Plagiocephaly: morphometry of skull base asymmetry

Area of Science:

• Craniofacial surgery
• Pediatric neurosurgery
• Medical imaging

Background:

• Plagiocephaly, a common condition in infants, presents as either malformational (due to synostosis) or deformational (due to external forces).
• Understanding the underlying skull base mechanics is crucial for accurate diagnosis and treatment planning.

Purpose of the Study:

• To conduct a morphometric analysis of the skull base in patients with malformational and deformational plagiocephaly.
• To elucidate the distinct mechanisms contributing to skull base asymmetry in these two conditions.

Main Methods:

• Analysis of 102 CT scans with 3D endocranial reconstructions.
• Comparison of hemibases and cranial fossa angles.
• Calculation of chondrocranial structural asymmetry and architectural asymmetry relative to the medio-labyrinthine plane.

Main Results:

• Malformational plagiocephaly (unicoronal and unilambdoid synostoses) showed localized structural anomalies in the anterior, middle, or posterior cranial fossae.
• Deformational plagiocephaly (frontal and occipital) exhibited architectural distortion with a symmetric chondrocranium.
• Skull base asymmetry in malformational cases stemmed from localized chondrocranial malformations, whereas deformational cases showed architectural deformation.

Conclusions:

• Skull base asymmetry in malformational plagiocephaly is secondary to localized chondrocranial malformations.
• Skull base asymmetry in deformational plagiocephaly is secondary to architectural deformation.
• Morphometric skull base analysis effectively differentiates the etiologies of malformational and deformational plagiocephaly.