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Somatosensory evoked potentials are abnormal with plagiocephaly
Maiju Härmä1, Leena Lauronen2, Junnu Leikola3
1Division of Musculoskeletal and Plastic Surgery, Department of Plastic Surgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland.
Insights
Cranioplasty surgery for severe deformational plagiocephaly did not improve brain function, as measured by electroencephalogram (EEG) and somatosensory evoked potentials (SEP). This study led to abandoning surgical interventions for this condition.
Area of Science:
- Pediatric Neurosurgery
- Craniofacial Surgery
- Neurophysiology
Background:
- Deformational plagiocephaly typically resolves with conservative management.
- Surgical intervention (cranioplasty) was previously performed for severe cases with neurological symptoms.
Purpose of the Study:
- To evaluate the impact of cranioplasty on brain electrophysiology in infants with severe deformational plagiocephaly and neurological symptoms.
- To compare outcomes between surgical and conservative management using electroencephalogram (EEG) and somatosensory evoked potentials (SEP).
Main Methods:
- A comparative study of 20 infants with severe deformational plagiocephaly and neurological symptoms.
- Ten infants underwent open posterior cranial vault reshaping (cranioplasty).
- Ten infants received conservative management with follow-up; brain electrophysiology (EEG, SEP) was assessed.
Main Results:
- Post-cranioplasty, six of ten operated infants showed abnormal SEP, though normalized post-surgery.
- In the conservative group, eight of ten infants had abnormal SEP at 24 months, with all normalizing by follow-up.
- Cranioplasty did not demonstrate a benefit in normalizing abnormal SEP-EEG recordings.
Conclusions:
- Open reshaping cranioplasty for severe deformational plagiocephaly with neurological symptoms does not improve brain electrophysiology.
- The findings suggest surgical intervention is not beneficial for brain function in this patient population.
- The Helsinki Cleft Palate and Craniofacial Center has ceased performing these operations.
Background:
Deformational plagiocephaly is usually managed conservatively, as it tends to improve over time and with the use of conservative measures. However, before the year 2017 we operated on patients with severe plagiocephaly and neurological symptoms at the Helsinki Cleft Palate and Craniofacial Center.
Methods:
Of the 20 infants with severe deformational plagiocephaly and neurological symptoms referred to us between 2014 and 2016, 10 underwent cranioplasty open reshaping of the posterior cranial vault. The parents of the last 10 patients were given information on the natural history of the condition and the patients were followed up with an outpatient protocol. The aim of this study was to gain information on the brain electrophysiology and recovery of patients after total cranial vault reconstruction by measuring the electroencephalogram (EEG) somatosensory evoked potentials (SEP; median nerve).
Results:
Of the 10 participants in the operation arm, six had abnormal SEP at least on the affected cerebral hemisphere and all SEPs were recorded as normal when controlled postoperatively. In the follow-up arm, eight out of 10 participants had abnormal SEP at the age of approximately 24 months, and all had normalized SEPs at control visits.
Conclusion:
Our data suggest that cranioplasty open reshaping of the posterior cranial vault did not affect abnormal SEP-EEG recordings. We have abandoned the operations in deformational plagiocephaly patients due to findings suggesting that expanding cranioplasty is not beneficial for brain function in this patient group.
