Correlation of Intracranial Volume With Head Surface Volume in Patients With Multisutural Craniosynostosis

Misier, Karan Ramdat; Breakey, Richard W. F.; Caron, Cornelia J.J.M.; Schievano, Silvia; Dunaway, David; Jeelani, Owase; Borghi, Alessandro

doi:10.1097/scs.0000000000006372

Cited by 4 publications

(3 citation statements)

References 20 publications

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“…It also allows some correction of a brachycephalic skull shape. At Great Ormond Street Hospital for Children (GOSH), the procedure of choice is a spring-assisted posterior vault expansion (sPVE) [ 10 ]. It is a less invasive operation than a fronto-orbital reconstruction, providing a greater degree of vault expansion [ 11 ] and leaving the frontal region intact for any subsequent fronto-facial surgery.…”

Section: Introductionmentioning

confidence: 99%

Electrophysiological and fundoscopic detection of intracranial hypertension in craniosynostosis

Rufai

Marmoy

Thompson

et al. 2022

Eye

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Aims To assess the diagnostic accuracy of fundoscopy and visual evoked potentials (VEPs) in detecting intracranial hypertension (IH) in patients with craniosynostosis undergoing spring-assisted posterior vault expansion (sPVE). Methods Children with craniosynostosis undergoing sPVE and 48-hour intracranial pressure (ICP) monitoring were included in this single-centre, retrospective, diagnostic accuracy study. Data for ICP, fundoscopy and VEPs were analysed. Primary outcome measures were papilloedema on fundoscopy, VEP assessments and IH, defined as mean ICP > 20 mmHg. Diagnostic indices were calculated for fundoscopy and VEPs against IH. Secondary outcome measures included final visual outcomes. Results Fundoscopic examinations were available for 35 children and isolated VEPs for 30 children, 22 of whom had at least three serial VEPs. Sensitivity was 32.1% for fundoscopy (95% confidence intervals [CI]: 15.9–52.4) and 58.3% for isolated VEPs (95% CI 36.6–77.9). Specificity for IH was 100% for fundoscopy (95% CI: 59.0–100) and 83.3% for isolated VEPs (95% CI: 35.9–99.6). Where longitudinal deterioration was suspected from some prVEPs but not corroborated by all, sensitivity increased to 70.6% (95% CI: 44.0–89.7), while specificity decreased to 60% (95% CI: 14.7–94.7). Where longitudinal deterioration was clinically significant, sensitivity decreased to 47.1% (23.0–72.2) and specificity increased to 100% (47.8–100). Median final BCVA was 0.24 logMAR (n = 36). UK driving standard BCVA was achieved by 26 patients (72.2%), defined as ≥0.30 logMAR in the better eye. Conclusion Papilloedema present on fundoscopy reliably indicated IH, but its absence did not exclude IH. VEP testing boosted sensitivity at the expense of specificity, depending on method of analysis.

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Section: Introductionmentioning

confidence: 99%

Electrophysiological and fundoscopic detection of intracranial hypertension in craniosynostosis

Rufai

Marmoy

Thompson

et al. 2022

Eye

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“…Additionally, this work included a relatively small population, due to the limited number of patients who had both pre- and postoperative CT scans available at GOSH. A recent study from our group 25 , showed that the ICV in syndromic patients correlates with the head surface volume. Therefore, in perspective works, non-ionizing imaging methods such as 3D surface scanning could be used to perform both preoperative planning and postoperative assessment and overcome the need for CT data in the modelling pipeline.…”

Section: Discussionmentioning

confidence: 81%

Spring-assisted posterior vault expansion: a parametric study to improve the intracranial volume increase prediction

Deliège,

Ramdat Misier,

Silva

et al. 2023

Sci Rep

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Spring-assisted posterior vault expansion has been adopted at the London Great Ormond Street Hospital for Children to treat raised intracranial pressure in patients affected by syndromic craniosynostosis, a congenital calvarial anomaly causing the premature fusion of skull sutures. This procedure involves elastic distractors used to dynamically reshape the skull and increase the intracranial volume (ICV). In this study, we developed and validated a patient-specific model able to predict the ICV increase and carried out a parametric study to investigate the effect of surgical parameters on that final volume. Pre- and post-operative computed tomography data relative to 18 patients were processed to extract simplified patient-specific skull shape, replicate surgical cuts, and simulate spring expansion. A parametric study was performed to quantify each parameter’s impact on the surgical outcome: for each patient, the osteotomy location was varied in a pre-defined range; local sensitivity of the predicted ICV to each parameter was analysed and compared. Results showed that the finite element model performed well in terms of post-operative ICV prediction and allowed for parametric optimization of surgical cuts. The study indicates how to optimize the ICV increase according to the type of procedure and provides indication on the most robust surgical strategy.

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“…A small cohort of patients was included in this study, due to the limited number of patients who had both pre-and postoperative CT scans available at our Centre. A recent study from our group has shown that ICV in SC patients correlates well with head surface volume (Ramdat Misier et al, 2020): in the future, both preoperative planning and post-operative assessment could be performed by means of nonionizing imaging methods such as 3D surface scanning (Ramdat Misier et al, 2020), thus overcoming the need for CT data in the modelling pipeline.…”

Section: Tablementioning

confidence: 99%

Validation of an in-silico modelling platform for outcome prediction in spring assisted posterior vault expansion

Deliège

Misier

Bozkurt

et al. 2021

Clinical Biomechanics

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Background: Spring-Assisted Posterior Vault Expansion has been adopted at Great Ormond Street Hospital for Children, London, UK to treat raised intracranial pressure in patients affected by syndromic craniosynostosis, a congenital calvarial anomaly which causes premature fusion of skull sutures. This procedure aims at normalising head shape and augmenting intracranial volume by means of metallic springs which expand the back portion of the skull. The aim of this study is to create and validate a 3D numerical model able to predict the outcome of spring cranioplasty in patients affected by syndromic craniosynostosis, suitable for clinical adoption for preoperative surgical planning. Methods: Retrospective spring expansion measurements retrieved from x-ray images of 50 patients were used to tune the skull viscoelastic properties for syndromic cases. Pre-operative computed tomography (CT) data relative to 14 patients were processed to extract patient-specific skull shape, replicate surgical cuts and simulate spring insertion. For each patient, the predicted finite element post-operative skull shape model was compared with the respective post-operative 3D CT data. Findings: The comparison of the sagittal and transverse cross-sections of the simulated end-of-expansion calvaria and the post-operative skull shapes extracted from CT images showed a good shape matching for the whole population. The finite element model compared well in terms of post-operative intracranial volume prediction (R 2 = 0.92, p < 0.0001). Interpretation: These preliminary results show that Finite Element Modelling has great potential for outcome prediction of spring assisted posterior vault expansion. Further optimisation will make it suitable for clinical deployment.

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Correlation of Intracranial Volume With Head Surface Volume in Patients With Multisutural Craniosynostosis

Cited by 4 publications

References 20 publications

Electrophysiological and fundoscopic detection of intracranial hypertension in craniosynostosis

Electrophysiological and fundoscopic detection of intracranial hypertension in craniosynostosis

Spring-assisted posterior vault expansion: a parametric study to improve the intracranial volume increase prediction

Validation of an in-silico modelling platform for outcome prediction in spring assisted posterior vault expansion

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