Analysis of the jugular foramen in pediatric patients with craniosynostosis
Colin D Booth1, Ramon E Figueroa, Andrew Lehn
1Section of Plastic and Reconstructive Surgery, Department of Radiology, School of Medicine, Medical College of Georgia, Augusta, Georgia, USA. colindbooth@gmail.com
Insights
Children with craniosynostosis have a significantly smaller right jugular foramen (JF) diameter, potentially increasing intracranial pressure (ICP). This finding suggests JF size may contribute to ICP elevation in these patients.
Area of Science:
- Neurosurgery
- Pediatric Radiology
- Craniofacial Surgery
Background:
- Craniosynostosis, a premature fusion of skull sutures, can lead to intracranial hypertension (ICP) in developing brains.
- Reduced jugular foramen (JF) size is hypothesized to be a contributing factor to elevated ICP in craniosynostosis patients.
Purpose of the Study:
- To compare jugular foramen (JF) dimensions between children with craniosynostosis and age-matched controls.
- To investigate the potential impact of JF size reduction on intracranial pressure (ICP) using the Hagen-Poiseuille equation.
Main Methods:
- Retrospective analysis of CT scans from 14 craniosynostosis patients and 27 controls.
- Measurement of anterior-posterior (AP) and lateral diameters of the jugular bulb by a single neuroradiologist.
Main Results:
- A statistically significant 23.02% reduction in the right jugular foramen (JF) anterior-posterior (AP) diameter was observed in craniosynostosis patients (P=0.0066).
- The left JF AP diameter and both lateral diameters showed non-significant differences between groups.
Conclusions:
- Children with craniosynostosis exhibit a significantly smaller right JF AP dimension.
- A 23.02% reduction in right JF AP diameter could theoretically increase ICP by 63.5% (6.35 mm Hg) if other factors remain constant.
Introduction:
Intracranial hypertension due to craniosynostosis is a dreaded potential complication that affects the developing brain. We hypothesized that craniosynostotic patients have significantly reduced jugular foramen (JF) when compared with age-matched controls. This may partially account for the observed increase in intracranial pressure (ICP) seen in some of these patients. We also estimated the potential effects on ICP using the Hagen-Poiseuille equation.
Materials And Methods:
Two institutional review board-approved groups were included in this study. Group 1 consists of 14 randomly selected craniosynostotic patients (7 boys and 7 girls; mean age, 9.33 mo; range, 0.6-21 mo). Group 2, the control group, consists of 27 children without craniosynostosis (13 boys and 14 girls; mean age, 8.71 mo; range, 0.23-45 mo). The same neuroradiologist used axial computed tomographic scans to measure the greatest anterior-posterior (AP) and lateral diameters of the jugular bulb.
Results:
The right JF AP diameter is 23.02% smaller in group 1 than in group 2 (P = 0.0066, 2-tailed t-test). The left JF AP diameter was also smaller for group 1 but was not statistically significant (P = 0.257, 2-tailed t-test). Group 1 also had a nonsignificant increase in both lateral diameters (P > 0.05).
Discussion:
The study showed a significant decrease (23.02%) in the right JF AP dimension in children with craniosynostosis. On the basis of the Hagen-Poiseuille equation, a 23.02% AP diameter reduction in 1 JF may theoretically increase the ICP 63.5% or 6.35 mm Hg, keeping all other variables, such as blood flow, constant. Although not supported by aspect ratio analysis, the slight increase in the lateral diameters of the patients' JFs may lessen this effect.
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