Neuroimaging in Nonsyndromic Craniosynostosis: Key Concepts to Unlock Innovation
Abstract
:1. Introduction
2. Major Types of Nonsyndromic Craniosynostosis
2.1. Sagittal Craniosynostosis (Scaphocephaly)
- Elongated, boat-shaped skull;
- Prominent forehead;
- Occipital bulging;
- Possible developmental delays due to restricted brain growth.
2.2. Coronal Craniosynostosis
- asymmetrical forehead;
- flattened forehead and brow on the affected side;
- elevated eye socket on the affected side;
- nose deviated toward the affected side.
- symmetrical flattening of the forehead;
- short, broad skull;
- increased ICP due to restricted growth.
2.3. Metopic Craniosynostosis (Trigonocephaly)
- triangular, keel-shaped forehead;
- closely spaced eyes (hypotolorism);
- midline ridge along the forehead;
- potential cognitive and developmental impairments.
2.4. Lambdoid Craniosynostosis (Posterior Plagiocephaly)
- asymmetrical flattening of the back of the head;
- one ear positioned higher than the other;
- tilted cranial base;
- misalignment of the jaw and facial structures.
2.5. Mixed and Complex Craniosynostosis
- mixed deformities depending on which sutures are involved;
- severe cranial asymmetry;
- high risk of developmental delays and neurological issues;
- complex surgical planning required for correction.
3. Optimizing Imaging Methods: Moving beyond Ionizing Radiation
3.1. Ultrasound
3.2. Computed Tomography
3.3. Magnetic Resonance Imaging
3.4. Digital Subtraction Angiography (DSA)
4. Associated Structural Brain Abnormalities: Beyond Sutures and Fontanelles
4.1. Intracranial Volume and Intracranial Pressure Alterations
4.2. Possible Associations with Macroscopic Alterations in Brain Morphology
4.3. Microstructural Abnormalities and Possible Impacts on Brain Development
5. Postoperative Imaging Challenges
6. Conclusions
Author Contributions
Funding
Financial Disclosures
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Abbreviations
References
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Major Sutures | Complete Fusion | Details |
---|---|---|
Metopic suture | 3–9 months | Fuses up to 6 years or never closes |
Closes from nasion to anterior fontanelle | ||
Sagittal suture | 21–30 years | Unfused through childhood |
Narrows from the 1st month | ||
Coronal suture | ~24 years | Unfused through childhood |
Narrows during childhood | ||
Lambdoid suture | ~26 years | Unfused through childhood |
Common site of Wormian bones |
Neuroimaging | Advantages | Disadvantages |
---|---|---|
Ultrasound | Non-irradiating technique Fast and repeatable Non-invasive No sedation required Widely available Low-cost | User-dependent Inconclusive if poor patients’cooperation Limited use in relatively advanced-age patients Poor evaluation of deeper structures |
Computed tomography | Fast acquisition Readily accessible Sedation generally not required Widely available Limited cost Excellent bone evaluation Multiplanar and 3D reconstructions easily available | Irradiating technique (thus repeated CT scans over time should be limited) Limited evaluation of soft tissues and associated brain abnormalities Iodinated contrast media required for vascular structures depiction |
Magnetic resonance imaging | Non-irradiating technique Repeatable over time Excellent soft tissue definition Excellent potential due to advanced techniques Gadolinium-based contrast media generally not required Reference method for associated brain and spine abnormalities search | Sedation usually required Not always readily accessible Long acquisition Higher cost Specific professional experience required for data interpretation Longer data post-processing |
Digital subtraction angiography | Excellent vascular structures depiction Real-time observation of blood flow dynamics Potentially combinable with interventional procedures, when required (cost-effective) | Irradiating technique More invasive Specific professional experience required Iodinated contrast media always required Sedation usually required Higher cost Not always readily accessible Limited spatial resolution Very poor or no evaluation of structures other than vascular |
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Russo, C.; Aliberti, F.; Ferrara, U.P.; Russo, C.; De Gennaro, D.V.; Cristofano, A.; Nastro, A.; Cicala, D.; Spennato, P.; Quarantelli, M.; et al. Neuroimaging in Nonsyndromic Craniosynostosis: Key Concepts to Unlock Innovation. Diagnostics 2024, 14, 1842. https://doi.org/10.3390/diagnostics14171842
Russo C, Aliberti F, Ferrara UP, Russo C, De Gennaro DV, Cristofano A, Nastro A, Cicala D, Spennato P, Quarantelli M, et al. Neuroimaging in Nonsyndromic Craniosynostosis: Key Concepts to Unlock Innovation. Diagnostics. 2024; 14(17):1842. https://doi.org/10.3390/diagnostics14171842
Chicago/Turabian StyleRusso, Camilla, Ferdinando Aliberti, Ursula Pia Ferrara, Carmela Russo, Domenico Vincenzo De Gennaro, Adriana Cristofano, Anna Nastro, Domenico Cicala, Pietro Spennato, Mario Quarantelli, and et al. 2024. "Neuroimaging in Nonsyndromic Craniosynostosis: Key Concepts to Unlock Innovation" Diagnostics 14, no. 17: 1842. https://doi.org/10.3390/diagnostics14171842