytogenetics, National Research Centre, Cairo, Egypt
| | - Maha S Zaki
- Division of Human Genetics and Genome Research, Department of Clinical Genetics, National Research Centre, Cairo, Egypt
| | - Samira Esmail
- Division of Human Genetics and Genome Research, Department of Clinical Genetics, National Research Centre, Cairo, Egypt
| | - Hanan H Afifi
- Division of Human Genetics and Genome Research, Department of Clinical Genetics, National Research Centre, Cairo, Egypt
| | - Ghada Y El-Kamah
- Division of Human Genetics and Genome Research, Department of Clinical Genetics, National Research Centre, Cairo, Egypt
| | - Ghada A Otaify
- Division of Human Genetics and Genome Research, Department of Clinical Genetics, National Research Centre, Cairo, Egypt
| | - Heba Ahmed El-Awady
- Department of Pediatrics, Faculty of Medicine, Fayoum University, Fayoum, Egypt
| | - Aya Elaidy
- Division of Human Genetics and Genome Research, Department of Clinical Genetics, National Research Centre, Cairo, Egypt
| | - Mahmoud Y Essa
- Division of Human Genetics and Genome Research, Department of Clinical Genetics, National Research Centre, Cairo, Egypt
| | - Mona El-Ruby
- Division of Human Genetics and Genome Research, Department of Clinical Genetics, National Research Centre, Cairo, Egypt
| | - Engy A Ashaat
- Division of Human Genetics and Genome Research, Department of Clinical Genetics, National Research Centre, Cairo, Egypt
| | - Saida A Hammad
- Division of Human Genetics and Genome Research, Department of Human Cytogenetics, National Research Centre, Cairo, Egypt
| | - Inas Mazen
- Division of Human Genetics and Genome Research, Department of Clinical Genetics, National Research Centre, Cairo, Egypt
| | - Ghada M H Abdel-Salam
- Division of Human Genetics and Genome Research, Department of Clinical Genetics, National Research Centre, Cairo, Egypt
| | - Mona Aglan
- Division of Human Genetics and Genome Research, Department of Clinical Genetics, National Research Centre, Cairo, Egypt
| | - Samia Temtamy
- Division of Human Genetics and Genome Research, Department of Clinical Genetics, National Research Centre, Cairo, Egypt
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14
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Kuehle R, Ewerbeck N, Rückschloß T, Ristow O, El Damaty A, Freudlsperger C, Hoffmann J, Engel M. Photogrammetric evaluation of corrective surgery for trigonocephaly. Int J Oral Maxillofac Surg 2021; 51:70-77. [PMID: 34229921 DOI: 10.1016/j.ijom.2021.06.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 05/30/2021] [Accepted: 06/08/2021] [Indexed: 11/16/2022]
Abstract
The aim of this study was to capture preoperative, postoperative, and follow-up head shapes of male trigonocephaly patients who underwent fronto-orbital remodelling (FOR), using three-dimensional (3D) photography. Fifty-seven male infants with metopic synostosis operated on using standardized FOR during a 5-year period were included. All measurements were compared with those of an age-matched healthy control cohort (n = 253 for early postoperative comparison, n = 43 for the 1-year follow-up comparison) to determine the effect of FOR at 14 days and at 1 year post-surgery. Intracranial volume, frontal angle, nasofrontal angle, interfrontoparietal-interparietal ratio, and inter-orbital distances were measured 1 day preoperatively, 14 days and 1 year postoperatively. Mean age at surgery was 9.7 ± 1.1 months. Prior to surgery, boys with metopic synostosis showed a reduced intracranial volume (-7.0%, P < 0.001), frontal angle (-10.2%, P < 0.001), interfrontoparietal-interparietal ratio (-4.9%, P < 0.01), and orbital distances (-6.5%, P < 0.001) compared to the reference group, but values did not differ significantly from the specific control group after surgery (all P> 0.05). This was consistent by the time of the follow-up examination. Corrective surgery should therefore aim to achieve volume expansion and correction of the deformity. Furthermore, 3D photogrammetry provides a valuable alternative to computed tomography scans in the diagnosis of metopic synostosis, significantly reducing the amount of radiation exposure to the brain.
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Affiliation(s)
- R Kuehle
- Department of Oral and Maxillofacial Surgery, University of Heidelberg, Heidelberg, Germany.
| | - N Ewerbeck
- Department of Oral and Maxillofacial Surgery, University of Heidelberg, Heidelberg, Germany
| | - T Rückschloß
- Department of Oral and Maxillofacial Surgery, University of Heidelberg, Heidelberg, Germany
| | - O Ristow
- Department of Oral and Maxillofacial Surgery, University of Heidelberg, Heidelberg, Germany
| | - A El Damaty
- Department of Neurosurgery, University of Heidelberg, Heidelberg, Germany
| | - C Freudlsperger
- Department of Oral and Maxillofacial Surgery, University of Heidelberg, Heidelberg, Germany
| | - J Hoffmann
- Department of Oral and Maxillofacial Surgery, University of Heidelberg, Heidelberg, Germany
| | - M Engel
- Department of Oral and Maxillofacial Surgery, University of Heidelberg, Heidelberg, Germany
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15
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Abstract
Objectives: Severity of trigonocephaly varies and potentially affects intracranial volume
(ICV) and intracranial pressure (ICP). The aim of this study is to measure
ICV in trigonocephaly patients and compare it to normative data and
correlate ICV with the severity of the skull deformity according to UCSQ
(Utrecht Cranial Shape Quantifier). Design: Retrospective study. Setting: Primary craniofacial center. Patients, Participants: Nineteen preoperative patients with nonsyndromic trigonocephaly (age ≤12
months). Intervention: Intracranial volume was measured on preoperative computed tomography (CT)
scans by manual segmentation (OsiriX Fondation). Utrecht Cranial Shape
Quantifier was used to quantify the severity of the skull deformity. When
present, papilledema as sign of elevated ICP was noted. Main Outcome Measures(s): Measured ICV was compared to Lichtenberg normative cranial volume growth
curves, and Pearson correlation coefficient was used to correlate UCSQ with
the ICV. Results: Mean age at CT scan was 6 months (2-11). Mean measured ICV was 842 mL
(579-1124). Thirteen of h19 patients (11/15 boys and 2/4 girls) had an ICV
between ±2 SD curves of Lichtenberg, 2 of 19 (1/15 boys and 1/4 girls) had
an ICV less than −2 SD and 4 of 19 (3/15 boys and 1/4 girls) had an ICV
greater than +2 SD. Mean UCSQ severity of trigonocephaly was 2.40 (−622.65
to 1279.75). Correlation between severity and ICV was negligible (r =
−0.11). No papilledema was reported. Conclusions: Measured ICV was within normal ranges for trigonocephaly patients, in both
mild and severe cases. No correlation was found between severity of
trigonocephaly and ICV.
