Intracranial Volume Before and After Surgical Treatment for Isolated Metopic Synostosis

Abstract

Metopic synostosis results in a keel-shaped forehead, hypotelorism, and an increased interparietal width. This study aimed to measure the frontal and total intracranial volume in patients with metopic synostosis before and after surgery and to compare the effect of 2 different operation methods. All patients operated for isolated metopic synostosis between 2002 and 2008 at Sahlgrenska University Hospital who had undergone preoperative and/or postoperative computed tomographic examination (at 3 y of age) were included. The patients were grouped according to operation method: (1) forehead remodeling in combination with a bone graft or (2) forehead remodeling in combination with a spring. Sex- and age-matched controls were identified. A previously developed MATLAB computer program was used to measure the frontal and total intracranial volumes. Sixty patients and 198 controls were included. Preoperatively, the patients with metopic synostosis had significantly lower frontal volumes than those of the controls (P < 0.001) but equal total intracranial volumes. The operations redistributed the intracranial volume and resulted in an improved, frontal-total intracranial volume ratio. However, at 3 years of age, the frontal volume (P < 0.001), total intracranial volume (P ≤ 0.002), and ratio between the 2 (P < 0.001) were significantly lower in the patients than in the controls. The 2 operation methods were equally efficient in creating an improved frontal-total ratio. Surgery for metopic synostosis improves the distribution of the intracranial volume but does not result in normal total intracranial volume or frontal volume at 3 years of age.

Metopic synostosis: Measuring intracranial volume change following fronto-orbital advancement using three-dimensional photogrammetry

“…Eighteen boys with trigonocephalus between the ages of 7 and 12 month and the respective pre-and post-operative intracranial volume. the intracranial volume, as reflected by a significant improvement in the frontal-to-total intracranial volume ratio toward that of the normal population (Maltese et al, 2014). Conversely, Paniagua et al (2013) have demonstrated in three children with metopic synostosis using pre-and postoperative CT scans, that brain volumes were larger than age-matched controls pre-and postoperatively.…”

“…Netherway et al (2005) have shown, that boys with metopic synostosis had a tendency toward smaller intracranial volumes than did healthy patients, more precisely patients younger than 7 months of age (17 boys) had normal intracranial volumes whereas patients older than 7 months (8 boys) had smaller volumes. Most recently, Maltese et al (2014) have demonstrated, that children with metopic synostosis, at least up to the ninth months, show normal intracranial volumes as a consequence of the bi-parietal widening. However, the proportion of the intracranial volume anterior to the coronal sutures is about 30% lower than normal.…”

A new quantitative image-based method for evaluation of bony temporal hollowing in metopic synostosis

“…The intra-cranial volume and its distribution have also been measured systematically [11,12]. The severity of metopic deformation can be classified, e.g.…”

The value of tranexamic acid during fronto-orbital advancement in isolated metopic craniosynostosis

“…Next, the orbital segment was bent up in the midline. In severe cases, a midline bone graft was inserted to improve hypotelorism (Maltese et al, 2014). After reinsertion of the osseous fragments with a slight advancement, fixation was performed using resorbable plates and vicryl stitches.…”

“…Typical clinical hallmarks of this isolated craniosynostosis include a keel-shaped forehead, a midline ridge, retrusion of the supraorbital region, a compensatory biparietal widening and hypotelorism (Maltese et al, 2014). Trigonocephaly used to be known as the third most common single suture craniosynostosis after sagittal and unilateral coronal synostosis, with an incidence varying from 1/7500 to 1/15 000.…”