title: Cerebrospinal fluid collections in sagittal suture synostosis.
abstract: OBJECTIVE
  The premature fusion of the sagittal suture (scaphocephaly) may be associated with intracranial cerebrospinal fluid (CSF) dynamics alterations resulting in pericerebral effusion (PE) and/or ventriculomegaly. However, the etiology and development of such collections are not fully elucidated. The aims of this study are to clarify the characteristics of intracranial CSF collection in scaphocephaly, consider the role of surgery, and analyze the prognostic factor on CSF dynamics.
  
  
  METHODS
  The pre- and postoperative cerebral imaging of 63 children (48 boys, 15 girls) with scaphocephaly who underwent craniotomy with decompression of the superior sagittal sinus (SSS) before 6 months of age between 2008 and 2015 were retrospectively studied. The PE was compared to the estimated value corrected for age (normal control). Evans' index (EI) was calculated. Correlations among these values and indices were analyzed.
  
  
  RESULTS
  Preoperatively, 36 of 63 patients (57 %) had larger PE than expected, and 36 of 63 patients (57 %) had pathological EI (EI > 0.3), and among them, 26 (46 %) had both. Patients with large PE tended to have pathological EI (p = 0.005). The PE and the EI were significantly decreased postoperatively (p < 0.001). The PE decreased faster than the expected natural course in 59 of 63 patients (92 %) postoperatively.
  
  
  CONCLUSIONS
  The precise comparison with estimated PE prevalence corrected for age showed that PE can be found in more than half of the children with scaphocephaly, associated with ventriculomegaly. Surgery has a significant efficacious role in decreasing those CSF collections. The long-term significance of such CSF collections in scaphocephaly is still to be elucidated.
authors.affiliation: Department of Pediatric Neurosurgery, Craniofacial Unit, Necker-Enfants Malades Hospital, 149 rue de Sèvres, 75015, Paris, France.
authors.forename: Kenichi
authors.initials: K
authors.lastname: Usami
authors.affiliation: Department of Pediatric Neurosurgery, Craniofacial Unit, Necker-Enfants Malades Hospital, 149 rue de Sèvres, 75015, Paris, France.
authors.forename: Francesca
authors.initials: F
authors.lastname: Nicolini
authors.affiliation: Department of Pediatric Neurosurgery, Craniofacial Unit, Necker-Enfants Malades Hospital, 149 rue de Sèvres, 75015, Paris, France.
authors.forename: Eric
authors.initials: E
authors.lastname: Arnaud
authors.affiliation: Department of Pediatric Neurosurgery, Craniofacial Unit, Necker-Enfants Malades Hospital, 149 rue de Sèvres, 75015, Paris, France. federico.dirocco@nck.aphp.fr.
authors.forename: Federico
authors.initials: F
authors.lastname: Di Rocco
mesh_terms: D003398:Craniosynostoses / Q000134:cerebrospinal fluid* / Q000150:complications; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000209:etiology*; D007223:Infant; D008297:Male; D012189:Retrospective Studies
keywords: Craniosynostosis; External hydrocephalus; Hydrocephalus; Outcome; Postoperative evolution; Scaphocephaly