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Affiliation(s)
- Otto D M Kronig
- Department of Plastic and Reconstructive Surgery, University Medical Center Utrecht, the Netherlands
| | - Sophia A J Kronig
- Department of Plastic and Reconstructive Surgery, University Medical Center Utrecht, the Netherlands
| | - Léon N A Van Adrichem
- Department of Plastic and Reconstructive Surgery, University Medical Center Utrecht, the Netherlands
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16
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Ferreira Furtado LM, Da Costa Val Filho JA, Lima Vieira JA, Dantas Dos Santos AK. Trigonocephaly and Cranium Bifidum Occultum Treated Simultaneously Using the Split-Bone Technique and Piezosurgery. Cureus 2021; 13:e15346. [PMID: 34084690 PMCID: PMC8165942 DOI: 10.7759/cureus.15346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Cranium bifidum occultum (CBO) is a rare congenital disease characterized by the anomalous ossification of parietal bones, which presents with a midline bone defect with no extrusion of intracranial content. Its association with craniosynostosis has been reported only a few times to date. The aim of this case report was to describe, for the first time, the association between presumed non-syndromic trigonocephaly and CBO, as well as the treatment of both conditions using the same surgical approach. This was done by performing fronto-orbital advancement and the split-bone technique using piezosurgery, in order to achieve an autologous sample to cover the bone defect. To the best of our knowledge, this approach was proven to be safe and able to treat both diseases without a heterologous bone graft.
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Affiliation(s)
| | | | - José Antônio Lima Vieira
- Neurosurgery, Biocor Instituto, Nova Lima, BRA.,Pediatric Neurosurgery, Vila da Serra Hospital, Nova Lima, BRA
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17
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Alghamdi M, Alhumsi TR, Altweijri I, Alkhamis WH, Barasain O, Cardona-Londoño KJ, Ramakrishnan R, Guzmán-Vega FJ, Arold ST, Ali G, Adly N, Ali H, Basudan A, Bakhrebah MA. Clinical and Genetic Characterization of Craniosynostosis in Saudi Arabia. Front Pediatr 2021; 9:582816. [PMID: 33937142 PMCID: PMC8085561 DOI: 10.3389/fped.2021.582816] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 03/03/2021] [Indexed: 11/20/2022] Open
Abstract
Background: Craniosynostosis (CS) is defined as pre-mature fusion of one or more of the cranial sutures. CS is classified surgically as either simple or complex based on the number of cranial sutures involved. CS can also be classified genetically as isolated CS or syndromic CS if the patient has extracranial deformities. Currently, the link between clinical and genetic patterns of CS in the Saudi population is poorly understood. Methodology: We conducted a retrospective cohort study among 28 CS patients, of which 24 were operated and four were not. Clinical and genetic data were collected between February 2015 and February 2019, from consenting patient's families. The electronic chart data were collected and analyzed including patient demographics, craniofacial features, other anomalies and dysmorphic features, operative data, intra cranial pressure (ICP), parent consanguinity and genetic testing results. Results: The most common deformity in our population was trigonocephaly. The most performed procedure was cranial vault reconstruction with fronto-orbital advancement, followed by posterior vault distraction osteogenesis and suturectomy with barrel staving. Genetics analysis revealed pathogenic mutations in FGFR2 (6 cases), TWIST1 (3 cases), ALPL (2 cases), and TCF12 (2 cases), and FREM1 (2 case). Conclusion: Compared to Western countries, our Saudi cohort displays significant differences in the prevalence of CS features, such as the types of sutures and prevalence of inherited CS. The genomic background allows our phenotype-genotype study to reclassify variants of unknown significance. Worldwide, the sagittal suture is the most commonly affected suture in simple CS, but in the Saudi population, the metopic suture fusion was most commonly seen in our clinic. Further studies are needed to investigate the characteristics of CS in our population in a multicenter setting.
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Affiliation(s)
- Malak Alghamdi
- Medical Genetic Division, Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Department of Pediatrics, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Taghreed R. Alhumsi
- Department of Plastic Surgery, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Ikhlass Altweijri
- Department of Neurosurgery, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Waleed H. Alkhamis
- Obstetrics and Gynecology, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Omar Barasain
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Kelly J. Cardona-Londoño
- Biological and Environmental Science and Engineering (BESE), Computational Bioscience Research Center (CBRC), King Abdullah University of Science and Technology (KAUST), Thuwal, Saudi Arabia
| | - Reshmi Ramakrishnan
- Biological and Environmental Science and Engineering (BESE), Computational Bioscience Research Center (CBRC), King Abdullah University of Science and Technology (KAUST), Thuwal, Saudi Arabia
| | - Francisco J. Guzmán-Vega
- Biological and Environmental Science and Engineering (BESE), Computational Bioscience Research Center (CBRC), King Abdullah University of Science and Technology (KAUST), Thuwal, Saudi Arabia
| | - Stefan T. Arold
- Biological and Environmental Science and Engineering (BESE), Computational Bioscience Research Center (CBRC), King Abdullah University of Science and Technology (KAUST), Thuwal, Saudi Arabia
- Center de Biochimie Structurale, CNRS, INSERM, Université de Montpellier, Montpellier, France
| | - Ghaida Ali
- College of Medicine, Imam Muhammad Ibn Saud University, Riyadh, Saudi Arabia
| | - Nouran Adly
- College of Medicine Research Centre, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Hebatallah Ali
- College of Medicine Research Centre, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Ahmed Basudan
- Chair of Medical and Molecular Genetics, Department of Clinical Laboratory Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Muhammed A. Bakhrebah
- Life Science and Environment Research Institute, King Abdulaziz City for Science and Technology, Riyadh, Saudi Arabia
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18
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Kronig ODM, Kronig SAJ, Vrooman HA, Veenland JF, Van Adrichem LNA. New method for quantification of the relative severity and (a)symmetry of isolated metopic synostosis. Int J Oral Maxillofac Surg 2021; 50:1477-1484. [PMID: 33744098 DOI: 10.1016/j.ijom.2021.03.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 01/17/2021] [Accepted: 03/03/2021] [Indexed: 11/16/2022]
Abstract
Trigonocephaly is the result of premature fusion of the metopic suture and its severity can vary widely. However, there is no gold standard for quantification of the severity. This study was performed to quantify severity using the Utrecht Cranial Shape Quantifier (UCSQ) and to assess forehead symmetry. Nineteen preoperative non-syndromic trigonocephaly patients (age ≤1 year) were included for the analysis of severity and symmetry. Severity according to the UCSQ was based on the following combined variables: forehead width and relative skull elongation. The UCSQ was compared to the most established quantification methods. A high correlation was found between the UCSQ and visual score (r=0.71). Moderate to negligible correlation was found between the UCSQ and frontal angle, binocular distance, inter-ocular distance, and frontal stenosis. Additionally, correlation between the visual score and these established quantification methods was negligible. Assessment of the frontal peak (a)symmetry (ratio of right to left triangle area in the curve) showed a mean right versus left triangle area ratio of 1.4 (range 0.9-2.4). The results suggest that the UCSQ is appropriate for the quantification of severity based on the high correlation with clinical judgement. Furthermore, a larger triangle area right than left was unexpectedly found, indicating forehead asymmetry.
