Intracranial volume (ICV) in isolated sagittal craniosynostosis: a retrospective case-matched-control study

Holland, J; Rodrigues, D.; Mohan, Shyam; White, Nicholas J.

doi:10.1007/s00381-018-4018-0

Cited by 8 publications

(4 citation statements)

References 24 publications

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“…Investigators have reported the ICV in patients with sagittal synostosis to be less than, equal to, or greater than the volumes in control patients. [41][42][43][44] In our study, we analyzed three-dimensional photographs to determine the percentage total ICV present in the anterior cranial fossa to assess whether changes in ICV distribution accompany the changes in curvature of the forehead and temple after ESC. Before surgery, the ESC cohort had a greater percentage of the total ICV in the anterior cranial fossa as compared with controls (22.03% versus 17.74%, respectively).…”

Section: Discussionmentioning

confidence: 99%

“Three-Dimensional Assessment of Frontal Bossing and Temporal Pinching in Patients with Sagittal Craniosynostosis using Curvature Analysis.”

Harrison

Mathew

Cole

et al. 2023

Plastic &Amp; Reconstructive Surgery

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In sagittal craniosynostosis, significant compensatory growth occurs at the coronal and metopic sutures. This growth results in characteristic changes of the anterior cranial vault. When compared with subjects without sagittal craniosynostosis, the anterior cranial vault has an increased anterior projection of the forehead, commonly referred to as frontal bossing. There is also an increase in the breadth of the forehead without a proportionate change in the width of the cranial base at the pterion, resulting in a pinched appearance to the temples. 1,2 There is a lack of consensus among craniofacial surgeons with regard to the ideal operative Background: Sagittal craniosynostosis results in varying degrees of frontal bossing and bilateral temporal pinching. This study assessed the three-dimensional changes in these regions using curvature analysis and volumetric analysis before and 1 year after extended sagittal strip craniectomy (ESC) with postoperative helmet therapy. Methods: A retrospective review of three-dimensional photographs of 50 subjects treated with ESC with postoperative helmet therapy and 50 age-matched controls was performed. Images were collected preoperatively and 1 year postoperatively. Forehead convexity and temple concavity were quantified. Computed tomographic scans of subjects with and without sagittal synostosis were analyzed to assess the percentage of total intracranial volume (ICV) in the anterior cranial fossa before and after ESC with postoperative helmet therapy. Results: Forehead convexity in the ESC with postoperative helmet therapy group preoperatively (24.49 ± 3.16 m −1 ) was significantly greater than controls (22.48 ± 3.84 m −1 ; P = 0.005). Forehead convexity significantly decreased after ESC with postoperative helmet therapy (18.79 ± 2.43 m −1 ; P < 0.001) and did not differ from controls (19.67 ± 3.08 m −1 ; P = 0.115). The ESC group had more concave temples preoperatively (−10.27 ± 4.37 m −1 ) as compared with controls (−6.99 ± 3.55 m −1 ; P < 0.001). Temple concavity significantly decreased after ESC (−4.82 ± 3.17 m −1 ; P < 0.001) and did not differ from controls (−5.64 ± 3.27 m −1 ; P = 0.075). In the ESC group, the percentage ICV in the anterior cranial fossa decreased from 22.03% to 18.99% after surgery, whereas the anterior volume in controls was stable (17.74% to 16.81%). Conclusions:The ESC group had significantly greater forehead convexity, temple concavity and anterior cranial fossa volume compared with controls. One year after ESC with postoperative helmet therapy, forehead convexity, temple concavity, and percentage ICV in the anterior fossa were comparable to controls.

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Section: Discussionmentioning

confidence: 99%

“Three-Dimensional Assessment of Frontal Bossing and Temporal Pinching in Patients with Sagittal Craniosynostosis using Curvature Analysis.”

Harrison

Mathew

Cole

et al. 2023

Plastic &Amp; Reconstructive Surgery

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“…5 In all cases of craniosynostosis, surgical treatment is indicated for elevated intracranial pressure (ICP) and/or substantial alterations in normal anatomy and appearance. The risk of elevated ICP in single suture, nonsyndromic sagittal synostosis is estimated to be 10%-20%, 6 but reports are inconclusive and often contradictory. Data regarding the probability of neurodevelopmental delay associated with the condition are likewise inconsistent; some suggest up to a 5-fold increased risk for developmental delays and Background: Surgical correction of craniosynostosis addresses potentially elevated intracranial pressure and the cranial deformity.…”

Section: Introductionmentioning

confidence: 99%

Evaluating Surgical Decision-making in Nonsyndromic Sagittal Craniosynostosis Using a Digital 3D Model

