Cortical development in patients with metopic craniosynostosis
Pauline A E Tio1, Meike C Tjaberinga1, Diede C Wijnbergen1,2
11Department of Plastic and Reconstructive Surgery, Erasmus University Medical Center, Rotterdam.
Objective:
Patients with metopic synostosis have an increased risk of neurodevelopmental disorders, despite a minimal risk of intracranial hypertension. While mechanical constraint due to premature suture fusion has been proposed as a contributing factor, evidence suggests intrinsic brain malformations may play a more significant role. Cortical thickness, volume, and surface area alterations have been implicated in neurodevelopmental disorders, yet their role in metopic synostosis remains unclear. In this retrospective study, authors investigated whether these cortical parameters are altered in patients with metopic synostosis compared with those in healthy controls.
Methods:
3D T1-weighted MRI brain scans from patients 0-2 years of age with metopic synostosis were reviewed. Children born preterm or with a syndromic condition were excluded. MRI brain scans of patients and age-matched controls were processed using the Infant FreeSurfer pipeline to quantify cortical thickness, cortical volume, cortical surface area, and intracranial volume. Linear regression models adjusted for age, sex, and intracranial volume were used to compare global cortical thickness, cortical volume, and cortical surface area between the groups, with secondary analyses of these metrics at the lobular level.
Results:
Sixty-four patients with metopic synostosis and 32 controls (median age at MRI 8.4 months [IQR 4.84] and 12.4 months [IQR 9.68], respectively) were eligible for inclusion. Patients with metopic synostosis had a significantly increased cortical surface area compared to that in controls (p = 0.029). No significant differences were found in global cortical thickness (p = 0.281) or total cortical volume (p = 0.141) between patients and controls.
Conclusions:
Increased cortical surface area is observed in patients with metopic synostosis; however, there are no significant differences in cortical thickness and volume. Similar developmental trajectories have been observed in infants with neurodevelopmental disorders. These findings shift the focus from mechanical deformation to fundamental brain development pathways in patients with metopic synostosis.
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