Preoperative imaging patterns and intracranial findings in single-suture craniosynostosis: a study from the Synostosis Research Group

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  • 1 Department of Neurosurgery, and
  • | 2 Division of Plastic and Reconstructive Surgery, University of Utah, Salt Lake City, Utah;
  • | 3 Division of Neurosurgery, University of California, San Diego;
  • | 4 Department of Neurosurgery, Naval Medical Center San Diego, California;
  • | 5 Department of Neurosurgery, Seattle Children’s Hospital, University of Washington, Seattle, Washington;
  • | 6 Department of Neurosurgery, Columbia University, Morgan Stanley Children’s Hospital, and
  • | 7 Division of Plastic Surgery, Columbia University Medical Center, NewYork-Presbyterian Hospital, New York, New York;
  • | 8 Division of Plastic and Reconstructive Surgery, Department of Surgery, and
  • | 9 Department of Neurosurgery, St. Louis Children’s Hospital, Washington University School of Medicine in St. Louis, Missouri;
  • | 10 and Departments of Pediatric Neurosurgery and
  • | 11 Plastic Surgery, Children’s Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania
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OBJECTIVE

The diagnosis of single-suture craniosynostosis can be made by physical examination, but the use of confirmatory imaging is common practice. The authors sought to investigate preoperative imaging use and to describe intracranial findings in children with single-suture synostosis from a large, prospective multicenter cohort.

METHODS

In this study from the Synostosis Research Group, the study population included children with clinically diagnosed single-suture synostosis between March 1, 2017, and October 31, 2020, at 5 institutions. The primary analysis correlated the clinical diagnosis and imaging diagnosis; secondary outcomes included intracranial findings by pathological suture type.

RESULTS

A total of 403 children (67% male) were identified with single-suture synostosis. Sagittal (n = 267), metopic (n = 77), coronal (n = 52), and lambdoid (n = 7) synostoses were reported; the most common presentation was abnormal head shape (97%), followed by a palpable or visible ridge (37%). Preoperative cranial imaging was performed in 90% of children; findings on 97% of these imaging studies matched the initial clinical diagnosis. Thirty-one additional fused sutures were identified in 18 children (5%) that differed from the clinical diagnosis. The most commonly used imaging modality by far was CT (n = 360), followed by radiography (n = 9) and MRI (n = 7). Most preoperative imaging was ordered as part of a protocolized pathway (67%); some images were obtained as a result of a nondiagnostic clinical examination (5.2%). Of the 360 patients who had CT imaging, 150 underwent total cranial vault surgery and 210 underwent strip craniectomy. The imaging findings influenced the surgical treatment 0.95% of the time. Among the 24% of children with additional (nonsynostosis) abnormal findings on CT, only 3.5% required further monitoring.

CONCLUSIONS

The authors found that a clinical diagnosis of single-suture craniosynostosis and the findings on CT were the same with rare exceptions. CT imaging very rarely altered the surgical treatment of children with single-suture synostosis.

ABBREVIATIONS

SynRG = Synostosis Research Group.

Illustration from Seaman et al. (pp 260–267). Copyright Jane Whitney. Published with permission.

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Contributor Notes

Correspondence John R. W. Kestle: University of Utah, Salt Lake City, UT. neuropub@hsc.utah.edu.

INCLUDE WHEN CITING Published online June 25, 2021; DOI: 10.3171/2021.2.PEDS2113.

Disclosures Dr. Patel: consultant for Stryker CMF.

  • 1

    Persing JA. MOC-PS(SM). CME article: management considerations in the treatment of craniosynostosis. Plast Reconstr Surg. 2008;121 (4)(suppl):111.

    • Search Google Scholar
    • Export Citation
  • 2

    Albright AL, Byrd RP. Suture pathology in craniosynostosis. J Neurosurg. 1981;54(3):384387.

  • 3

    Kirmi O, Lo SJ, Johnson D, Anslow P. Craniosynostosis: a radiological and surgical perspective. Semin Ultrasound CT MR. 2009;30(6):492512.

