Surgical Correction of Metopic Craniosynostosis: A 3-D Photogrammetric Analysis of Cranial Vault Outcomes

2018 ◽  
Vol 56 (2) ◽  
pp. 231-235 ◽  
Author(s):  
Olivia E. Linden ◽  
Vanessa M. Baratta ◽  
Jose A. Gonzalez ◽  
Margaret E. Byrne ◽  
Petra M. Klinge ◽  
...  
Keyword(s):  
Average Distance ◽  
Cranial Vault ◽  
3 Dimensional ◽  
Postoperative Time ◽  
The Face ◽  
Academic Teaching Hospital ◽  
One Year ◽  
Cranial Vault Remodeling ◽  
Metopic Craniosynostosis

Objective: To evaluate 3-dimensional (3-D) photogrammetry as a tool for assessing the postoperative head shape of patients who had undergone cranial vault remodeling for metopic synostosis. Design: We prospectively analyzed images of patients with metopic craniosynostosis who had undergone anterior cranial vault remodeling and age-matched controls. To ensure standardized facial orientation, each 3-D image was positioned to “best fit” the preoperative face by aligning 6 soft tissue landmarks. Forehead measurements were taken from a standardized position behind the surface of the face to landmarks placed in a ray configuration across the forehead. Setting: Academic teaching hospital. Patients, Participants: Thirteen pediatric patients with metopic craniosynostosis who had undergone anterior cranial vault remodeling and age-matched controls. Interventions: Images were taken preoperatively, immediately postoperatively, and over 1-year postoperatively. Main Outcome Measures: Forehead contours preoperatively and postoperatively, with statistics performed using a multivariate analysis of variance shape analysis. Results: Mean postoperative follow-up was 1.8 (0.6) years. The average distance from the origin to forehead landmarks was 55.1 (3.4) mm preoperatively, 59.3 (0.7) mm immediate postoperatively, 59.1 (1.0) mm 1-year postoperatively, and 59.4 (0.6) mm in controls. Postoperative metopic forehead contours varied significantly from preoperative contours ( P < .01), while there was no statistical difference between the 2 postoperative time points ( P = .70). One-year postoperative patients were not significantly different from their age-matched controls ( P > .99). Conclusions: Preoperative metopic forehead contours varied significantly from postoperative contours. Cranial reconstructions approximated the foreheads of normal controls, and reconstructions were stable at more than 1-year follow-up.

The Prognosis of Depression in Old Age

1983 ◽  
Vol 142 (2) ◽  
pp. 111-119 ◽  
Author(s):  
Elaine Murphy
Keyword(s):  
Life Events ◽  
Life Stress ◽  
Intimate Relationship ◽  
Class Differences ◽  
Poor Outcome ◽  
Physical Health Problems ◽  
The Face ◽  
One Year ◽  
Severe Life Events

SummaryThe paper describes a one year prospective study of 124 elderly depressed patients. Only one third of the group had a good outcome. Poor outcome was associated with severity of initial illness, those with depressive delusions having a particularly poor outcome. Outcome was also influenced by physical health problems and severe life events in the follow-up year. Social class differences in outcome were thought to be due to class differences in the experience of severe life events. There was no evidence that an intimate relationship protected against relapse in the face of continuing life stress.

scholarly journals Improved cephalic index following early cranial vault remodeling in patients with isolated nonsyndromic sagittal synostosis

2021 ◽  
Vol 50 (4) ◽  
pp. E7
Author(s):  
Arvid Frostell ◽  
Maryam Haghighi ◽  
Jiri Bartek ◽  
Ulrika Sandvik ◽  
Bengt Gustavsson ◽  
...  
Keyword(s):  
Mixed Model ◽  
Linear Mixed Model ◽  
Cranial Vault ◽  
Hospital Length Of Stay ◽  
Cephalic Index ◽  
Sagittal Synostosis ◽  
The Mean ◽  
Cranial Vault Remodeling

