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Intracranial volume (ICV) in isolated sagittal craniosynostosis: a retrospective case-matched-control study
James Holland1,2, Desideiro Rodrigues1,3, Shyam Mohan1,4
1Craniofacial Unit, Birmingham Children's Hospital, Birmingham, UK.
Insights
Children with sagittal craniosynostosis may have altered intracranial volume (ICV). This study found ICV was larger in infants but smaller in older children with SC compared to controls.
Area of Science:
- Neurosurgery
- Pediatric Neurosurgery
- Craniofacial Surgery
Background:
- Sagittal craniosynostosis (SC) poses a risk for increased intracranial pressure (ICP) due to cephalocranial disproportion.
- The precise impact of SC on intracranial volume (ICV) remains incompletely understood.
Purpose of the Study:
- To conduct a novel volumetric analysis of the scaphocephalic skull.
- To compare supratentorial (ST) volume, infratentorial (IT) volume, and total ICV in patients with SC against normal controls.
Main Methods:
- Compared ICVs of 32 patients with isolated SC undergoing total calvarial vault remodelling (TCVR) to 32 age- and sex-matched controls.
- Utilized manual volumetric measurements on head CT scans via OsiriX software.
- Employed a paired t-test for statistical comparison between groups.
Main Results:
- Mean total ICV, ST volume, and IT volume were generally larger in SC patients than controls, with exceptions noted in females over 6 months.
- Regression analysis indicated larger ICVs in SC patients younger than 10 months, with this trend reversing for older children.
- The infratentorial to supratentorial (IT/ST) volume ratio remained consistent in SC patients, closely mirroring that of controls.
Conclusions:
- Sagittal craniosynostosis may be associated with an enlarged cranial vault in infants under 10 months.
- A smaller cranial vault in SC patients appears more likely in those older than 10 months.
- These findings suggest an evolving risk of cephalocranial disproportion in SC beyond 10 months of age.
Purpose:
Children with sagittal craniosynostosis (SC) are at risk of developing raised intracranial pressure (ICP). This is thought to result from cephalocranial disproportion-the restriction of normal cerebral development by a small cranial vault. It remains unclear whether intracranial volume (ICV) is altered in SC. This study offers a novel volumetric analysis of the scaphocephalic skull, comparing supratentorial (ST) volume, infratentorial (IT) volume, and total ICV of patients with sagittal synostosis to normal controls.
Methods:
ICVs of 32 consecutive patients undergoing total calvarial vault remodelling (TCVR) for isolated SC were compared to 32 age- and sex-matched normal controls. ICV was measured with manual techniques on head computerised tomographic (CT) scans using OsiriX software. A paired t test was used to compare data between cases and controls.
Results:
Mean total ICV, ST volume and IT volume were larger in SC than in controls, except in females > 6 months of age. There was no statistical significance. Regression analysis demonstrated larger ICVs in diseased children than in controls younger than 10 months, at which age trend lines intersected and the reverse became true for older children. This likely represents an evolving risk of cephalocranial disproportion beyond 10 months of age. The IT/ST volume ratio was conserved in scaphocephaly, and very closely approximated that of controls.
Conclusions:
Sagittal craniosynostosis appears to be associated with a larger cranial vault at less than 10 months and a smaller vault at greater than 10 months, although statistical significance was not achieved.
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