Use of Ultra-high-frequency Ultrasound for Aplasia Cutis Congenita of the Scalp

Abstract

Summary: Aplasia Cutis Congenita (ACC) in the scalp is a rare congenital malformation. The treatment for ACC with large defects involving the scalp, bone, and the dura is challenging. Local debridement of necrotic tissue is important to prevent lethal complications such as infection and meningitis. However, debridement has the risk of damaging the sagittal sinus or the dura. Recent developments in ultra-high-frequency ultrasound(US) systems provide frequencies of 70 MHz and capability resolution as fine as 30 μm, which could allow precise imaging of small and thin anatomical structures. The study aimed to describe the methods of precise evaluation of the defect in the scalp and safe debridement using ultra-high-frequency US. This is the first report on direct observation of a newborn’s brain using ultra-high-frequency US. The boy was delivered spontaneously with a large defect of the scalp and bone. After 14 days, due to signs of infection, local debridement was performed carefully under ultra-high-frequency US-based evaluation. The dura, the sagittal sinus, and the small anatomical structures such as arachnoid granulations could be observed. Because the brain herniation gradually aggravated, dural reconstruction using fascia lata and scalp reconstruction using transposition flap was performed. Finally, good skin coverage over the defects was obtained. This method minimizes the risk of damaging the sagittal sinus and the brain parenchyma, which may cause fatal complications. Although further clinical investigations will be required to confirm its efficacy, ultra-high-frequency US has the potential to be a useful device for ACC treatment.

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“…85 BCCs can also present a mix of high and low-risk recurrence variants. 85,86 Occasionally, the superficial types may not present hyperechoic spots at high frequencies (15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33). Nevertheless, in our experience, these hyperechoic spots are better observed with ultrahigh frequency .…”

“…Particularly, the ultrahigh-frequency probes (≥50 MHz) allow us to detect exquisite details of the skin, nails, hair follicles with their inner hair tracts, the sebaceous, Montgomery, and apocrine glands as well as the arrector pili muscles 19,20 (Figures 1-3). 13,[21][22][23][24][25][26][27][28][29][30]…”

Clinical application of ultra‐high frequency ultrasound: Discovering a new imaging frontier

“…Li et al 39 in a retrospective observational study, evaluated the characteristics of pilomatricoma in children and they concluded that 48 MHz‐UHFUS could be a useful tool for its diagnosis and evaluation. Karakawa et al 40 described, in a child, the debridement of aplasia cutis congenital in the scalp and reported that UHFUS allows to visualize the exact location of the venous sinus and the dura, reducing the risk of damage to the brain parenchyma. Latham et al 41 proposed the use of UHFUS to address the problem of difficult vascular access, particularly in children below 6 years of age, both for cannulation of the shallower peripheral arteries and central venous access.…”

“…Li et al 39 ; Karakawa et al 40 Diagnosis and evaluation of pilomatricoma and aplasia cutis congenita Latham et al 41 Evaluate the vascular accesses in children for cannulation of peripheral arteries and central venous access Regensbruger et al 42 Evaluate nerve structure in congenital neuromuscular disorders Puma et al 43 Peripheral nerve and osteoarticular…”

“…Clinical evidence: Pediatric settingGraneli et al38 using 70 MHz-UHFUS investigated children with Hirschsprung disease and concluded that UHFUS is a promising technique to identify aganglionosis, transition zones, and ganglionic bowel.Li et al39 in a retrospective observational study, evaluated the characteristics of pilomatricoma in children and they concluded that 48 MHz-UHFUS could be a useful tool for its diagnosis and evaluation. Karakawa et al40 described, in a child, the debridement of aplasia cutis congenital in the scalp and reported that UHFUS allows to visualize the exact location of the venous sinus and the dura, reducing the risk of damage to the brain parenchyma. Latham et al41 proposed the F I G U R E 1 A 60-year-old man with cutaneous melanoma.…”