OBJECTIVE Isolated nonsyndromic sagittal synostosis (SS) is the most common form of craniosynostosis in children, accounting for approximately 60% of all craniosynostoses. The typical cranial measurement used to define and follow SS is the cephalic index (CI). Several surgical techniques have been suggested, but agreement on type and timing of surgery is lacking. This study aimed to evaluate the authors’ institutional experience of surgically treating SS using a modified subtotal cranial vault remodeling technique in a population-based cohort. Special attention was directed toward the effect of patient age at time of surgery on long-term CI outcome. METHODS A retrospective analysis was conducted on all patients with isolated nonsyndromic SS who were surgically treated from 2003 to 2011. Data from electronic medical records were gathered. Eighty-two patients with SS were identified, 77 fulfilled inclusion criteria, and 72 had sufficient follow-up data and were included. CI during follow-up after surgery was investigated with ANOVA and a linear mixed model. RESULTS In total, 72 patients were analyzed, consisting of 16 females (22%) and 56 males (78%). The mean ± SD age at surgery was 4.1 ± 3.1 months. Blood transfusions were received by 81% of patients (26% intraoperatively, 64% postoperatively, 9% both). The mean ± SD time in the pediatric ICU was 1.1 ± 0.25 days, and the mean ± SD total hospital length of stay was 4.6 ± 2.0 days. No patient required reoperation. The mean ± SD CI increased from 69 ± 3 to 87 ± 5 for patients who underwent surgery before 45 days of age. Surgery resulted in a larger increase in CI for patients who underwent surgery at a younger age compared with older patients (p < 0.05, Tukey’s HSD test). In the comparison of patients who underwent surgery before 45 days of age with patients who underwent surgery at 45–90, 90–180, and more than 180 days of age, the linear mixed model estimated a long-term loss of CI of 3.0, 5.5, and 7.4 points, respectively. CONCLUSIONS The modified subtotal cranial vault remodeling technique used in this study significantly improved CI in patients with SS. The best results were achieved when surgery was performed early in life.

Nonsyndromic craniosynostosis in Vietnam: initial surgical outcomes of subspecialty mentorship

2021 ◽  
pp. 1-8
Author(s):  
Dang Do Thanh Can ◽  
Jacob R. Lepard ◽  
Nguyen Minh Anh ◽  
Pham Anh Tuan ◽  
Tran Diep Tuan ◽  
...  
Keyword(s):  
Scale Up ◽  
Unmet Need ◽  
Case Series ◽  
Surgical Care ◽  
Cranial Vault ◽  
Female Ratio ◽  
Estimated Blood Loss ◽  
Common Diagnosis ◽  
Cranial Vault Remodeling

OBJECTIVE There is a global deficit of pediatric neurosurgical care, and the epidemiology and overall surgical care for craniosynostosis is not well characterized at the global level. This study serves to highlight the details and early surgical results of a neurosurgical educational partnership and subsequent local scale-up in craniosynostosis correction. METHODS A prospective case series was performed with inclusion of all patients undergoing correction of craniosynostosis by extensive cranial vault remodeling at Children’s Hospital 2, Ho Chi Minh City, Vietnam, between January 1, 2015, and December 31, 2019. RESULTS A total of 76 patients were included in the study. The group was predominantly male, with a male-to-female ratio of 3.3:1. Sagittal synostosis was the most common diagnosis (50%, 38/76), followed by unilateral coronal (11.8%, 9/76), bicoronal (11.8%, 9/76), and metopic (7.9%, 6/76). The most common corrective technique was anterior cranial vault remodeling (30/76, 39.4%) followed by frontoorbital advancement (34.2%, 26/76). The overall mean operative time was 205.8 ± 38.6 minutes, and the estimated blood loss was 176 ± 89.4 mL. Eleven procedures were complicated by intraoperative durotomy (14.5%, 11/76) without any damage of dural venous sinuses or brain tissue. Postoperatively, 4 procedures were complicated by wound infection (5.3%, 4/76), all of which required operative wound debridement. There were no neurological complications or postoperative deaths. One patient required repeat reconstruction due to delayed intracranial hypertension. There was no loss to follow-up. All patients were followed at outpatient clinic, and the mean follow-up period was 32.3 ± 18.8 months postoperatively. CONCLUSIONS Surgical care for pediatric craniosynostosis can be taught and sustained in the setting of collegial educational partnerships with early capability for high surgical volume and safe outcomes. In the setting of the significant deficit in worldwide pediatric neurosurgical care, this study provides an example of the feasibility of such relationships in addressing this unmet need.

Suboccipital decompression during posterior cranial vault remodeling for selected cases of Chiari malformations associated with craniosynostosis

2013 ◽  
Vol 12 (2) ◽  
pp. 166-170 ◽  
Author(s):  
William W. Scott ◽  
Jeffrey A. Fearon ◽  
Dale M. Swift ◽  
David J. Sacco
Keyword(s):  
Chiari Malformation ◽  
Demographic Data ◽  
Foramen Magnum ◽  
Cranial Vault ◽  
Direct Result ◽  
Suboccipital Decompression ◽  
Combined Technique ◽  
Cranial Vault Remodeling ◽  
Chiari Malformations

Object The optimal management of Chiari malformations in the setting of craniosynostosis is not well established. In this report the authors describe their outcomes with the combined technique of simultaneous suboccipital decompression (SOD) during posterior cranial vault remodeling (PCVR). Methods A retrospective review was performed of all patients undergoing PCVR and simultaneous SOD. Demographic data, diagnosis, imaging studies, operative intervention, and clinical follow-up were evaluated. Results Thirty-four patients were identified as having undergone a simultaneous PCVR/SOD for Chiari malformation associated with craniosynostosis. Eighty-eight percent of these patients had syndromic, multisutural craniosynostosis, and the remaining patients had unilateral lambdoid craniosynostosis. There were no postoperative complications as a direct result from this combined procedure. Two patients required a subsequent direct approach for decompression of the Chiari malformation. The interval between these subsequent surgeries was 3 years and 19 months. Conclusions Chiari malformations are commonly associated with syndromic, complex craniosynostosis and isolated lambdoid craniosynostosis. In appropriately selected patients, a combined posterior cranial vault enlargement and SOD of the foramen magnum is associated with a low complication rate and appears to be an effective procedure.