    • Search Google Scholar
    • Export Citation
  • 4

    Saarikko A, Mellanen E, Kuusela L, et al. Comparison of Black Bone MRI and 3D-CT in the preoperative evaluation of patients with craniosynostosis. J Plast Reconstr Aesthet Surg. 2020;73(4):723731.

    • Search Google Scholar
    • Export Citation
  • 5

    Fearon JA, Singh DJ, Beals SP, Yu JC. The diagnosis and treatment of single-sutural synostoses: are computed tomographic scans necessary? Plast Reconstr Surg. 2007;120(5):13271331.

    • Search Google Scholar
    • Export Citation
  • 6

    Badve CA, Mallikarjunappa MK, Iyer RS, et al. Craniosynostosis: imaging review and primer on computed tomography. Pediatr Radiol. 2013;43(6):725742.

    • Search Google Scholar
    • Export Citation
  • 7

    Nagaraja S, Anslow P, Winter B. Craniosynostosis. Clin Radiol. 2013;68(3):284292.

  • 8

    Frush DP, Donnelly LF, Rosen NS. Computed tomography and radiation risks: what pediatric health care providers should know. Pediatrics. 2003;112(4):951957.

    • Search Google Scholar
    • Export Citation
  • 9

    Pearce MS, Salotti JA, Little MP, et al. Radiation exposure from CT scans in childhood and subsequent risk of leukaemia and brain tumours: a retrospective cohort study. Lancet. 2012;380(9840):499505.

    • Search Google Scholar
    • Export Citation
  • 10

    Cardis E, Vrijheid M, Blettner M, et al. Risk of cancer after low doses of ionising radiation: retrospective cohort study in 15 countries. BMJ. 2005;331(7508):77.

    • Search Google Scholar
    • Export Citation
  • 11

    Kaasalainen T, Palmu K, Lampinen A, et al. Limiting CT radiation dose in children with craniosynostosis: phantom study using model-based iterative reconstruction. Pediatr Radiol. 2015;45(10):15441553.

    • Search Google Scholar
    • Export Citation
  • 12

    Schweitzer T, Böhm H, Meyer-Marcotty P, et al. Avoiding CT scans in children with single-suture craniosynostosis. Childs Nerv Syst. 2012;28(7):10771082.

    • Search Google Scholar
    • Export Citation
  • 13

    Danelson KA, Gordon ES, David LR, Stitzel JD. Using a three dimensional model of the pediatric skull for pre-operative planning in the treatment of craniosynostosis - biomed 2009. Biomed Sci Instrum. 2009;45:358363.

    • Search Google Scholar
    • Export Citation
  • 14

    da Silva Freitas R, de Freitas Azzolini T, Shin JH, Persing JA. Associated (parallel) tomographic findings in patients with single-sutural synostosis. J Craniofac Surg. 2010;21(2):411413.

    • Search Google Scholar
    • Export Citation
  • 15

    O’Hayon BB, Drake JM, Ossip MG, et al. Frontal and occipital horn ratio: a linear estimate of ventricular size for multiple imaging modalities in pediatric hydrocephalus. Pediatr Neurosurg. 1998;29(5):245249.

    • Search Google Scholar
    • Export Citation
  • 16

    Boyle CM, Rosenblum JD. Three-dimensional CT for pre- and postsurgical imaging of patients with craniosynostosis: correlation of operative procedure and radiologic imaging. AJR Am J Roentgenol. 1997;169(4):11731177.

    • Search Google Scholar
    • Export Citation
  • 17

    Posnick JC, Bite U, Nakano P, et al. Indirect intracranial volume measurements using CT scans: clinical applications for craniosynostosis. Plast Reconstr Surg. 1992;89(1):3445.

    • Search Google Scholar
    • Export Citation
  • 18

    Girod S, Teschner M, Schrell U, et al. Computer-aided 3-D simulation and prediction of craniofacial surgery: a new approach. J Craniomaxillofac Surg. 2001;29(3):156158.

    • Search Google Scholar
    • Export Citation
  • 19

    Rodt T, Schlesinger A, Schramm A, et al. 3D visualization and simulation of frontoorbital advancement in metopic synostosis. Childs Nerv Syst. 2007;23(11):13131317.

