Investigation of the Effect of Cranial Vault Surgery On Parenchymal Perfusion Before and After Surgery in Craniosynostosis Patients

Yıl 2023, Cilt: 17 Sayı: 2, 160 - 165, 22.03.2023

Süleyman Taha Aslan , Harun Demirci

https://doi.org/10.12956/tchd.1252646

Cited By: 1

Öz

Objective: In our study, it is aimed to examine the effect of surgery on brain perfusion with ASL sequence perfusion MRI taken before surgery and 12 weeks after surgery in cases of non-syndromic craniosynostosis treated in our clinic.
Materials and Methods: The study was conducted between 28.12.2021-16.09.2022 with 10 patients who evaluated preoperatively and treated surgically at the Neurosurgery Clinic of Ankara City Hospital. Perfusion MRI was performed preoperatively and 12 weeks postoperatively. The preoperative and postoperative images obtained were evaluated comparatively at the workstation.
Results: After the exclusion of patients who did not appropriate the study criteria, the results of 9 patients were examined. MRI scans taken preoperatively and 87 days as average postoperatively. After surgery, there is perfusion enhancement in 7 patients and a perfusion impairment in 2 patients. About the average perfusion rates, the results were found to be statistically significant in four of the seven patients in whom an increase was detected (p≤0.05), while the results were found to be statistically significant in one of the patients in whom a decrease was observed. (p≤0.05)
Conclusion: Surgical treatment is effective on brain perfusion in patients with non-syndromic craniosynostosis. Perfusion alteration may be different according to surgical technique, patient age at the time of surgery and type of craniosynostosis. In addition to cosmetic improvement, surgical treatment can also be effective in changing neurological functions. ASL sequence perfusion MRI, which doesn’t require contrast and is non-invasive, is a successful method of demonstrating the quantitative effectiveness of surgery in patients with craniosynostosis.

Anahtar Kelimeler

Cerebral Blood Flow, Craniosynostosis, Magnetic Resonance, Nonsyndromic, Perfusion Imaging

Kraniyosinostoz Hastalarinda Kubbe Cerrahisinin, Cerrahi Öncesi ve Sonrası Parankimal Perfüzyon Üzerine Etkisinin İncelenmesi

Öz

Amaç: Çalışmamızda kliniğimizde tedavi edilen non-sendromik kraniyosinostoz olgularında cerrahi öncesi ve cerrahiden 12 hafta sonra çekilen ASL sekans perfüzyon MRG ile cerrahinin beyin perfüzyonu üzerindeki etkisinin incelenmesi amaçlanmaktadır.
Gereç ve Yöntem: Çalışma 28.12.2021-16.09.2022 tarihleri arasında Ankara Şehir Hastanesi Beyin ve Sinir Cerrahi kliniğinde cerrahi tedavileri, preoperatif ve postoperatif tetkikleri gerçekleştirilen 10 hasta ile yapıldı. Hastalara preoperatif ve postoperatif 12. haftada Perfüzyon MRG çekimleri yapıldı. Preoperatif ve postoperatif elde edilen görüntüler çalışma istasyonunda karşılaştırmalı değerlendirildi.
Bulgular: Çalışma kriterlerini karşılamayan hastaların çalışma dışında bırakılmasını takiben 9 hastanın sonuçları incelendi. Beş hastaya açık cerrahi rekonstrüksiyon dört hastaya endoskopik cerrahi uygulandı. Preoperatif ve postoperatif ortalama 87 gün sonra MRG çekimleri yapıldı. Cerrahi sonrası 7 hastada perfüzyon artışı ve 2 hastada perfüzyonda azalma oldu. Ortalama perfüzyon hızlarına bakıldığında artış saptanan yedi hastanın dördünde sonuçlar istatistiksel olarak anlamlıyken (p≤0,05) azalma görülen hastaların birinde sonuçlar istatistiksel olarak anlamlı bulundu. (p≤0,05)
Sonuç: Non-sendromik kraniyosinostoz hastalarında cerrahi tedavi beyin perfüzyonu üzerinde etkilidir. Perfüzyon değişikliği cerrahi teknik, cerrahi sırasında hasta yaşı ve kraniyosinostoz çeşidine göre farklı olabilir. Cerrahi tedavi kozmetik düzelmenin yanında nörolojik fonksiyonların değişikliğinde de etkili olabilir. Kontrast gerektirmeyen ve non-invaziv olan ASL sekans perfüzyon MRG kraniyosinostoz hastalarında cerrahinin kantatif etkinliğini göstermede başarılı bir yöntemdir.