Hughes

Langa

Nuzzi

et al. 2021

Plastic and Reconstructive Surgery - Global Open

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Background: Surgical correction of craniosynostosis addresses potentially elevated intracranial pressure and the cranial deformity. In nonsyndromic sagittal synostosis, approximately 15% of patients have elevated intracranial pressure. The decision to operate therefore likely reflects a combination of aesthetic goals, prevention of brain growth restriction over time, surgeon training and experience, and parental expectations. This study examines clinical factors that influence surgical decision-making in nonsyndromic sagittal synostosis. Methods: An online survey sent to craniofacial and neurosurgeons presented 5 theoretical patients with varying severities of sagittal synostosis. For each cephalic index, 4 separate clinical scenarios were presented to assess influences of parental concern and developmental delay on the decision to operate. Results: Fifty-six surveys were completed (response rate = 28%). Participants were predominantly from North America (57%), had over 10 years of experience (75%), and performed over 20 craniosynostosis procedures annually (50%). Thirty percent of respondents indicated they would operate regardless of head shape and without clinical and/or parental concern. Head shape was the greatest predictor of decision to operate ( P < 0.001). Parental concern and developmental delay were independently associated with decision to operate ( P < 0.001). Surgeons with more experience were also more likely to operate across all phenotypes (OR: 2.69, P < 0.004). Conclusions: Surgeons responding to this survey were more strongly compelled to operate on children with nonsyndromic sagittal craniosynostosis when head shape was more severe. Additional factors, including parental concern and developmental delay, also influence the decision to operate, especially for moderate phenotypes. Geographic and subspecialty variations were not significant.

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“…There have been several studies utilizing 3D models from computerized tomography (CT) scans to calculate intracranial volumes to measure outcomes. [9][10][11] However, having only one measurement of volume does not adequately describe how the head shape is changing following treatment. Our institution hypothesized that if we partition volumetric growth by cranial bone region, frontal, temporal, parietal, and occipital, a more precise analysis can be done to measure the changes following treatment.…”

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confidence: 99%

“…Since the CI is an index that measures two dimensions and head shape is observed in three dimensions (3D), 3D analysis of head shapes is needed to bridge the gap between quantitative and subjective measurements of success following correction of SC with ESC and HT. There have been several studies utilizing 3D models from computerized tomography (CT) scans to calculate intracranial volumes to measure outcomes 9–11 . However, having only one measurement of volume does not adequately describe how the head shape is changing following treatment.…”

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confidence: 99%

Characterization of Regional Morphological Changes in Sagittal Craniosynostosis Following Endoscopic Strip Craniectomy With Post-operative Helmeting: Predictors for Success

Nguyen

Washington

Cepeda

et al. 2023

Journal of Craniofacial Surgery

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Background: Sagittal craniosynostosis (SC) restricts craniofacial growth perpendicular to the sagittal plane resulting in scaphocephaly. The cranium grows in the anterior-posterior dimension causing disproportionate changes, which can be corrected with either cranial vault reconstruction (CVR) or endoscopic strip craniectomy (ESC) combined with post-operative helmet therapy. ESC is performed at an earlier age, and studies demonstrate benefits in risk profile and morbidity compared to CVR, with comparable results if the post-operative banding protocol is strictly upheld. We aim to identify predictors of successful outcome and, using three-dimensional (3D) imaging, assess cranial changes following ESC with post-banding therapy. Materials and Methods: A single institution retrospective review was performed from 2015-19 for patients with SC who underwent ESC. Patients received immediate post-operative 3D photogrammetry for helmet therapy planning and implementation as well as post-therapy 3D imaging. Using these 3D images, the cephalic index (CI) for study patients was calculated before and after helmet therapy. In addition, Deformetrica™ was used to measure volume and shape changes of pre-defined anatomic skull regions (frontal, parietal, temporal, & occipital) based on the pre-and post-therapy 3D imaging results. Fourteen institutional raters evaluated the pre-and post-therapy 3D imaging in order to determine the success of the helmeting therapy.Results: Twenty-one SC patients met our inclusion criteria. Using 3D photogrammetry, 14 raters at our institution rated 16 of the 21 patients to have had successful helmet therapy. There was a significant difference in CI following helmet therapy with both groups, but there was no significant difference in CI between the "successful" and "unsuccessful" groups. Furthermore, the comparative analysis demonstrated that the parietal region had a significantly higher change in mean RMS distance when compared to the frontal or occipital regions. Conclusion: For patients with SC, 3D photogrammetry may be able to objectively recognize nuanced findings not readily detectable when using CI alone. The greatest changes in volume were observed in the parietal region, which falls in line with treatment goals for SC. Patients deemed to have unsuccessful outcomes were found to be older at time of surgery and initiation of helmet therapy. This suggests that early diagnosis and management for SC may increase the likelihood of success.

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Intracranial volume (ICV) in isolated sagittal craniosynostosis: a retrospective case-matched-control study

Cited by 8 publications

References 24 publications

“Three-Dimensional Assessment of Frontal Bossing and Temporal Pinching in Patients with Sagittal Craniosynostosis using Curvature Analysis.”

“Three-Dimensional Assessment of Frontal Bossing and Temporal Pinching in Patients with Sagittal Craniosynostosis using Curvature Analysis.”

Evaluating Surgical Decision-making in Nonsyndromic Sagittal Craniosynostosis Using a Digital 3D Model

Characterization of Regional Morphological Changes in Sagittal Craniosynostosis Following Endoscopic Strip Craniectomy With Post-operative Helmeting: Predictors for Success

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