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Affiliation(s)
- O D M Kronig
- Department of Plastic and Reconstructive Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - S A J Kronig
- Department of Plastic and Reconstructive Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - H A Vrooman
- Department of Radiology, Erasmus MC, Rotterdam, University Medical Center Rotterdam, Rotterdam, The Netherlands; Department of Medical Informatics, Erasmus MC, Rotterdam, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - J F Veenland
- Department of Radiology, Erasmus MC, Rotterdam, University Medical Center Rotterdam, Rotterdam, The Netherlands; Department of Medical Informatics, Erasmus MC, Rotterdam, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - L N A Van Adrichem
- Department of Plastic and Reconstructive Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
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19
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Katsianou M, Papavassiliou KA, Zoi I, Gargalionis AN, Panagopoulos D, Themistocleous MS, Piperi C, Papavassiliou AG, Basdra EK. Polycystin-1 modulates RUNX2 activation and osteocalcin gene expression via ERK signalling in a human craniosynostosis cell model. J Cell Mol Med 2021; 25:3216-3225. [PMID: 33656806 PMCID: PMC8034462 DOI: 10.1111/jcmm.16391] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 02/06/2021] [Accepted: 02/09/2021] [Indexed: 12/13/2022] Open
Abstract
Craniosynostosis refers to the premature fusion of one or more cranial sutures leading to skull shape deformities and brain growth restriction. Among the many factors that contribute to abnormal suture fusion, mechanical forces seem to play a major role. Nevertheless, the underlying mechanobiology-related mechanisms of craniosynostosis still remain unknown. Understanding how aberrant mechanosensation and mechanotransduction drive premature suture fusion will offer important insights into the pathophysiology of craniosynostosis and result in the development of new therapies, which can be used to intervene at an early stage and prevent premature suture fusion. Herein, we provide evidence for the first time on the role of polycystin-1 (PC1), a key protein in cellular mechanosensitivity, in craniosynostosis, using primary cranial suture cells isolated from patients with trigonocephaly and dolichocephaly, two common types of craniosynostosis. Initially, we showed that PC1 is expressed at the mRNA and protein level in both trigonocephaly and dolichocephaly cranial suture cells. Followingly, by utilizing an antibody against the mechanosensing extracellular N-terminal domain of PC1, we demonstrated that PC1 regulates runt-related transcription factor 2 (RUNX2) activation and osteocalcin gene expression via extracellular signal-regulated kinase (ERK) signalling in our human craniosynostosis cell model. Altogether, our study reveals a novel mechanotransduction signalling axis, PC1-ERK-RUNX2, which affects osteoblastic differentiation in cranial suture cells from trigonocephaly and dolichocephaly patients.
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Affiliation(s)
- Maira Katsianou
- Department of Biological Chemistry, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Kostas A Papavassiliou
- Department of Biological Chemistry, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Ilianna Zoi
- Department of Biological Chemistry, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Antonios N Gargalionis
- Department of Biological Chemistry, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | | | - Christina Piperi
- Department of Biological Chemistry, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Athanasios G Papavassiliou
- Department of Biological Chemistry, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Efthimia K Basdra
- Department of Biological Chemistry, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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20
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Baş NS, Baş S. Craniometric Measurements and Surgical Outcomes in Trigonocephaly Patients Who Underwent Surgical Treatment. Cureus 2021; 13:e13676. [PMID: 33824827 PMCID: PMC8018725 DOI: 10.7759/cureus.13676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective The aim of this study was to discuss the results of craniometric measurements and surgical treatments in patients operated for isolated trigonocephaly (TC) in light of the current literature. Methods A total of 18 cases who underwent surgery for isolated TC were included in the study. Age, gender, family history, follow-up time, complications, duration of surgery, surgical blood loss, and amount of blood replacement in these patients were recorded. Craniometric measurements such as metopic angle (MA), cephalic index (CI), interparietal distance (IPD), intercoronal distance (ICD), and their ratio to each other were evaluated according to pre-and postoperative parameters. Photographs of the patients were taken before and after the operation. The Whitaker classification and Kampf "aesthetic outcome staging" were used in the evaluations. Results The mean MA values after the operation increased to reach above 147 degrees in all cases. The average CI did not change. ICD measurement averages increased significantly. The average IPD/ICD ratio decreased due to the increase in ICD and the enlargement of the anterior fossa after the operation. According to the Whitaker classification and Kampf “aesthetic outcome staging” scale, 17 of our cases were at stage I, rated as perfect, and one was at stage II, rated as good. Conclusion Surgery performed at the appropriate time for TC yields cosmetically satisfactory results. Since potential neurological and cognitive morbidities occur mostly in school-age patients, long-term follow-up of the cases is required. Performing craniometric measurements enables patients to be evaluated with objective and measurable numerical data.
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Affiliation(s)
- Nuri Serdar Baş
- Department of Neurosurgery, Bagcilar Education and Research Hospital, University of Health Sciences, Istanbul, TUR
| | - Serap Baş
- Department of Radiology, Gaziosmanpaşa Hospital, İstanbul Yeni Yüzyıl University, Istanbul, TUR
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21
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Chandler L, Park KE, Allam O, Mozaffari MA, Khetpal S, Smetona J, Pourtaheri N, Lu X, Persing JA, Alperovich M. Distinguishing craniomorphometric characteristics and severity in metopic synostosis patients. Int J Oral Maxillofac Surg 2021; 50:1040-1046. [PMID: 33483210 DOI: 10.1016/j.ijom.2020.11.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 09/29/2020] [Accepted: 11/27/2020] [Indexed: 11/30/2022]
Abstract
The decision about which metopic synostosis patients should undergo surgery remains controversial. Multiple measures for radiographic severity have been developed in order to determine the optimal criteria for treatment. The aim of this study was to perform an extensive craniomorphometric analysis of patients who underwent surgery for metopic synostosis to validate and compare the various severity scales developed for this non-syndromic craniosynostosis. A comparative morphometric analysis was performed using computed tomography scans of preoperative metopic synostosis patients (n=167) and normal controls (n=44). Measurements included previous and newly developed metopic severity indices. Volumetric and area analyses were used to determine the degree of anterior cranial area and potential volume restrictions. Of the severity indices measured, the frontal angle, endocranial bifrontal angle (EBF), adjusted EBF (aEBF), anterior cranial fossa angle, horizontal cone angle, and bitemporal/biparietal distance ratio were significantly different in the metopic subjects relative to controls overall. However, metopic index, orbital rim angle, foramen ovale distance, and cranial volume exhibited no significant difference from controls. Only the frontal angle and aEBF correlated with the changes in anterior cranial dimensions observed in metopic synostosis. In conclusion, the frontal angle and aEBF provide the most accurate measures of severity in metopic synostosis.
