Surgical treatment of single-suture craniosynostosis: an argument for quantitative methods to evaluate cosmetic outcomes

Hankinson, Todd C.; Fontana, Elizabeth J.; Anderson, Richard C. E.; Feldstein, Neil A.

doi:10.3171/2010.5.peds09313

Cited by 46 publications

(29 citation statements)

References 62 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…5,40,57 The goal of early surgery to provide excellent cosmetic outcomes through vault reconstruction has been well established. 17,25,41,43,46 However, the question "does surgery assist in normalized brain development and improved cognitive performance later in life?" is one of great importance.…”

Section: Discussionmentioning

confidence: 99%

Normalization of brain morphology after surgery in sagittal craniosynostosis

Brooks

Yang

Beckett

et al. 2016

PED

View full text Add to dashboard Cite

OBJECT Nonsyndromic craniosynostosis (NSC) is associated with significant learning disability later in life. Surgical reconstruction is typically performed before 1 year of age to correct the cranial vault morphology and to allow for normalized brain growth with the goal of improving cognitive function. Yet, no studies have assessed to what extent normalized brain growth is actually achieved. Recent advances in MRI have allowed for automated methods of objectively assessing subtle and pronounced brain morphological differences. The authors used one such technique, deformation-based morphometry (DBM) Jacobian mapping, to determine how previously treated adolescents with sagittal NSC (sNSC) significantly differ in brain anatomy compared with healthy matched controls up to 11.5 years after surgery. METHODS Eight adolescent patients with sNSC, previously treated via whole-vault cranioplasty at a mean age of 7 months, and 8 age- and IQ-matched control subjects without craniosynostosis (mean age for both groups = 12.3 years), underwent functional 3-T MRI. Statistically significant group tissue-volume differences were assessed using DBM, a whole-brain technique that estimates morphological differences between 2 groups at each voxel (p < 0.01). Group-wise Jacobian volume maps were generated using a spacing of 1.5 mm and a resolution of 1.05 × 1.05 × 1.05 mm3. RESULTS There were no significant areas of volume reduction or expansion in any brain areas in adolescents with sNSC compared with controls at a significance level of p < 0.01. At the more liberal threshold of p < 0.05, two areas of brain expansion extending anteroposteriorly in the right temporooccipital and left frontoparietal regions appeared in patients with sNSC compared with controls. CONCLUSIONS Compared with previous reports on untreated infants with sNSC, adolescents with sNSC in this cohort had few areas of brain dysmorphology many years after surgery. This result suggests that comprehensive cranioplasty performed at an early age offers substantial brain normalization by adolescence, but also that some effects of vault constriction may still persist after treatment. Specifically, few areas of expansion in frontoparietal and temporooccipital regions may persist. Overall, data from this small cohort support the primary goal of surgery in allowing for more normalized brain growth. Larger samples, and correlating degree of normalization with cognitive performance in NSC, are warranted.

show abstract

Section: Discussionmentioning

confidence: 99%

Normalization of brain morphology after surgery in sagittal craniosynostosis

Brooks

Yang

Beckett

et al. 2016

PED

View full text Add to dashboard Cite

show abstract

“…pressure may lead to neurocognitive impairment (17). The incidence of craniosynostosis overall is one in 2000-2500 children (18)(19)(20), with 8% of the cases familial or syndromic (21). Nonsyndromic craniosynostosis can be either isolated (single suture) or complex (multiple sutures).…”

Section: Neonatal Scalp Hematomamentioning

confidence: 99%

US of Pediatric Superficial Masses of the Head and Neck

et al. 2018

View full text Add to dashboard Cite

Superficial palpable masses of the head and neck are common in the pediatric population, with the vast majority of the lesions ultimately proven to be benign. Duplex ultrasonography (US) has emerged as the first-line imaging modality for the evaluation of superficial pediatric masses. Without utilizing radiation, iodinated contrast material, or sedation and/or anesthesia, US provides a means for quick and cost-effective acquisition of information, including the location, size, shape, internal content, and vascularity of the mass. In this review, the US findings are described for a variety of common and uncommon pediatric head and neck masses diagnosed in our practice. Specifically, the entities covered include neonatal scalp hematoma, craniosynostosis, dermoid and epidermoid cysts, Langerhans cell histiocytosis, lymph nodes and their complications, fibromatosis colli, thyroglossal duct cyst, branchial cleft cyst, cervical thymus, congenital goiter, thyroid papillary carcinoma, parathyroid adenoma, hemangioma, lymphangioma, jugular vein phlebectasia, Lemierre syndrome, acute parotitis and parotid abscess, leukemia and/or lymphoma, neurogenic tumor, and rhabdomyosarcoma. Ultimately, in situations in which the head or neck mass is too large, deep, or hyperechoic to be fully assessed within the US field of view, or if malignancy or a high-flow vascular lesion is suspected, then further evaluation with cross-sectional imaging is warranted. Online supplemental material is available for this article. RSNA, 2018.

show abstract

“…19 Without an objective grading system, clinical determination of trigonocephaly that requires surgical intervention is challenging. 8 The use of anthropometric cranial measurements has improved the precision and reliability of the assessment of other cranial deformities such as positional plagiocephaly, scaphocephaly, and brachycephaly. 21,22 The objective of this study was to describe the metopic index (MI), a simple anthropometric cranial measurement that can be obtained both from CT scans and from palpable cranial landmarks, as a rapid tool for evaluating patients with metopic synostosis in both pre-and postoperative settings.…”

mentioning

confidence: 99%

The metopic index: an anthropometric index for the quantitative assessment of trigonocephaly from metopic synostosis

Wang¹,

Dorafshar

Liu³

et al. 2016

PED

View full text Add to dashboard Cite

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.

show abstract

Surgical treatment of single-suture craniosynostosis: an argument for quantitative methods to evaluate cosmetic outcomes

Cited by 46 publications

References 62 publications

Normalization of brain morphology after surgery in sagittal craniosynostosis

Normalization of brain morphology after surgery in sagittal craniosynostosis

US of Pediatric Superficial Masses of the Head and Neck

The metopic index: an anthropometric index for the quantitative assessment of trigonocephaly from metopic synostosis

Contact Info

Product

Resources

About