Fronto-Orbital Advancement and Cranial Vault Remodeling for Metopic Craniosynostosis

CSurgeries ◽  
2016 ◽  
Author(s):  
Akshay Krishnan ◽  
Michael Golinko ◽  
Eylem Ocal ◽  
Kumar Patel
Keyword(s):  
Cranial Vault ◽  
Cranial Vault Remodeling ◽  
Metopic Craniosynostosis

scholarly journals Hydroxychloroquine-Induced Hyperpigmentation: A Case Report

2020 ◽  
Author(s):  
Mona Talaschian ◽  
Anahita Sadeghi ◽  
Sara Pakzad
Keyword(s):  
Skin Diseases ◽  
Antimalarial Agents ◽  
The Face ◽  
History Of ◽  
Inflammatory Drugs ◽  
Skin Discoloration ◽  
Anti Inflammatory ◽  
One Year ◽  
Rheumatoid Diseases

Antimalarial agents, including chloroquine and hydroxychloroquine, have been used for the treatment of various rheumatoid diseases and skin diseases because of their anti-inflammatory and immune-modulating properties. Cutaneous adverse effects such as exacerbation of psoriasis, pruritus, and hyperpigmentation have been reported as side-effects of antimalarial drugs. In this case, we report a middle-aged man with a history of rheumatoid arthritis who was treated with non-steroidal anti-inflammatory drugs and hydroxychloroquine. He complainedof hyperpigmentation of the face after one year of initiating the hydroxychloroquine. It was discontinued and methotrexate was started. Skin biopsy was confirmed drug reaction. Aftermore than 10 years of follow up, his skin discoloration had not been improved.

scholarly journals Unusual mandible fracture caused by metallic spear: case report and literature review

2020 ◽  
Vol 26 (2) ◽  
pp. 20
Author(s):  
Samuel Macedo Costa ◽  
Bruna Campos Ribeiro ◽  
Bernardo Barcelos Greco ◽  
Rodolfo César Gual ◽  
Alessandro Oliveira de Jesus ◽  
...  
Keyword(s):  
Unusual Case ◽  
Mandible Fracture ◽  
Operative Care ◽  
Surgical Incisions ◽  
The Face ◽  
Gun Shot ◽  
History Of ◽  
One Year ◽  
Water Sports

Spear gun projectiles injuries are are very rare and are usually related to lack of attention during water- sports or fishing practices. This study aims to describe an unusual case of facial injury associated with a mandibular fracture after a spear gun shot. A 38-years-old man was admitted with a history of penetrating injury on the face caused by an accidental shot from a spear gun. After the initial stabilization and examination, the patient was taken to the surgical room for the removal of the projectile. The post-operative care was uneventful and the patient was discharged with no concerns, being in follow-up for one year with no signs of infection or malocclusion. The surgical procedure should be done as soon as possible and the removal of the spear must be done carefully, under direct vision, with or without surgical incisions. Major complications can occur after spear injuries, therefore, the patient must be observed in the postoperative period and should maintain follow up until the end of the rehabilitative process.

Comparative analysis of cranial vault remodeling versus endoscopic suturectomy in the treatment of unilateral lambdoid craniosynostosis

2020 ◽  
Vol 26 (2) ◽  
pp. 105-112
Author(s):  
Abbas Rattani ◽  
Coleman P. Riordan ◽  
John G. Meara ◽  
Mark R. Proctor
Keyword(s):  
Head Circumference ◽  
Cranial Vault ◽  
Surgical Approaches ◽  
Normal Brain ◽  
Invasive Approach ◽  
Cranial Growth ◽  
Estimated Blood Loss ◽  
Lambdoid Synostosis ◽  
Cranial Vault Remodeling