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Affiliation(s)
- L Chandler
- Section of Plastic Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - K E Park
- Section of Plastic Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - O Allam
- Section of Plastic Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - M A Mozaffari
- Section of Plastic Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - S Khetpal
- Section of Plastic Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - J Smetona
- Section of Plastic Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - N Pourtaheri
- Division of Plastic and Reconstructive Surgery, Riley Children's Hospital, Indiana University School of Medicine, Indianapolis, IN, USA
| | - X Lu
- Section of Plastic Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - J A Persing
- Section of Plastic Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - M Alperovich
- Section of Plastic Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT, USA.
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22
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Schraw JM, Woodhouse JP, Langlois PH, Canfield MA, Scheuerle AE, Agopian AJ, Benjamin RH, Lupo PJ. Risk factors and time trends for isolated craniosynostosis. Birth Defects Res 2020; 113:43-54. [PMID: 33091229 DOI: 10.1002/bdr2.1824] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 10/07/2020] [Accepted: 10/08/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND We sought to investigate associations between maternal/infant characteristics and isolated craniosynostosis as well as its subtypes sagittal, metopic, and coronal synostosis, and assess trends in the prevalence of these conditions. METHODS We identified cases in the Texas Birth Defects Registry from 1999 to 2014. We used Poisson regression to identify associations between maternal/infant characteristics and craniosynostosis. We used joinpoint regression and unadjusted Poisson regression to evaluate temporal trends. Finally, we computed adjusted Poisson models to evaluate whether temporal trends were evident after accounting for changes in the population distributions of maternal/infant characteristics over time. RESULTS Relative to all live births in the general population, cases were more frequently male or preterm. Mothers of cases were more frequently non-Hispanic white and more frequently obese. Non-Hispanic black or Hispanic maternal race/ethnicity was associated with a lower prevalence of all craniosynostosis subtypes. Previous live births were associated with sagittal synostosis; residence on the U.S.-Mexico border was associated with sagittal and coronal synostosis. The prevalence of any isolated craniosynostosis increased (average annual percent change estimated from joinpoint regression [AAPC]: 2.9%), as did the prevalences of sagittal (AAPC: 3.3%) and metopic synostosis (AAPC: 5.4%). In crude Poisson models, the same temporal trends were observed, however these were attenuated after adjusting for maternal/infant characteristics. CONCLUSIONS Prevalence of isolated craniosynostosis increased from 1999 to 2014. The largest AAPC was observed for metopic synostosis. Changes in the population distribution of associated maternal/infant characteristics may explain these trends.
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Affiliation(s)
- Jeremy M Schraw
- Center for Epidemiology and Population Health, Baylor College of Medicine, Houston, Texas, USA.,Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - J P Woodhouse
- Center for Epidemiology and Population Health, Baylor College of Medicine, Houston, Texas, USA.,Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Peter H Langlois
- Texas Department of State Health Services, Birth Defects Epidemiology and Surveillance Branch, Austin, Texas, USA.,Department of Epidemiology, Human Genetics and Environmental Sciences, University of Texas School of Public Health, Austin, Texas, USA
| | - Mark A Canfield
- Texas Department of State Health Services, Birth Defects Epidemiology and Surveillance Branch, Austin, Texas, USA
| | - Angela E Scheuerle
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - A J Agopian
- Department of Epidemiology, Human Genetics and Environmental Sciences, University of Texas School of Public Health, Houston, Texas, USA
| | - Renata H Benjamin
- Department of Epidemiology, Human Genetics and Environmental Sciences, University of Texas School of Public Health, Houston, Texas, USA
| | - Philip J Lupo
- Center for Epidemiology and Population Health, Baylor College of Medicine, Houston, Texas, USA.,Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
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23
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Gandhoke CS, Syal SK, Sharma A, Srivastava AK, Singh D. Craniosynostosis: To Study the Spectrum and Outcome of Surgical Intervention at a Tertiary Referral Institute in India. J Pediatr Neurosci 2020; 15:72-80. [PMID: 33042234 PMCID: PMC7519732 DOI: 10.4103/jpn.jpn_101_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 09/04/2019] [Accepted: 10/30/2019] [Indexed: 11/23/2022] Open
Abstract
Aims and Objectives: This study aimed to analyze the spectrum and surgical outcome of cases of craniosynostosis operated at a tertiary referral institute in India Design: This was a cross-sectional study. Materials and Methods: We retrospectively examined 60 cases of craniosynostosis operated at our institute from 2008 to 2014 (with a minimum follow-up of 2 years). Data was collected including name, age, gender, involved sutures, other medical conditions, whether syndromic craniosynostosis or not, whether symptoms and signs of intracranial hypertension were present or not, associated findings on magnetic resonance imaging of brain and cervico-medullary junction, type of surgery performed, age at which surgery was performed, perioperative complications (if any), and findings on follow-up. To be able to analyze the surgical results, we used the seven category classification system used by Sloan et al. Results: Craniosynostosis affected more men than women. The incidence of syndromic craniosynostosis was 11.67%. Mean age at first surgery was 3.85 years. Chiari malformation was present in 80% of the Crouzon’s syndrome cases, 62.5% of the oxycephaly cases, and 4.44% of the non-syndromic, non-oxycephaly cases. Intracranial hypertension was present in 80% of the Crouzon’s syndrome cases, 75% of the oxycephaly cases, and 6.67% of the non-syndromic, non-oxycephaly cases. Perioperative complications were present in 42.86% of the syndromic craniosynostosis cases, 50% of the oxycephaly cases, and 15.56% of the non-syndromic, non-oxycephaly cases. Compromised overall correction was present in 4 of 7 cases of syndromic craniosynostosis, 3 of 8 cases of oxycephaly, and 2 of 45 cases of non-syndromic, non-oxycephaly group. Conclusion: The study highlights the importance of educating the masses so that cases of craniosynostosis present early. The incidence of Chiari malformation, intracranial hypertension, and perioperative complications was significantly higher in the syndromic craniosynostosis and oxycephaly groups than in single-suture craniosynostosis. The best surgical outcome and the least perioperative complications were seen in the trigonocephaly group. Compromised overall correction and reoperations were more common in the syndromic and complex craniosynostosis groups than in single-suture craniosynostosis.
