The skull base in plagiocephaly

Abstract

Between 1975 and 1992, 426 children with craniofacial malformations were treated in the Department of Pediatric Neurosurgery at the Hôpital des Enfants de la Timone in Marseille. Plagiocephaly was present in 71 (16.6%). The authors present a reproducible analysis of the skull base in plagiocephaly based on these 71 patients. A control group of Mediterranean children (n = 20) was used for comparison. Clinical anthropometric patterns were analyzed in all cases. Comparison with the control group showed a difference only in the nasion-lambda distance. Data obtained from clinical anthropometry were compared for the involved and the uninvolved sides. A three-dimensional reconstruction was possible in 20 cases. The statistical correlation between the basal angles (nasion-pterional, nasion-petrosal, nasion-clino-basion, and zygomatic angles) of the involved and uninvolved sides allows a new nosographic identification of this complex malformation.

Skull Base Growth in Craniosynostosis

“…Several publications document well such abnormalities with measurements both on lateral skull radiographs [3, 4, 5]and on 2D slices of CT scans [11, 12, 13, 14, 15, 25]. It is now established that in most forms of craniosynostosis, the anterior skull base is abnormally formed as a result of varying degrees of involvement and early closure of the spheno-ethmoidal sutures.…”

“…The abnormal configuration of the posterior skull base in various forms of synostosis has been quantified with measurements of 2D parameters either on lateral skull radiographs [3, 16]or on CT scans [11, 13, 14, 18]. It is now established that in most forms of craniosynostosis which affect the coronal suture ring there is also abnormality of the posterior skull base due to abnormal growth in the spheno-occipital suture.…”

“…Less attention has been paid to the posterior skull base in particular to the syndromic forms of coronal synostosis, with published work focusing on the indirect results of early closure of the lambdoid suture [19, 20]. Little work exists outlining measurements of posterior skull base deformities [3, 13, 14]. …”

“…Since the advent of CT scan, with the added facility of three-dimensional (3D) reconstruction, it became easier to observe and characterise the deformities of the skull base [6, 7, 8, 9, 10]. Abnormalities in the geometry of the skull base have been reported in all forms of craniosynostosis [7, 11, 12, 13, 14, 15, 16, 17, 18], but most published material concentrates on the anterior skull base and in particular on the coronal suture complex. Less attention has been paid to the posterior skull base in particular to the syndromic forms of coronal synostosis, with published work focusing on the indirect results of early closure of the lambdoid suture [19, 20].…”

Astigmatism in unilateral coronal synostosis: Incidence and laterality

“…While the bony changes in the orbit and forehead on the side of the synostosis are most conspicuous, compensatory growth on the unfused side leads to abnormal changes in the entire craniofacial skeleton. 2,14,15 Lo and colleagues used 3D computed tomographic images to document that the orbital index (ϫ100 orbital height/orbital width) was consistently increased (more vertical) on the fused side and decreased (more horizontal) on the unfused side compared with normal values. 16 The authors also noted a 7% difference in globe volume on the ipsilateral (smaller) versus the contralateral (larger) side.…”