Abstract 18. A Method for Quantifying Intracranial Volume Change by Distraction Osteogenesis for Craniosynostosis

Abstract Background The enlargement of the posterior cranial fossa volume is considered one of the main steps of the surgical management of children with multiple sutures craniosynostosis. Different management options have been proposed including fixed expansive craniotomy, free bone flap craniotomy, and distraction osteogenesis. Objectives To review indications to “free bone flap” craniotomy for the posterior fossa expansion, detailing advantages, disadvantages, and complications related to the technique. Results and conclusions A review of the literature shows that “free bone flap” posterior expansion cranioplasty still has a role, particularly in infants with thin and “honeycomb” structure of the bone, allowing to gain adequate intracranial volume increases and to postpone to a more adequate time surgery aimed at anterior cranial fossa expansion.

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Computer Simulation and Optimization of Cranial Vault Distraction

The Cleft Palate-Craniofacial Journal ◽

10.1177/1055665617738999 ◽

2017 ◽

Vol 55 (3) ◽

pp. 356-361

Author(s):

Michael J. Foley ◽

Patrick S. Cottler ◽

Silvia S. Blemker ◽

Arlen D. Denny ◽

Jonathan S. Black

Keyword(s):

Computer Simulation ◽

Volume Change ◽

Digital Simulation ◽

Ct Images ◽

Cranial Vault ◽

Intracranial Volume ◽

Proof Of Concept ◽

Simulation And Optimization ◽

Computed Tomographic ◽

The Relationship

Objective: The objective of this study was to validate the proof of concept of a computer-simulated cranial distraction, demonstrating accurate shape and end volume. Design: Detailed modeling was performed on pre- and postoperative computed tomographic (CT) scans to generate accurate measurements of intracranial volume. Additionally, digital distraction simulations were performed on the preoperative scan and the resultant intracranial volume and shape were evaluated. Setting: Tertiary Children’s Hospital. Patients, Participants: Preoperative and postoperative CT images were used from 10 patients having undergone cranial distraction for cephalocranial disproportion. Interventions: None; computer simulation. Main Outcome Measure: Computer simulation feasibility of cranial vault distraction was demonstrated through creation of digital osteotomies, simulating distraction through translating skull segments, followed by simulated consolidation. Accuracy of the model was evaluated through comparing the intracranial volumes of actual and simulated distracted skulls. Results: The developed digital distraction simulation was performed on the CT images of 10 patients. Plotting the relationship between the actual and simulated postdistraction volumes for the 10 patients yielded a slope of 1.0 and a correlation coefficient of 0.99. The average actual resultant volume change from distraction was 77.0 mL, compared to a simulated volume change of 76.9 mL. Conclusions: Digital simulation of cranial distraction was demonstrated through manipulation of the CT images and confirmed by comparing the actual to simulated volume change. This process may provide objective data in designing an individual distraction plan to optimize volume expansion and resultant cranial shape as well as patient education.

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Hippocampal volume change relates to clinical outcome in childhood-onset schizophrenia

Psychological Medicine ◽

10.1017/s0033291715000677 ◽

2015 ◽

Vol 45 (12) ◽

pp. 2667-2674 ◽

Cited By ~ 11

Author(s):

A. A. Anvari ◽

L. A. Friedman ◽

D. Greenstein ◽

P. Gochman ◽

N. Gogtay ◽

...

Keyword(s):

Clinical Outcome ◽

Volume Change ◽

Negative Symptoms ◽

Hippocampal Volume ◽

Percentage Change ◽

Positive Symptoms ◽

Intracranial Volume ◽

Childhood Onset ◽

Global Functioning ◽

Childhood Onset Schizophrenia

BackgroundFixed hippocampal volume reductions and shape abnormalities are established findings in schizophrenia, but the relationship between hippocampal volume change and clinical outcome has been relatively unexplored in schizophrenia and other psychotic disorders. In light of recent findings correlating hippocampal volume change and clinical outcome in first-episode psychotic adults, we hypothesized that fewer decreases in hippocampal volume would be associated with better functional outcome and fewer psychotic symptoms in our rare and chronically ill population of childhood-onset schizophrenia (COS) patients.MethodWe prospectively obtained 114 structural brain magnetic resonance images (MRIs) from 27 COS subjects, each with three or more scans between the ages of 10 and 30 years. Change in hippocampal volume, measured by fit slope and percentage change, was regressed against clinical ratings (Children's Global Assessment Scale, Scale for the Assessment of Positive Symptoms, Scale for the Assessment of Negative Symptoms) at last scan (controlling for sex, time between scans and total intracranial volume).ResultsFewer negative symptoms were associated with less hippocampal volume decrease (fit slope: p = 0.0003, and percentage change: p = 0.005) while positive symptoms were not related to hippocampal change. There was also a relationship between improved clinical global functioning and maintained hippocampal volumes (fit slope: p = 0.025, and percentage change: p = 0.043).ConclusionsThese results suggest that abnormal hippocampal development in schizophrenia can be linked to global functioning and negative symptoms. The hippocampus can be considered a potential treatment target for future therapies.

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