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Affiliation(s)
- Charandeep S Gandhoke
- Department of Neurosurgery, Maulana Azad Medical College, Lok Nayak Jai Prakash Narayan Hospital, Guru Nanak Eye Centre and Govind Ballabh Pant Institute of Postgraduate Medical Education and Research (GIPMER), New Delhi, India
| | - Simran K Syal
- Department of Paediatrics, Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar, Punjab, India
| | - Ajay Sharma
- Department of Neurosurgery, Maulana Azad Medical College, Lok Nayak Jai Prakash Narayan Hospital, Guru Nanak Eye Centre and Govind Ballabh Pant Institute of Postgraduate Medical Education and Research (GIPMER), New Delhi, India
| | - Arvind K Srivastava
- Department of Neurosurgery, Maulana Azad Medical College, Lok Nayak Jai Prakash Narayan Hospital, Guru Nanak Eye Centre and Govind Ballabh Pant Institute of Postgraduate Medical Education and Research (GIPMER), New Delhi, India
| | - Daljit Singh
- Department of Neurosurgery, Maulana Azad Medical College, Lok Nayak Jai Prakash Narayan Hospital, Guru Nanak Eye Centre and Govind Ballabh Pant Institute of Postgraduate Medical Education and Research (GIPMER), New Delhi, India
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24
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Pressler MP, Geisler EL, Hallac RR, Seaward JR, Kane AA. The Use of Eye Tracking to Discern the Threshold at Which Metopic Orbitofrontal Deformity Attracts Attention. Cleft Palate Craniofac J 2020; 57:1392-1401. [PMID: 32489115 DOI: 10.1177/1055665620926014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION AND OBJECTIVES Surgical treatment for trigonocephaly aims to eliminate a stigmatizing deformity, yet the severity that captures unwanted attention is unknown. Surgeons intervene at different points of severity, eliciting controversy. This study used eye tracking to investigate when deformity is perceived. MATERIAL AND METHODS Three-dimensional photogrammetric images of a normal child and a child with trigonocephaly were mathematically deformed, in 10% increments, to create a spectrum of 11 images. These images were shown to participants using an eye tracker. Participants' gaze patterns were analyzed, and participants were asked if each image looked "normal" or "abnormal." RESULTS Sixty-six graduate students were recruited. Average dwell time toward pathologic areas of interest (AOIs) increased proportionally, from 0.77 ± 0.33 seconds at 0% deformity to 1.08 ± 0.75 seconds at 100% deformity (P < .0001). A majority of participants did not agree an image looked "abnormal" until 90% deformity from any angle. CONCLUSION Eye tracking can be used as a proxy for attention threshold toward orbitofrontal deformity. The amount of attention toward orbitofrontal AOIs increased proportionally with severity. Participants did not generally agree there was "abnormality" until deformity was severe. This study supports the assertion that surgical intervention may be best reserved for more severe deformity.
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Affiliation(s)
- Mark P Pressler
- Department of Plastic Surgery, 12334UT Southwestern, Dallas, TX, USA.,Analytical Imaging and Modeling Center, Children's Medical Center, Dallas, TX, USA
| | - Emily L Geisler
- Department of Plastic Surgery, 12334UT Southwestern, Dallas, TX, USA.,Analytical Imaging and Modeling Center, Children's Medical Center, Dallas, TX, USA
| | - Rami R Hallac
- Department of Plastic Surgery, 12334UT Southwestern, Dallas, TX, USA.,Analytical Imaging and Modeling Center, Children's Medical Center, Dallas, TX, USA
| | - James R Seaward
- Department of Plastic Surgery, 12334UT Southwestern, Dallas, TX, USA.,Analytical Imaging and Modeling Center, Children's Medical Center, Dallas, TX, USA
| | - Alex A Kane
- Department of Plastic Surgery, 12334UT Southwestern, Dallas, TX, USA.,Analytical Imaging and Modeling Center, Children's Medical Center, Dallas, TX, USA
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25
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Kampf S, Micko A, Schwartz E, Schopper C, Reinprecht A. Clinical and aesthetic outcome analysis of a case series of trigonocephaly patients after early fronto-orbital advancement. Int J Oral Maxillofac Surg 2020; 49:1115-21. [PMID: 32171618 DOI: 10.1016/j.ijom.2020.02.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 12/27/2019] [Accepted: 02/26/2020] [Indexed: 11/24/2022]
Abstract
The timing of operation for trigonocephaly is recommended before the age of 1 year. To evaluate the outcome of a consecutive series operated in a single centre, the current study was performed. The study cohort comprised a retrospective single-centre series of 20 patients with trigonocephaly operated before the age of 12 months. Intra- and postoperative clinical data, as well as aesthetic outcome measured by two-dimensional asymmetry index (2D AI) and correction of the curvature on lateral and pictures from above were evaluated. Furthermore, to evaluate postoperative aesthetic outcome, a new classification (Grades I-IV) was proposed. The mean age of the cohort was 7.9 months. 2D AI changed from 0.049 pre- to 0.03 postoperatively (P=0.165). The correction of the curvature in lateral pictures yielded a significant change on postoperative pictures (P=0.002) as well as on pictures from above. Using the proposed classification, 16/20 (80%) patients had a postoperative outcome of Grade I, 4/20 (20%) Grade II. In patients operated before the age of 12 months an excellent (Grade I, AI <0.03) or good aesthetic (Grade II, adequate parents' or surgeon's opinion) result could be reached in all patients.
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26
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Mircevsk V, Zogovska E, Chaparoski A, Micunovic M, Filipce V, Mirchevski MM, Kostov M, Мicunovic L. Trigonocephaly - Our Experience and Treatment in the Republic of Macedonia. ACTA ACUST UNITED AC 2019; 38:35-40. [PMID: 28593893 DOI: 10.1515/prilozi-2017-0004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Prematurely fused metopic suture results in developmental anomaly named trigonocephaly. The treatment of trigonocephaly is a surgical reconstruction, starting from the simple suturectomy toward the complicated cranial vault reconstructions with aim to obtain enough endocranial space for normal development of the brain and aesthetic correction as well. THE AIM The aim of our paper is to present our experience on this pathology in the Republic of Macedonia, stressing the trigonocephaly as one of the rare forms of craniosynostosis. Our material: During a period of 20 years (from 1996 to 2015) at the Pediatric department of the Clinic for Neurosurgery in Skopje, we observed 18 babies with trigonocephaly, including one with Carpenter syndrome and trigonocephaly, 14 males and 4 females. All children had simple trigonocephaly, one had syndromic trigonocephaly (Carpenter's syndrome). According to Oi and Matsumoto classification done in 19865 severe trigonocephaly is observed in 11 cases and, moderate trigonocephaly in 7 cases. Our method: Our treatment consisted of slightly modified Di Rocco's3 surgical procedure named "shell" operation, adding transposition of the "bone flap". RESULTS The postoperative period was uneventful except for the expected forehead swelling. The babies were discharged from the hospital on average at the 8th postoperative day. At the three months control after the surgery, the head had excellent aesthetic appearance, with regular psychomotor development according to the age of the patient (Fig 3а and 3b). We had no serious complications except the expected postoperative swelling of the forehead. All operated children had excellent "long term" aesthetic effect and normal psychomotor development. CONCLUSION The early recognition of these anomalies including all craniosynostoses, the deformities of the newborn and infant's head and the preventive operative reconstruction would prevent abnormal disturbance of the psychomotor development during the child's growth. The multidisciplinary approach can prevent new disabled individuals in the society. Our technique allows shortening the entire surgical procedure, especially in the departments where blood saving devices are not available.
