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Positron emission tomography studies confirm the need for early surgical intervention in patients with single-suture
L R David1, D G Genecov, A A Camastra
1Department of Plastic and Reconstructive Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA.
Insights
Single-suture craniosynostosis, a premature cranial suture fusion, may impact brain development. This study found increased cerebral glucose metabolism in the posterior occipital region after surgical correction, suggesting improved brain function.
Area of Science:
- Pediatric Neurosurgery
- Neurodevelopmental Imaging
- Craniofacial Surgery
Background:
- Craniosynostosis involves premature fusion of cranial sutures, potentially affecting brain development.
- While multiple-suture synostosis is linked to cognitive issues, single-suture craniosynostosis is often debated as purely aesthetic.
- Emerging evidence suggests a correlation between single-suture craniosynostosis and developmental abnormalities.
Purpose of the Study:
- To investigate cerebral glucose metabolism in children with single-suture craniosynostosis using positron emission tomography (PET) scans.
- To determine if surgical intervention for single-suture craniosynostosis alters local brain function as indicated by metabolic changes.
Main Methods:
- Prospective study of 10 children (0.1-3.2 years) with single-suture craniosynostosis (sagittal, metopic, coronal).
- Preoperative and postoperative PET scans were performed 1-5 weeks before and 6-12 weeks after cranial reconstructive surgery.
- Scans were analyzed qualitatively and quantitatively to assess changes in cerebral glucose metabolism.
Main Results:
- Postoperative PET scans revealed variable regional changes in cerebral glucose metabolism.
- A consistent increase in glucose metabolism was observed in the posterior occipital region in all 10 patients.
- Metabolic rate increases ranged up to 30.2% (maximum) and 18.8% (average) in the occipital cortex.
Conclusions:
- Surgical release of single-suture craniosynostosis leads to a consistent increase in cerebral glucose metabolism in the posterior occipital cortex.
- These metabolic changes suggest potential improvements in brain function, particularly in visual development and spatial coordination.
- Further studies are underway to explore the long-term functional consequences of these observed metabolic alterations.
Abstract:
Craniosynostosis, the premature fusion of one or more cranial sutures, may occur in isolation or in association with a syndromic constellation. Multiple-suture synostosis has consistently been associated with brain compression and increased intracranial pressure, and frequently decreased cognitive development. Single-suture craniosynostosis, however, has been thought by some to be an aesthetic problem with infrequent consequences on brain function and development. Some studies have disputed this concept and have argued a correlation between single-suture craniosynostosis and abnormalities in development. The purpose of this study was to determine, using an objective radiographic tool, positron emission tomography scans, if patients with single-suture craniosynostosis had any abnormalities in cerebral glucose metabolism that would indicate changes in local brain function. A total of 10 children with single-suture craniosynostosis, eight males and two females, ranging in age from 0.1 to 3.2 years, were enrolled in this prospective study approved by the Internal Review Board. Six of the children had sagittal synostosis, three had metopic synostosis, and one had coronal craniosynostosis. Each of the patients had preoperative positron emission tomography scans performed 1 to 5 weeks before cranial reconstructive surgery and postoperative scans at 6 to 12 weeks after surgery. Surgical treatment consisted of cranial vault remodeling in eight of the children and strip craniectomy with cranial expansion in two of the children. After surgery, the two scans were compared qualitatively and quantitatively by a single radiologist. The results demonstrated variable regional increases and decreases in local post-operative cerebral glucose metabolism. However, in the posterior occipital region, the area of visual development and visual spatial coordination, there was a consistent postoperative increase in all 10 patients. Maximum glucose metabolic rate was increased up to 30.2% with a mean of 9.9%, and average glucose metabolic rates demonstrated a maximum increase of up to 18.8%. The results of this study indicate cerebral glucose metabolism consistently increases in the posterior occipital cortex after surgical release of single-suture craniosynostosis. Future developmental studies are being performed to examine the functional consequences of these metabolic changes.