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Structural brain differences in school-age children with and without single-suture craniosynostosis.
J Neurosurg Pediatr 2017; 19(4):479-489JN

Abstract

OBJECTIVE

Single-suture craniosynostosis (SSC), the premature fusion of a cranial suture, is characterized by dysmorphology of the craniofacial skeleton. Evidence to suggest that children with SSC are at an elevated risk of mild to moderate developmental delays and neurocognitive deficits is mounting, but the associations among premature suture fusion, neuroanatomy, and neurocognition are unexplained. The goals of this study were to determine 1) whether differences in the brain are present in young children with the 2 most common forms of SSC (sagittal and metopic) several years following surgical correction, and 2) whether the pattern of differences varies by affected suture (sagittal or metopic). Examination of differences in the brains of children with SSC several years after surgery may illuminate the growth trajectory of the brain after the potential constraint of the dysmorphic cranium has been relieved.

METHODS

The authors compared quantitative measures of the brain acquired from MR images obtained from children with sagittal or metopic craniosynostosis (n = 36) at 7 years of age to those obtained from a group of unaffected controls (n = 27) at the same age. The authors measured the volumes of the whole brain, cerebral cortex, cerebral white matter, cerebral cortex by lobe, and ventricles. Additionally, they measured the midsagittal area of the corpus callosum and its segments and of the cerebellar vermis and its component lobules. Measurements obtained from children with SSC and controls were compared using linear regression models.

RESULTS

No volume measures of the cerebrum or of the whole brain differed significantly between patients with SSC and controls (p > 0.05). However, ventricle volume was significantly increased in patients with SSC (p = 0.001), particularly in those with sagittal craniosynostosis (p < 0.001). In contrast, the area of the corpus callosum was significantly reduced in patients with metopic synostosis (p = 0.04), particularly in the posterior segments (p = 0.004). Similarly, the area of lobules VI-VII of the cerebellar vermis was reduced in patients with SSC (p = 0.03), with those with metopic craniosynostosis showing the greatest reduction (p = 0.01).

CONCLUSIONS

The lack of differences in overall brain size or regional differences in the size of the lobes of the cerebrum in children with metopic and sagittal synostosis suggests that the elevated risk of neurodevelopmental deficits is not likely to be associated with differences in the cerebral cortex. Instead, this study showed localized differences between sagittal and metopic craniosynostosis cases as compared with controls in the ventricles and in the midsagittal structures of the corpus callosum and the cerebellum. It remains to be tested whether these structural differences are associated with the increased risk for developmental delay and neurocognitive deficits in children with SSC.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28156213

Citation

"Structural Brain Differences in School-age Children With and Without Single-suture Craniosynostosis." Journal of Neurosurgery. Pediatrics, vol. 19, no. 4, 2017, pp. 479-489.
Structural brain differences in school-age children with and without single-suture craniosynostosis. J Neurosurg Pediatr. 2017;19(4):479-489.
(2017). Structural brain differences in school-age children with and without single-suture craniosynostosis. Journal of Neurosurgery. Pediatrics, 19(4), pp. 479-489. doi:10.3171/2016.9.PEDS16107.
Structural Brain Differences in School-age Children With and Without Single-suture Craniosynostosis. J Neurosurg Pediatr. 2017;19(4):479-489. PubMed PMID: 28156213.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Structural brain differences in school-age children with and without single-suture craniosynostosis. Y1 - 2017/02/03/ PY - 2017/2/6/pubmed PY - 2017/4/7/medline PY - 2017/2/4/entrez KW - CGV = cerebral cortical gray matter volume KW - CWV = cerebral white matter volume KW - FGV = frontal cortical gray matter volume KW - ICC = interclass correlation coefficient KW - MRI KW - POGV = parieto-occipital cortical gray matter volume KW - ROI = region of interest KW - SSC = single-suture craniosynostosis KW - TGV = temporal cortical gray matter volume KW - VV = ventricular volume KW - WBV = whole brain volume KW - brain KW - craniofacial KW - craniosynostosis KW - development SP - 479 EP - 489 JF - Journal of neurosurgery. Pediatrics JO - J Neurosurg Pediatr VL - 19 IS - 4 N2 - OBJECTIVE Single-suture craniosynostosis (SSC), the premature fusion of a cranial suture, is characterized by dysmorphology of the craniofacial skeleton. Evidence to suggest that children with SSC are at an elevated risk of mild to moderate developmental delays and neurocognitive deficits is mounting, but the associations among premature suture fusion, neuroanatomy, and neurocognition are unexplained. The goals of this study were to determine 1) whether differences in the brain are present in young children with the 2 most common forms of SSC (sagittal and metopic) several years following surgical correction, and 2) whether the pattern of differences varies by affected suture (sagittal or metopic). Examination of differences in the brains of children with SSC several years after surgery may illuminate the growth trajectory of the brain after the potential constraint of the dysmorphic cranium has been relieved. METHODS The authors compared quantitative measures of the brain acquired from MR images obtained from children with sagittal or metopic craniosynostosis (n = 36) at 7 years of age to those obtained from a group of unaffected controls (n = 27) at the same age. The authors measured the volumes of the whole brain, cerebral cortex, cerebral white matter, cerebral cortex by lobe, and ventricles. Additionally, they measured the midsagittal area of the corpus callosum and its segments and of the cerebellar vermis and its component lobules. Measurements obtained from children with SSC and controls were compared using linear regression models. RESULTS No volume measures of the cerebrum or of the whole brain differed significantly between patients with SSC and controls (p > 0.05). However, ventricle volume was significantly increased in patients with SSC (p = 0.001), particularly in those with sagittal craniosynostosis (p < 0.001). In contrast, the area of the corpus callosum was significantly reduced in patients with metopic synostosis (p = 0.04), particularly in the posterior segments (p = 0.004). Similarly, the area of lobules VI-VII of the cerebellar vermis was reduced in patients with SSC (p = 0.03), with those with metopic craniosynostosis showing the greatest reduction (p = 0.01). CONCLUSIONS The lack of differences in overall brain size or regional differences in the size of the lobes of the cerebrum in children with metopic and sagittal synostosis suggests that the elevated risk of neurodevelopmental deficits is not likely to be associated with differences in the cerebral cortex. Instead, this study showed localized differences between sagittal and metopic craniosynostosis cases as compared with controls in the ventricles and in the midsagittal structures of the corpus callosum and the cerebellum. It remains to be tested whether these structural differences are associated with the increased risk for developmental delay and neurocognitive deficits in children with SSC. SN - 1933-0715 UR - https://www.unboundmedicine.com/medline/citation/28156213/Structural_brain_differences_in_school_age_children_with_and_without_single_suture_craniosynostosis_ L2 - https://thejns.org/doi/10.3171/2016.9.PEDS16107 DB - PRIME DP - Unbound Medicine ER -