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Affiliation(s)
- Vladimir Mircevsk
- University Clinic for Neurosurgery, Clinical Center "Mother Teresa" Skopje
| | - Elizabeta Zogovska
- University Clinic for Plastic, Aesthetic and Reconstructive Surgery, Clinical Center "Mother Teresa" Skopje
| | | | - Mile Micunovic
- Special Hospital for Orthopedic Surgery and Traumatology "St. Erazmo" - Ohrid
| | - Venko Filipce
- University Clinic for Neurosurgery, Clinical Center "Mother Teresa" Skopje
| | | | - Milenko Kostov
- University Clinic for Neurosurgery, Clinical Center "Mother Teresa" Skopje
| | - Ljubica Мicunovic
- Clinic for Anesthesiology, Reanimation and Intensive Care, Clinical Center "Mother Teresa" Skopje
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27
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Abstract
BACKGROUND Premature closure and ossification of the metopic suture results in a triangular head shape called trigonocephaly and is characterized by a wedge-shaped forehead and frontotemporal narrowing. Untreated craniosynostosis may lead to increased intracranial pressure (ICP) and, thereby, impaired neurodevelopment. Over the last decades, its incidence has been increasing, currently making it the 2nd most common type of isolated craniosynostosis. Treatment consist of cranioplasty, which should be performed before the age of 1 year. OBJECTIVES The aim of this study was to evaluate the long-term surgical outcomes in children operated on for trigonocephaly. MATERIAL AND METHODS The authors reviewed 30 consecutive cases of metopic synostosis treated over a 14-year period in the Plastic Surgery Department in Polanica-Zdrój, Poland. The data was evaluated using the patients' clinical records, and preoperative and postoperative photographs. The patients showed up on a follow-up visit at a median age of 9 years and were examined by an ophthalmologist and a neurologist. The surgical outcomes were evaluated according to the Whitaker classification. In 23 patients, remodeling and the advancement of fronto-orbital skull segments was performed at a median age of 18 months and in 7 milder cases, simple suturectomy or burring of the metopic ridge was sufficient. RESULTS According to the Whitaker classification, results were considered good to excellent (category I and II). Only 1 patient was included into category III. None of the examined cases were included into category IV, which would require a major craniofacial procedure, duplicating or exceeding the original operation. Neurological abnormalities were found in 12 cases and vision defects in 15 cases. CONCLUSIONS Trigonocephaly is currently the 2nd most common type of isolated synostosis. Surgical treatment based on Tessier's and Marchac's modified methods provides good results in patients at the age of about 12 months and prevents the consequences of ICP increase. Primary neurological and behavioral disorders may occur, despite corrective surgery.
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Affiliation(s)
- Piotr Wójcicki
- Department of Plastic Surgery, Wroclaw Medical University, Polanica-Zdrój, Poland
| | - Bernard Prudel
- Department of Plastic Surgery, Wroclaw Medical University, Polanica-Zdrój, Poland
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28
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Verma B, Abhinay A, Singh A, Kumar M. Double outlet right ventricle and aortopulmonary window in a neonate with Bohring-Opitz (Oberklaid-Danks) syndrome: First case report. J Family Med Prim Care 2019; 8:1279-1281. [PMID: 31041292 PMCID: PMC6482752 DOI: 10.4103/jfmpc.jfmpc_74_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Bohring-Opitz syndrome (BOS) is a rare, sporadic genetic disorder, characterized by feeding difficulties, developmental delay, flexion abnormalities, dysmorphic facial features and typical body posture (BOS posture). This syndrome is diagnosed on the basis of distinctive clinical features with or without confirmation by genetic studies. Cardiac abnormalities are seen in almost half of the patients, but are nonspecific. We present a case of a 3-week-old male baby with BOS who was referred to our hospital with congestive heart failure, seizures and failure to thrive. He was diagnosed to have double outlet right ventricle and aortopulmonary window (DORV and APW). To our knowledge, this is the first case of Bohring-Opitz Syndrome ever reported with such clinical presentation.
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Affiliation(s)
- Bhupendra Verma
- Department of Cardiology, Ujala Superspeciality Hospital, Kashipur, Uttarakhand, India
| | - Abhishek Abhinay
- Department of Paediatrics, Institute of Medical Sciences, BHU, Varanasi, Uttar Pradesh, India
| | - Amrita Singh
- Department of Cardiology, Ujala Superspeciality Hospital, Kashipur, Uttarakhand, India
| | - Manu Kumar
- Department of Cardiology, Ujala Superspeciality Hospital, Kashipur, Uttarakhand, India
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Jimenez DF, McGinity MJ, Barone CM. Endoscopy-assisted early correction of single-suture metopic craniosynostosis: a 19-year experience. J Neurosurg Pediatr 2018; 23:61-74. [PMID: 30265229 DOI: 10.3171/2018.6.peds1749] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 06/14/2018] [Indexed: 11/06/2022]
Abstract
In BriefThe long-term results of treating infants with metopic craniosynostosis by using endoscopic, minimally invasive techniques are reported. The impetus arose from the lack of consistent and favorable outcomes associated with calvarial vault remodeling techniques and from the very traumatic and invasive nature of these procedures. The results presented show excellent and consistent long-term outcomes that are superior to traditional methods and are associated with minimal trauma, blood loss, and anesthetic exposure, and with short surgical times.
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Affiliation(s)
- David F Jimenez
- 1Department of Neurosurgery, University of Texas Health San Antonio; and
| | - Michael J McGinity
- 1Department of Neurosurgery, University of Texas Health San Antonio; and
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30
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Peña-Padilla C, Marshall CR, Walker S, Scherer SW, Tavares-Macías G, Razo-Jiménez G, Bobadilla-Morales L, Acosta-Fernández E, Corona-Rivera A, Mendoza-Londono R, Corona-Rivera JR. Compound heterozygous mutations in the IFT140 gene cause Opitz trigonocephaly C syndrome in a patient with typical features of a ciliopathy. Clin Genet 2017; 91:640-646. [PMID: 27874174 DOI: 10.1111/cge.12924] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Revised: 11/17/2016] [Accepted: 11/18/2016] [Indexed: 01/16/2023]
Abstract
〈 We report on an infant with Opitz trigonocephaly C syndrome (OTCS), who also had manifestations of ciliopathy, including short ribs (non-asphyxiating), trident acetabular roofs, postaxial polydactyly cone-shaped epiphyses, and dysplasia of the renal, hepatic and pancreatic tissues. To investigate the molecular cause, we used an exome sequencing strategy followed by Sanger sequencing. Two rare variants, both predicted to result in loss of functional protein, were identified in the IFT140 gene; a substitution at the splice donor site of exon 24 (c.723 + 1 G > T) and a 17 bp deletion, impacting the first coding exon (c.-11_6del). The variants were confirmed as being biallelic using Sanger sequencing, showing that the splice variant was inherited from the propositus mother and the deletion from the father. To date, Mainzer-Saldino syndrome, Jeune syndrome, and a form of nonsyndromic retinal dystrophy, have been identified as ciliopathies caused by IFT140 mutations. We provide the first description of an OTCS phenotype that appears to result from IFT140 mutations. The presentation of this patient is consistent with previous reports showing that OTCS already exhibited skeleletal and nonskeletal features of a ciliopathy.
