Associated (parallel) tomographic findings in patients with single-sutural synostosis.
BACKGROUND
Craniosynostosis is the premature fusion of 1 or more of the cranial sutures, which causes an abnormal skull shape. The treatment is complex and requires surgical intervention for correction, between 3 and 12 months of age. The current standard for diagnosing craniosynostosis is to obtain a computed tomographic (CT) scan. However, recent studies have emphasized potential problems associated with ionizing radiation. The aim of this study was to evaluate the use of the preoperative CT scan, and its findings, and to define the value of these data.


METHODS
This study is a retrospective analysis of 89 patients with craniosynostosis during the period between 1998 and 2007, who had CT using the Yale-New Haven Hospital computer system. Clinical findings such as age, sex, and diagnosis were recorded. All intraoperative abnormalities were noted. Preoperative CT scans were reevaluated for accuracy and completeness of diagnosis, cerebral anomalies, and other head and neck pathologic conditions.


RESULTS
Initially, 131 cases of nonsyndromic craniosynostosis were identified. Of these, we had access to CT evaluations in 89 patients. The mean age at the time of the surgery was 13 months, varying from 2 months to 18 years old. Most patients were males. The most common diagnoses were sagittal synostosis in 47 cases; unilateral coronal, 16; and metopic, 15. In most patients, the CT scan demonstrated the same diagnosis as the clinical examination-derived diagnosis. However, 6 patients had an incomplete diagnosis or misdiagnosis. In addition, 3 cases of prominence of the subarachnoid space, 2 cases of cerebral atrophy, 1 case of subarachnoid tumor, and 1 deformational dysplasia of encephalon were identified. Other minor additional diagnoses were 5 cases of fluid in the middle ear and antrum of mastoid, 2 cases of cysts in the maxilla, and 1 case of an associated cervical lymphatic tumor.


CONCLUSIONS
The advantage of CT use is greater accuracy in diagnosis, less potential for inappropriate surgery, and, as an ancillary effect, a more complete and timely assessment of congenital anomalies so that more appropriate referrals can be made. Low-dose (pediatric) radiation CT still seems to have a place in the examination of a patient with skull deformity and potential craniosynostosis.
da Silva Freitas
Renato
R
Section of Plastic Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut 06520-8041, USA.
de Freitas Azzolini
Thais
T
Shin
Joseph H
JH
Persing
John A
JA
D000293:Adolescent; D000367:Age Factors; D001284:Atrophy; D001921:Brain / Q000002:abnormalities / Q000000981:diagnostic imaging / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D003393:Cranial Sutures / Q000002:abnormalities; D003398:Craniosynostoses / Q000000981:diagnostic imaging*; D005260:Female; D005500:Follow-Up Studies; D005624:Frontal Bone / Q000002:abnormalities; D006801:Humans; D007223:Infant; D007430:Intraoperative Care; D007570:Jaw Cysts / Q000000981:diagnostic imaging; D008297:Male; D008439:Maxillary Diseases / Q000000981:diagnostic imaging; D010033:Otitis Media / Q000000981:diagnostic imaging; D010294:Parietal Bone / Q000002:abnormalities; D012189:Retrospective Studies; D012737:Sex Factors; D013346:Subarachnoid Space / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data*