OBJECTIVEUnilateral lambdoid synostosis is the premature fusion of a lambdoid suture or sutures and represents the least common form of craniosynostosis, occurring in 1 in 40,000 births. Cranial vault remodeling (CVR) and endoscopic suturectomy with helmet therapy (ES) are surgical approaches that are used to allow for normal brain growth and improved craniofacial symmetry. The authors conducted a comparative outcomes analysis of patients with lambdoid synostosis undergoing either CVR or ES.METHODSThe authors conducted a retrospective consecutive cohort study of patients with nonsyndromic lambdoid synostosis who underwent surgical correction identified from a single-institution database of patients with craniosynostosis seen between 2000 and 2018. Cranial growth was measured in head circumference percentile and z score.RESULTSNineteen patients (8 female and 11 male) with isolated unilateral lambdoid synostosis were identified (8 right and 11 left). Six underwent CVR and 13 underwent ES. No statistically significant differences were noted between surgical groups with respect to suture laterality, the patient’s sex, and length of follow-up. Patients treated with ES presented and underwent surgery at a younger age than those treated with CVR (p = 0.0002 and p = 0.0001, respectively). Operating and anesthesia time, estimated blood loss, and ICU and total hospital days were significantly lower in ES (all p < 0.05). No significant differences were observed in pre- and postoperative head circumference percentiles or z scores between groups up to 36 months postoperatively. No patients required reoperation as of last follow-up.CONCLUSIONSEndoscopic management of lambdoid synostosis is safe, efficient, and efficacious in terms of intraoperative and long-term cranial growth outcomes when compared to CVR. The authors recommend this minimally invasive approach as an option for correction of lambdoid synostosis in patients presenting early in their course.

The effectiveness of telepsychiatry measured using the Health of the Nation Outcome Scale and the Mental Health Inventory

2003 ◽  
Vol 9 (1) ◽  
pp. 12-16 ◽  
Author(s):  
Craig Kennedy ◽  
Peter Yellowlees
Keyword(s):  
Mental Health ◽  
Health Outcome ◽  
General Practice ◽  
Initial Assessment ◽  
Face To Face ◽  
Significant Difference ◽  
Outcome Scores ◽  
The Face ◽  
One Year

In a telepsychiatry project in rural Queensland, data were collected from 124 patients attending hospital and general practice facilities for mental health-care and then again at follow-up one year later. Thirty-two of the patients were dealt with using telepsychiatry. Two health status scales were used to measure effectiveness: the Health of the Nation Outcome Scale (HoNOS), administered by the practitioners; and the Mental Health Inventory (MHI), which was self-administered by the patients. There was a significant difference between the initial assessment and follow-up groups on most subscales of the HoNOS, but no significant difference between the face-to-face and telepsychiatry groups. Similarly, the MHI results showed a significant difference on all subscales between the initial assessment and follow-up groups, but no significant difference between the face-to-face and telepsychiatry groups. Individuals who used and did not use telepsychiatry all had improved health outcome scores on the HoNOS and MHI during the study period. Telepsychiatry was as effective as face-to-face care.

Increases in Cranial Volume with Posterior Cranial Vault Distraction in 31 Consecutive Cases

Neurosurgery ◽  
2017 ◽  
Vol 81 (5) ◽  
pp. 803-811 ◽  
Author(s):  
Niina Salokorpi ◽  
Ville Vuollo ◽  
Juha-Jaakko Sinikumpu ◽  
Leonid Satanin ◽  
Heleia Nestal Zibo ◽  
...  
Keyword(s):  
Cranial Vault ◽  
Outpatient Clinics ◽  
Radiation Doses ◽  
Intracranial Volume ◽  
Volume Increase ◽  
3 Dimensional ◽  
Skull Radiographs ◽  
The Mean ◽  
Cranial Expansion

Abstract BACKGROUND Posterior cranial vault distraction (PCVD) is a technique widely used in surgical treatment of craniosynostosis when cranial expansion is required. It has proven to be safe and to allow a significant increase of intracranial volume. OBJECTIVE To evaluate increases in intracranial volume as a result of PCVD performed in Oulu Craniofacial center using 2 different methods based on 3-dimensional (3-D) photogrammetric imaging or plain skull radiographs. METHODS All children less than 16 yr of age who were treated by PCVD (n = 31) from 2009 to 2015 at the Oulu Craniofacial Center were included. All patients were followed at outpatient clinics with plain radiographs performed for follow-up. In 5 patients, additional 3-D photogrammetric imaging was done pre- and postoperatively. RESULTS The mean intracranial volume increase was 25.0%, ranging from 16.9% to 39.4%. In 5 patients, the increase in volume was calculated from the photogrammetric 3-D images comprising a mean of 17.4%. Volume calculations from cephalograms in the same patients gave a mean of 20.8%. Whether the distraction was a primary operation or patient had undergone previous cranioplasty did not influence the achieved volumetric results. There were no statistically significant differences in the distraction results between different diagnostic groups. CONCLUSION PCVD is an effective surgical method to increase intracranial volume in a variety of clinical entities. Volumetric results of this procedure could be easily evaluated using 3-D photogrammetric imaging or plane radiographs that expose the patients to only low ionizing radiation doses.

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