Publication: Intracranial volume post cranial expansion surgery using 3D CT scan imaging in children with craniosynostosis
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Date
2018
Authors
Sulong, Shukriyah
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Abstract
Background: Craniosynostosis is a congenital defect that cause one or more suture to
fuse prematurely. Cranial expansion surgery which consist of cranial vault reshaping
with or without fronto-orbital advancement (FOA) is done to correct the skull to a more
normal shape of the head as well as to increase the intracranial volume. Therefore, it is
important to evaluate the changes of intracranial volume (ICV) after the surgery and the
effect of surgery both clinically and radiologically.
Objective: This study is to (1) evaluate the ICV in primary craniosynostosis patients
after the cranial vault reshaping with or without fronto-orbital advancement and to
compare between syndromic and non-syndromic synostosis group, (2) to determine
factors that associated with significant changes in the ICV postoperative, and (3) to
evaluate the resolution of copper beaten sign and improvement in neurodevelopment
after the surgery.
Method: A prospective observational study of all primary craniosynostosis patients who
underwent operation cranial vault reshaping with or without FOA in Hospital Kuala
Lumpur from January 2017 until Jun 2018. The ICV preoperative and postoperative was
measured using the 3D CT imaging and analysed. The demographic data, clinical and
radiological findings was identified and analysed.
Result: 14 cases (6 males and 8 females) with 28 3D CT scan were identified. The mean
age of patients was 23 months. The patients were 7 syndromic synostosis (4 Crouzon
syndrome and 3 Apert syndrome) and 7 were non-syndromic synostosis. The mean
preoperative ICV was 880 mL (range, 641-1234 mL) while the mean postoperative ICV was 1081 mL (range,811-1385 mL) The difference was 201 mL which was statistically significant (P<0.001). In comparison, the mean volume increment for syndromic
synostosis and non-syndromic synostosis were 282 mL and 120 mL respectively. The
difference was statistically significant (P<0.004). Me Nemar’s test was used to analyse
pre and post-operative changes within the same patients. At 3 months post-surgery, all
13 patients with copper beaten sign pre-operatively did not show complete resolution on
3D CT imaging. Therefore the p-value was insignificant (P>1.0). While 2 patients with
neurodevelopmental delay pre-operatively showed no improvement during assessment
at 3 months post-surgery. Again the p-value was insignificant (P>1.0). Hence, there were
no significant resolution in copper beaten sign and improvement in neurodevelopmental
delay in this study.
Conclusion: Surgery in craniosynostosis patients increases the intracranial volume
besides it improves the shape of the head. From this study, the syndromic synostosis had
better increment of intracranial volume compared to non-syndromic synostosis.