Plastic Surgery Research Council

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The Differences Before And After Whole Vault Cranioplasty In Patients With Sagittal With Metopic Craniosynostosis
Raysa Cabrejo, BA1, Cheryl Lacadie, BS1, Carolyn Chuang, MD, MHS1, Jenny Yang, MD, MHS1, Alexander Sun, BS1, Eric Brooks, MD, MHS1, Joel Beckett, MD, MHS1, Kyle Gabrick, MD1, Derek Steinbacher, DMD, MD1, Michael Alperovich, MD, MSc1, Kevin Pelphrey, PhD2, Todd Constable, PhD1, John Persing, MD1.
1Yale School of Medicine, New Haven, CT, USA, 2George Washington University, Washington, DC, USA.

Purpose:
The purpose of this study is to understand the neurological changes before and after whole vault cranioplasty (WVC) for patients born with combined sagittal and metopic craniosynostosis (SMc).
Methods:
The authors collected functional MRI (fMRI) and diffusion tension imaging (DTI) data in five infant patients before (of age 5±2 months) and after (of age 9±2 months) WVC for patients born with SMc. The imaging data were acquired using a 3-T Siemens Trio MRI system (Erlangen, Germany) while infant patients slept without any sedatives. fMRI data was corrected for movement using SPM (University College London, UK), and analyzed with BioImageSuite (Yale University, USA). The DTI data was processed utilizing FMRIB Sfotware Library (Oxford University, UK) and BioImageSuite (Yale University, USA).
Results:
Aberrations in functional brain connectivity and white matter microstructure before and after surgery using fMRI and DTI, respectively, were documented. Comparing the after WVC vs. before WVC group, after WVC demonstrated a decreased connectivity in the Broadmann Area (BA) 8 corresponding to the medial frontal cortex. Analysis of the DTI data, demonstrates an increase in anisotropy in the areas of precuneus area, corpus callosum, posterior limb of the internal capsule, brain stem after surgery (p<0.05). There is also a decrease in anisotropy in the cingulum despite or after surgery (p<0.05).
Conclusion:
Functional brain “connectivity” measures differences in blood oxygen utilization throughout the brain and is interpreted as higher connectivity where there is increased oxygenation and vice versa. Despite surgery, patients had a decreased connectivity in the medial frontal cortex, an area important in cognitive function. However later in life (adolescents) compared to controls, there is an increase in connectivity in this area.1 White matter microstructure “anisotropy” is the representation of bidirectional movements of water in white matter tracts. Anisotropy increases in the normally developing brain, most likely due to the increase myelination, reduction in brain water, and the compactness of fiber tract.2 The increase in anisotropy seen in the corpus callosum, internal capsule and brain stem after surgery are most likely due to development.3 The cortical area of the brain does not change in anisotropy during the first months of life, therefore the increase in anisotropy in the precuneus and decrease in the cingulum is most likely due to changes that develop or persist following surgery. It was previously found that areas connected to the cingulum, anterior and posterior cingulate, and precuneus have decreased connectivity in patients with operated sagittal craniosynostosis in the adolescent age group, and possibly present an uncorrected component of sagittal craniosynostosis by current surgical techniques.1
References:
1.
Beckett, J. S. et al. Altered brain connectivity in sagittal craniosynostosis. J. Neurosurg. Pediatr. 13, 690–698 (2014).
2.
Mukherjee, P. et al. Normal Brain Maturation during Childhood: Developmental Trends Characterized with Diffusion-Tensor MR Imaging. Radiology 221, 349–358 (2001).
3.
Hermoye, L. et al. Pediatric diffusion tensor imaging: normal database and observation of the white matter maturation in early childhood. NeuroImage 29, 493–504 (2006).


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