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Published on: March 26, 2019
Cerebrospinal fluid volume does not have etiological role in the incidence of positional skull deformities
Guillaume Captier1, Adrien Galeron2, Gérard Subsol3
1Department of Plastic and Craniofacial Pediatric Surgery (Head: Guillaume Captier), Lapeyronie University Hospital, Avenue Du Doyen Gaston Giraud, Montpellier, France; EA2415, Epidemiologic Biostastic and Clinical Research Laboratory, University of Montpellier, France.
Insights
Cerebrospinal fluid (CSF) volume does not increase in infants with positional skull deformities (PSD). These findings do not support a role for CSF volume changes in the cause of PSD, though macrocephaly may be a factor in occipital plagiocephaly.
Area of Science:
- Pediatric Neurosurgery
- Craniofacial Surgery
- Medical Imaging Analysis
Background:
- Positional skull deformities (PSD) are a growing concern for craniofacial surgeons.
- Previous studies suggested increased cerebrospinal fluid (CSF) space in infants with PSD.
- A potential causal link between CSF volume and PSD was hypothesized.
Purpose of the Study:
- To quantitatively estimate total brain and CSF volumes using a semi-automatic method.
- To investigate the correlation between total CSF volume and the occurrence of PSD.
- To explore potential etiological factors in different types of PSD.
Main Methods:
- A retrospective study analyzed 79 CT scans of infants with PSD and 60 control scans.
- Endocranial and brain volumes were segmented using automated and semi-automatic methods.
- Total CSF volume was calculated as the difference between endocranial and brain volumes.
Main Results:
- Endocranial and total CSF volumes did not significantly differ between infants with PSD and controls.
- Brain volume was enlarged in the occipital plagiocephaly subgroup compared to other PSD groups.
- The semi-automatic method allowed for reliable volume estimations in a subset of scans.
Conclusions:
- Total CSF volume is not altered in infants with PSD, refuting its role in PSD etiology.
- Macrocephaly in occipital plagiocephaly may represent a distinct etiological factor.
- Further research into specific etiological factors for different PSD types is warranted.
Background:
Positional skull deformities (PSD) are becoming a daily health concern for craniofacial surgeons. Several reports have indicated that cerebrospinal fluid (CSF) space increases on computed tomography (CT) scans of infants suffering from PSD, suggesting a potential causal link. Here, we describe a semi-automatic method to estimate total brain and CSF volumes quantitatively. We tested the potential correlation between total CSF volume and the occurrence of PSD.
Methods:
A single-center retrospective study was carried out using 79 CT scans of PSD and 60 CT scans of control subjects. The endocranium was segmented automatically using a three-dimensional deformable surface model, and the brain was segmented using a semi-automatic threshold-based method. Total CSF volume was estimated based on the difference between endocranial and brain volumes.
Results:
Automatic segmentation of the endocranium was possible in 75 CT scans. Semi-automatic brain and CSF volume evaluations were performed in 40 CT scans of infants with PSD (18 = occipital plagiocephaly, 11 = fronto-occipital plagiocephaly, and 11 = posterior brachycephaly) and in six control CT scans. Endocranial and total CSF volumes were not significantly different between patients with PSD and controls. The occipital plagiocephaly group had an enlarged brain volume compared with that in patients in the other groups.
Conclusions:
Total CSF volume did not change in infants with PSD, and the results do not support a role for volume changes in CSF in the etiology of PSD. Macrocephaly in patients with occipital plagiocephaly may be a specific etiological factor compared with that in other PSDs.
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