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Affiliation(s)
- C Peña-Padilla
- Center for Registry and Research on Congenital Anomalies (CRIAC), Division of Pediatrics, Service of Genetics and Cytogenetic Unit, "Dr. Juan I. Menchaca" Civil Hospital of Guadalajara, Guadalajara, Mexico
| | - C R Marshall
- The Centre for Applied Genomics, Genetics and Genome Biology, Toronto, Canada.,Genome Diagnostics, Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Canada
| | - S Walker
- The Centre for Applied Genomics, Genetics and Genome Biology, Toronto, Canada
| | - S W Scherer
- The Centre for Applied Genomics, Genetics and Genome Biology, Toronto, Canada.,Department of Molecular Genetics and the McLaughlin Centre, University of Toronto, Toronto, Canada
| | - G Tavares-Macías
- Service of Pathology, "Dr. Juan I. Menchaca" Civil Hospital of Guadalajara, Guadalajara, Mexico
| | - G Razo-Jiménez
- Service of Pathology, "Dr. Juan I. Menchaca" Civil Hospital of Guadalajara, Guadalajara, Mexico
| | - L Bobadilla-Morales
- Center for Registry and Research on Congenital Anomalies (CRIAC), Division of Pediatrics, Service of Genetics and Cytogenetic Unit, "Dr. Juan I. Menchaca" Civil Hospital of Guadalajara, Guadalajara, Mexico.,"Dr. Enrique Corona-Rivera" Institute of Human Genetics, Department of Molecular Biology and Genomics, Health Sciences University Centre, University of Guadalajara, Guadalajara, Mexico
| | - E Acosta-Fernández
- Center for Registry and Research on Congenital Anomalies (CRIAC), Division of Pediatrics, Service of Genetics and Cytogenetic Unit, "Dr. Juan I. Menchaca" Civil Hospital of Guadalajara, Guadalajara, Mexico
| | - A Corona-Rivera
- Center for Registry and Research on Congenital Anomalies (CRIAC), Division of Pediatrics, Service of Genetics and Cytogenetic Unit, "Dr. Juan I. Menchaca" Civil Hospital of Guadalajara, Guadalajara, Mexico.,"Dr. Enrique Corona-Rivera" Institute of Human Genetics, Department of Molecular Biology and Genomics, Health Sciences University Centre, University of Guadalajara, Guadalajara, Mexico
| | - R Mendoza-Londono
- Division of Clinical and Metabolic Genetics, Department of Paediatrics, The Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - J R Corona-Rivera
- Center for Registry and Research on Congenital Anomalies (CRIAC), Division of Pediatrics, Service of Genetics and Cytogenetic Unit, "Dr. Juan I. Menchaca" Civil Hospital of Guadalajara, Guadalajara, Mexico.,"Dr. Enrique Corona-Rivera" Institute of Human Genetics, Department of Molecular Biology and Genomics, Health Sciences University Centre, University of Guadalajara, Guadalajara, Mexico
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Wang JY, Dorafshar AH, Liu A, Groves ML, Ahn ES. The metopic index: an anthropometric index for the quantitative assessment of trigonocephaly from metopic synostosis. J Neurosurg Pediatr 2016; 18:275-80. [PMID: 27153376 DOI: 10.3171/2016.2.peds15524] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Because the metopic suture normally fuses during infancy, there are varying degrees of severity in head shape abnormalities associated with premature fusion. A method for the objective and reproducible assessment of metopic synostosis is needed to guide management, as current methods are limited by their reliance on aesthetic markers. The object of this study was to describe the metopic index (MI), a simple anthropometric cranial measurement. The measurements can be obtained from CT scans and, more importantly, from palpable cranial landmarks, and the index provides a rapid tool for evaluating patients in both pre- and postoperative settings. METHODS High-resolution head CT scans obtained in 69 patients (age range 0-24 months) diagnosed with metopic craniosynostosis were retrospectively reviewed. Preoperative 3D reconstructions were available in 15 cases, and these were compared with 3D reconstructions of 324 CT scans obtained in a control group of 316 infants (age range 0-24 months) who did not have any condition that might affect head size or shape and also in a subset of this group, comprising 112 patients precisely matched to the craniosynostosis patients with respect to age and sex. Postoperative scans were available and reviewed in 9 of the craniosynostosis patients at a mean time of 7.1 months after surgical repair. 3D reconstructions of these scans were matched with controls based upon age and sex. RESULTS The mean preoperative MI for patients with trigonocephaly was 0.48 (SD 0.05), significantly lower than the mean values of 0.57 (SD 0.04) calculated on the basis of all 324 scans obtained in controls (p < 0.001) and 0.58 (SD 0.04) for the subset of 112 age- and sex-matched controls (p < 0.001). For 7 patients with both pre- and postoperative CT scans available for evaluation, the mean postoperative MI was 0.55 (SD 0.03), significantly greater than their preoperative MIs (mean 0.48 [SD 0.04], p = 0.001) and comparable to the mean MI of the controls (p = 0.30). In 4 patients, clinically obtained postoperative MIs by caliper measurement were comparable to measurements derived from CT (p = 0.141). CONCLUSIONS The MI is a useful measurement of the severity of trigonocephaly in patients with metopic synostosis. This simple quantitative assessment can potentially be used in the clinical setting to guide preoperative evaluation, surgical repair, and postoperative degree of correction.
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Affiliation(s)
- Joanna Y Wang
- Division of Pediatric Neurosurgery, Department of Neurosurgery, and
| | - Amir H Dorafshar
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ann Liu
- Division of Pediatric Neurosurgery, Department of Neurosurgery, and
| | - Mari L Groves
- Division of Pediatric Neurosurgery, Department of Neurosurgery, and
| | - Edward S Ahn
- Division of Pediatric Neurosurgery, Department of Neurosurgery, and
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Urreizti R, Roca-Ayats N, Trepat J, Garcia-Garcia F, Aleman A, Orteschi D, Marangi G, Neri G, Opitz JM, Dopazo J, Cormand B, Vilageliu L, Balcells S, Grinberg D. Screening of CD96 and ASXL1 in 11 patients with Opitz C or Bohring-Opitz syndromes. Am J Med Genet A 2015; 170A:24-31. [PMID: 26768331 DOI: 10.1002/ajmg.a.37418] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Accepted: 09/23/2015] [Indexed: 12/30/2022]
Abstract
Opitz C trigonocephaly (or Opitz C syndrome, OTCS) and Bohring-Opitz syndrome (BOS or C-like syndrome) are two rare genetic disorders with phenotypic overlap. The genetic causes of these diseases are not understood. However, two genes have been associated with OTCS or BOS with dominantly inherited de novo mutations. Whereas CD96 has been related to OTCS (one case) and to BOS (one case), ASXL1 has been related to BOS only (several cases). In this study we analyze CD96 and ASXL1 in a group of 11 affected individuals, including 2 sibs, 10 of them were diagnosed with OTCS, and one had a BOS phenotype. Exome sequences were available on six patients with OTCS and three parent pairs. Thus, we could analyze the CD96 and ASXL1 sequences in these patients bioinformatically. Sanger sequencing of all exons of CD96 and ASXL1 was carried out in the remaining patients. Detailed scrutiny of the sequences and assessment of variants allowed us to exclude putative pathogenic and private mutations in all but one of the patients. In this patient (with BOS) we identified a de novo mutation in ASXL1 (c.2100dupT). By nature and location within the gene, this mutation resembles those previously described in other BOS patients and we conclude that it may be responsible for the condition. Our results indicate that in 10 of 11, the disease (OTCS or BOS) cannot be explained by small changes in CD96 or ASXL1. However, the cohort is too small to make generalizations about the genetic etiology of these diseases.
