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Trigonocephaly (metopic synostosis). Clinical, surgical and anatomical concepts
1Department of Neurosurgery, National Kagawa Children's Hospital, Japan.
Insights
Metopic synostosis, a condition affecting infant skull development, can lead to mental retardation and other issues. Surgical correction of the anterior cranial fossa aims to improve outcomes by reshaping the forehead and orbital structures.
Area of Science:
- Craniofacial Surgery
- Pediatric Neurosurgery
- Developmental Biology
Background:
- Metopic synostosis (trigonocephaly) is a premature fusion of the metopic suture, leading to a triangular head shape.
- This condition can impact anterior cranial fossa development and is associated with neurodevelopmental deficits.
Purpose of the Study:
- To analyze the clinical features and anatomical concepts of anterior cranial fossa development in metopic synostosis.
- To correlate cranial configuration severity with neurodevelopmental and other anomalies.
- To describe a surgical approach based on quantitative CT measurements.
Main Methods:
- Evaluation of 13 infant cases of trigonocephaly over 4 years.
- Quantitative analysis of anterior cranial fossa dimensions using CT scans compared to normal infants.
- Assessment of clinical features, including mental retardation, cardiopulmonary disorders, and chromosome anomalies.
Main Results:
- Five of the 13 children exhibited mental retardation.
- A more pronounced triangular cranial shape and acute nasopterional angle correlated with more severe outcomes.
- Key surgical considerations include correcting the nasopterional angle, advancing pterional and frontal bone regions, and reducing metopic suture ridge prominence.
Conclusions:
- Surgical correction of metopic synostosis requires addressing specific anatomical abnormalities of the anterior cranial fossa.
- Quantitative CT analysis provides a basis for determining surgical interventions.
- The described surgical procedures aim to normalize cranial shape and potentially improve associated neurodevelopmental outcomes.
Abstract:
The clinical features, surgical and anatomical concepts based on an evaluation of the development of the anterior cranial fossa in metopic synostosis are discussed. Thirteen cases of trigonocephaly of infancy during last 4 years are described. Five children were mentally retarded. A more marked triangular cranial configuration with acute nasopterional angle was associated with more severe mental retardation and other unfavorable conditions, including cardiopulmonary disorders and chromosome anomalies. From a quantitative analysis of the anterior cranial fossa development obtained from CT measurement in comparison with values in normal infants, the following procedures appeared to be important: (1) correction of acute nasopterional angle, achieving a flat forehead; (2) forward advancement of both pterions and anterolateral parts of the frontal bones, rebuilding the orbital roof and frontal eminences; (3) shortening of the overgrown midline structure by removal of the bony ridge of the metopic suture. Our procedure on the basis of these measurements for determination of surgical intervention is described.