    • Search Google Scholar
    • Export Citation
  • 20

    Saber NR, Phillips J, Looi T, et al. Generation of normative pediatric skull models for use in cranial vault remodeling procedures. Childs Nerv Syst. 2012;28(3):405410.

    • Search Google Scholar
    • Export Citation
  • 21

    Magge KT, Magge SN, Keating RF, et al. Incidental findings on preoperative computed tomography for nonsyndromic single suture craniosynostosis. J Craniofac Surg. 2014;25(4):13271330.

    • Search Google Scholar
    • Export Citation
  • 22

    Cerovac S, Neil-Dwyer JG, Rich P, et al. Are routine preoperative CT scans necessary in the management of single suture craniosynostosis? Br J Neurosurg. 2002;16(4):348354.

    • Search Google Scholar
    • Export Citation
  • 23

    Birgfeld CB, Heike CL, Saltzman BS, Hing AV. Clinical characteristics and surgical decision making for infants with metopic craniosynostosis in conjunction with other congenital anomalies. Plast Reconstr Surg Glob Open. 2013;1(7):e62.

    • Search Google Scholar
    • Export Citation
  • 24

    Rogers AJ, Maher CO, Schunk JE, et al. Incidental findings in children with blunt head trauma evaluated with cranial CT scans. Pediatrics. 2013;132(2):e356e363.

    • Search Google Scholar
    • Export Citation
  • 25

    Ortega HW, Vander Velden H, Reid S. Incidental findings on computed tomography scans in children with mild head trauma. Clin Pediatr (Phila). 2012;51(9):872876.

    • Search Google Scholar
    • Export Citation
  • 26

    Brenner DJ, Hall EJ. Computed tomography—an increasing source of radiation exposure. N Engl J Med. 2007;357(22):22772284.

  • 27

    Miglioretti DL, Johnson E, Williams A, et al. The use of computed tomography in pediatrics and the associated radiation exposure and estimated cancer risk. JAMA Pediatr. 2013;167(8):700707.

    • Search Google Scholar
    • Export Citation
  • 28

    Slovis TL. Children, computed tomography radiation dose, and the As Low As Reasonably Achievable (ALARA) concept. Pediatrics. 2003;112(4):971972.

    • Search Google Scholar
    • Export Citation
  • 29

    Donnelly LF. Reducing radiation dose associated with pediatric CT by decreasing unnecessary examinations. AJR Am J Roentgenol. 2005;184(2):655657.

    • Search Google Scholar
    • Export Citation
  • 30

    Proisy M, Bruneau B, Riffaud L. How ultrasonography can contribute to diagnosis of craniosynostosis. Neurochirurgie. 2019;65(5):228231.

    • Search Google Scholar
    • Export Citation
  • 31

    Pogliani L, Zuccotti GV, Furlanetto M, et al. Cranial ultrasound is a reliable first step imaging in children with suspected craniosynostosis. Childs Nerv Syst. 2017;33(9):15451552.

    • Search Google Scholar
    • Export Citation
  • 32

    Redberg RF, Smith-Bindman R. We are giving ourselves cancer. New York Times. January 30, 2014. Accessed March 15, 2021. https://www.nytimes.com/2014/01/31/opinion/we-are-giving-ourselves-cancer.html

    • Search Google Scholar
    • Export Citation
  • 33

    Eley KA, Sheerin F, Taylor N, et al. Identification of normal cranial sutures in infants on routine magnetic resonance imaging. J Craniofac Surg. 2013;24(1):317320.

    • Search Google Scholar
    • Export Citation
  • 34

    Patel KB, Eldeniz C, Skolnick GB, et al. 3D pediatric cranial bone imaging using high-resolution MRI for visualizing cranial sutures: a pilot study. J Neurosurg Pediatr. 2020;26(3):311317.

    • Search Google Scholar
    • Export Citation
  • 35

    Medina LS, Richardson RR, Crone K. Children with suspected craniosynostosis: a cost-effectiveness analysis of diagnostic strategies. AJR Am J Roentgenol. 2002;179(1):215221.

    • Search Google Scholar
    • Export Citation

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