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Affiliation(s)
- Roser Urreizti
- Department of Genetics, Faculty of Biology, Universitat de Barcelona, CIBERER, IBUB, Barcelona, Spain
| | - Neus Roca-Ayats
- Department of Genetics, Faculty of Biology, Universitat de Barcelona, CIBERER, IBUB, Barcelona, Spain
| | - Judith Trepat
- Department of Genetics, Faculty of Biology, Universitat de Barcelona, CIBERER, IBUB, Barcelona, Spain
| | - Francisco Garcia-Garcia
- Department of Computational Genomics, Centro Investigación Prí, ncipe Felipe, Valencia, Spain.,BIER, CIBERER, Valencia, Spain
| | | | - Daniela Orteschi
- Istituto Genetica Medica, Università Cattolica Sacro Cuore, Policlínico A Gemelli, Roma, Italy
| | - Giuseppe Marangi
- Istituto Genetica Medica, Università Cattolica Sacro Cuore, Policlínico A Gemelli, Roma, Italy
| | - Giovanni Neri
- Istituto Genetica Medica, Università Cattolica Sacro Cuore, Policlínico A Gemelli, Roma, Italy
| | - John M Opitz
- Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah
| | - Joaquin Dopazo
- Department of Computational Genomics, Centro Investigación Prí, ncipe Felipe, Valencia, Spain.,BIER, CIBERER, Valencia, Spain
| | - Bru Cormand
- Department of Genetics, Faculty of Biology, Universitat de Barcelona, CIBERER, IBUB, Barcelona, Spain
| | - Lluïsa Vilageliu
- Department of Genetics, Faculty of Biology, Universitat de Barcelona, CIBERER, IBUB, Barcelona, Spain
| | - Susana Balcells
- Department of Genetics, Faculty of Biology, Universitat de Barcelona, CIBERER, IBUB, Barcelona, Spain
| | - Daniel Grinberg
- Department of Genetics, Faculty of Biology, Universitat de Barcelona, CIBERER, IBUB, Barcelona, Spain
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McEwan TW, Martin AL, Tanaka T, Aldridge K, Muzaffar AR. Evaluating Children With Metopic Craniosynostosis: The Cephalic Width-Intercoronal Distance Ratio. Cleft Palate Craniofac J 2015; 53:e95-e100. [PMID: 26090786 DOI: 10.1597/14-310] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To identify an additional objective measure to aid in the evaluation of children with isolated metopic craniosynostosis. DESIGN This is a retrospective study comparing specific computed tomography scan measurements between surgical and nonsurgical cohorts of children with isolated metopic craniosynostosis. Children were included if they were diagnosed with isolated metopic craniosynostosis and ultimately underwent computed tomography scan imaging as part of their evaluation. The subjects were placed in the surgical or nonsurgical cohorts on the basis of the final treatment recommendation after they completed a full multidisciplinary, multimodality evaluation. Comparisons were made with a control group of unaffected patients from our institutional trauma registry. SETTING Tertiary academic institution. PATIENTS, PARTICIPANTS The subjects are patients who had been previously evaluated in our clinic for isolated metopic craniosynostosis and received a computed tomography scan as part of their workup. RESULTS The average intercoronal distances were significantly different among all three groups (P < .002). The average cephalic width-intercoronal distance ratio for children who received a recommendation for surgery differed significantly from that of both the observation cohort and the control group (P < .001). However, the cephalic width-intercoronal distance ratio did not differ between the observation cohort and the control group (P = .927). CONCLUSIONS The cephalic width-intercoronal distance ratio may be an additional objective measurement to aid in the clinical evaluation of children with metopic craniosynostosis.
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Abstract
Trigonocephaly is the premature fusion of the metopic suture leading to deformation of anterior calvarium causing keel shaped deformity of forehead. In most cases, surgical correction is for aesthetic and psychosocial reasons. Various techniques have been described. Here we describe a technique, which is simple to perform with good postoperative results. Metopic suture is excised, one side is reconstructed in finger clasping manner to fit in an expanded area, and the other side is transected and simply molded, and all these fixed with nonabsorbable suture. Supraorbital horizontal bar is mobilized on either side anteriorly and fixed with titanium plate and screws.
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Affiliation(s)
- Danish Mohammad
- Department of Neurosurgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sivashanmugam Dhandapani
- Department of Neurosurgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Abstract
Metopic craniosynostosis is a common growth disturbance in the infant cranium, second only to sagittal synostosis. Presenting symptoms are usually of a clinical nature and are defined by an angular forehead, retruded lateral brow, bitemporal narrowing, and a broad-based occiput. These changes create the pathognomonic trigonocephalic cranial shape. Aesthetic in nature, these morphological changes do not constitute the only developmental issues faced by children who present with this malady. Recent studies and anecdotal evidence have also demonstrated that children who present with metopic synostosis may face issues with respect to intellectual and/or psychological development. The authors present an elegant approach to the surgical reconstruction of the trigonocephalic cranium using an in situ bandeau approach.
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Affiliation(s)
- Eric H Hubli
- Department of Craniofacial Reconstruction, Cook Children's Hospital, Fort Worth, Texas
| | - Richard A Roberts
- Department of Neurosurgery, Cook Children's Hospital, Fort Worth, Texas
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Abstract
Premature closure of the metopic suture results in a growth restriction of the frontal bones, which leads to a skull malformation known as trigonocephaly. Over the course of recent decades, its incidence has been rising, currently making it the second most common type of craniosynostosis. Treatment consists of a cranioplasty, usually preformed before the age of 1 year. Metopic synostosis is linked with an increased level of neurodevelopmental delays. Theories on the etiology of these delays range from a reduced volume of the anterior cranial fossa to intrinsic malformations of the brain. This paper aims to provide an overview of this entity by giving an update on the epidemiology, etiology, evolution of treatment, follow-up, and neurodevelopment of metopic synostosis.
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Affiliation(s)
- Jacques van der Meulen
- Dutch Craniofacial Unit, Department of Plastic, Reconstructive and Hand Surgery, Sophia Children's Hospital, Erasmus Medical Center, Dr Molewaterplein 60, 3015GJ, Rotterdam, The Netherlands.
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