Deformational brachycephaly: the clinical utility of the cranial index

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  • 1 Surgical Outcomes Center for Kids, Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville, Tennessee;
  • 2 Florida State University College of Medicine, Tallahassee, Florida;
  • 3 University of South Carolina School of Medicine, Columbia, South Carolina; and
  • 4 Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
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OBJECTIVE

The incidence of deformational brachycephaly has risen since the “Back to Sleep” movement in 1992 by the American Academy of Pediatrics. Brachycephaly prevalence and understanding the dynamic nature of the pediatric skull have not been explored in relation to the cranial index (CI). The objective of the study was to determine the prevalence of brachycephaly, via the CI, with respect to time.

METHODS

The authors conducted a retrospective review of 1499 patients ≤ 19 years of age who presented for trauma evaluation with a negative CT scan for trauma (absence of bleed) in 2018. The CI was calculated using CT at the lateral-most point of the parietal bone (cephalic width), and the distance from the glabella to the opisthocranion (cephalic length). Brachycephaly was defined as a CI ≥ 90%.

RESULTS

The mean CI was 82.6, with an average patient age of 6.8 years. The prevalence of deformational brachycephaly steadily decreased from 27% to 4% from birth to > 2 years of life. The mean CI was statistically different between ages < 12 months, 12–24 months, and > 24 months (F[2,1496] = 124.058, p < 0.0005). A simple linear regression was calculated to predict the CI based on age; the CI was found to decrease by 0.038 each month. A significant regression equation was found (F[1,1497] = 296.846, p < 0.0005), with an R2 of 0.140.

CONCLUSIONS

The incidence of deformational brachycephaly is common in infants but decreases as the child progresses through early childhood. Clinicians can expect a significant decrease in mean CI at 12 and 24 months. Additionally, these regression models show that clinicians can expect continued improvement throughout childhood.

ABBREVIATIONS AAP = American Academy of Pediatrics; CI = cranial index; MCJCHV = Monroe Carell Jr. Children’s Hospital at Vanderbilt.

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Contributor Notes

Correspondence Ranbir Ahluwalia: Florida State University College of Medicine, Tallahassee, FL. ra16@med.fsu.edu.

INCLUDE WHEN CITING Published online May 1, 2020; DOI: 10.3171/2020.2.PEDS19767.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

  • 1

    Rogers GF. Deformational plagiocephaly, brachycephaly, and scaphocephaly. Part I: terminology, diagnosis, and etiopathogenesis. J Craniofac Surg. 2011;22(1):916.

    • Search Google Scholar
    • Export Citation
  • 2

    Kelly KM, Joganic EF, Beals SP, Helmet treatment of infants with deformational brachycephaly. Glob Pediatr Health. 2018;5:X18805618.

  • 3

    Turk AE, McCarthy JG, Thorne CH, Wisoff JH. The “back to sleep campaign” and deformational plagiocephaly: is there cause for concern? J Craniofac Surg. 1996;7(1):1218.

    • Search Google Scholar
    • Export Citation
  • 4

    Feijen M, Franssen B, Vincken N, van der Hulst RR. Prevalence and consequences of positional plagiocephaly and brachycephaly. J Craniofac Surg. 2015;26(8):e770e773.

    • Search Google Scholar
    • Export Citation
  • 5

    Graham JM Jr, Kreutzman J, Earl D, Deformational brachycephaly in supine-sleeping infants. J Pediatr. 2005;146(2):253257.

  • 6

    Likus W, Bajor G, Gruszczyńska K, Cephalic index in the first three years of life: study of children with normal brain development based on computed tomography. ScientificWorldJournal. 2014;2014:502836.

    • Search Google Scholar
    • Export Citation
  • 7

    Waitzman AA, Posnick JC, Armstrong DC, Pron GE. Craniofacial skeletal measurements based on computed tomography: Part II. Normal values and growth trends. Cleft Palate Craniofac J. 1992;29(2):118128.

    • Search Google Scholar
    • Export Citation
  • 8

    Hummel P, Fortado D. Impacting infant head shapes. Adv Neonatal Care. 2005;5(6):329340.

  • 9

    Bialocerkowski AE, Vladusic SL, Wei Ng C. Prevalence, risk factors, and natural history of positional plagiocephaly: a systematic review. Dev Med Child Neurol. 2008;50(8):577586.

    • Search Google Scholar
    • Export Citation
  • 10

    Hutchison BL, Thompson JM, Mitchell EA. Determinants of nonsynostotic plagiocephaly: a case-control study. Pediatrics. 2003;112(4):e316.

    • Search Google Scholar
    • Export Citation
  • 11

    Lipira AB, Gordon S, Darvann TA, Helmet versus active repositioning for plagiocephaly: a three-dimensional analysis. Pediatrics. 2010;126(4):e936e945.

    • Search Google Scholar
    • Export Citation
  • 12

    McKinney CM, Cunningham ML, Holt VL, Characteristics of 2733 cases diagnosed with deformational plagiocephaly and changes in risk factors over time. Cleft Palate Craniofac J. 2008;45(2):208216.

    • Search Google Scholar
    • Export Citation
  • 13

    Meyer-Marcotty P, Böhm H, Linz C, Spectrum of positional deformities—is there a real difference between plagiocephaly and brachycephaly? J Craniomaxillofac Surg. 2014;42(6):10101016.

    • Search Google Scholar
    • Export Citation

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