Anahtar Kelimeler

Kraniyosinostoz, Manyetik Rezonans, Non-sendromik, Perfüzyon Görüntüleme, Serebral Kan Akımı

Kaynakça

• Di Rocco C, Pang D, Rutka JT, (eds).Textbook of Pediatric Neurosurgery [Internet]. Cham: Springer International Publishing; 2020 [a.yer 31 Ocak 2023]. Accessed: https://link.springer.com/10.1007/978-3-319-31512-6
• Chico Ponce de León F, Franco-Jiménez JA. Types of Craniosynostosis and their Etiology, Pathophysiology and Epidemiology. İçinde: The Sutures of the Skull: Anatomy, Embryology, Imaging, and Surgery. Springer 2021:201-31.
• Dempsey RF, Monson LA, Maricevich RS, Truong TA, Olarunnipa S, Lam SK, vd. Nonsyndromic craniosynostosis. Clin Plast Surg 2019;46:123-39.
• Kapp-Simon KA, Speltz ML, Cunningham ML, Patel PK, Tomita T. Neurodevelopment of children with single suture craniosynostosis: a review. Childs Nerv Syst 2007;23:269-81.
• Kalmar CL, Lang SS, Heuer GG, Schreiber JE, Tucker AM, Swanson JW, vd. Neurocognitive outcomes of children with non-syndromic single-suture craniosynostosis. Childs Nerv Syst 2022;38:893-901.
• David LR, Wilson JA, Watson NE, Argenta LC. Cerebral perfusion defects secondary to simple craniosynostosis. J Craniofac Surg 1996;7:177-85.
• Yu M, Ma L, Yuan Y, Ye X, Montagne A, He J, et al. Cranial Suture Regeneration Mitigates Skull and Neurocognitive Defects in Craniosynostosis. Cell 2021;184:243-56.e18.
• Thiele-Nygaard AE, Foss-Skiftesvik J, Juhler M. Intracranial pressure, brain morphology and cognitive outcome in children with sagittal craniosynostosis. Childs Nerv Syst 2020;36:689-95.
• Becker DB, Petersen JD, Kane AA, Cradock MM, Pilgram TK, Marsh JL. Speech, cognitive, and behavioral outcomes in nonsyndromic craniosynostosis. Plast Reconstr Surg 2005;116:400-7.
• Timberlake AT, Junn A, Flores R, Staffenberg DA, Lifton RP, Persing JA. Genetic influence on neurodevelopment in nonsyndromic craniosynostosis. Plast Reconstr Surg 2022;149:1157-65.
• Doerga PN, Lequin MH, Dremmen MH, den Ottelander BK, Mauff KA, Wagner MW, et al. Cerebral blood flow in children with syndromic craniosynostosis: cohort arterial spin labeling studies. J Neurosurg Pediatr 2019;25:340-50.
• Cabrejo R, Lacadie C, Sun A, Chuang C, Yang J, Brooks E, et al. Functional network development in sagittal craniosynostosis treated with whole vault cranioplasty. J Craniofac Surg 2021;32:1721-6.
• Cabrejo R, Lacadie C, Brooks E, Beckett J, Sun A, Yang J, et al. Understanding the learning disabilities linked to sagittal craniosynostosis. J Craniofac Surg 2019;30:497-502.
• Dong SZ, Zhu M, Bulas D. Techniques for minimizing sedation in pediatric MRI. J Magn Reson Imaging 2019;50:1047-54.
• Mazandi VM, Lang SS, Rahman RK, Nishisaki A, Beaulieu F, Zhang B, et al. Co-administration of Ketamine in Pediatric Patients with Neurologic Conditions at Risk for Intracranial Hypertension. Neurocrit Care 2022;1-12. 10.1007/s12028-022-01611-2. Online ahead of print.
• Bambach S, Smith M, Morris PP, Campeau NG, Ho ML. Arterial spin labeling applications in pediatric and adult neurologic disorders. J Magn Reson Imaging 2022;55:698-719.
• Narayanan S, Schmithorst V, Panigrahy A. Arterial spin labeling in pediatric neuroimaging. Semin Pediatr Neurol 2020;33:100799. doi: 10.1016/j.spen.2020.100799.
• Limperopoulos C, Chilingaryan G, Guizard N, Robertson RL, Du Plessis AJ. Cerebellar injury in the premature infant is associated with impaired growth of specific cerebral regions. Pediatr Res 2010;68:145-50.
• Brooks ED, Beckett JS, Yang J, Timberlake AT, Sun AH, Chuang C, vd. The etiology of neuronal development in craniosynostosis: a working hypothesis. J Craniofac Surg 2018;29:49-55.
• Wilson AT, Den Ottelander BK, Van Veelen MLC, Dremmen MH, Persing JA, Vrooman HA, vd. Cerebral cortex maldevelopment in syndromic craniosynostosis. Dev Med Child Neurol 2022;64:118-24.
• Mandela R, Bellew M, Chumas P, Nash H. Impact of surgery timing for craniosynostosis on neurodevelopmental outcomes: a systematic review. J Neurosurg Pediatr 2019;23:442-54.
• Sawh-Martinez R, Steinbacher DM. Syndromic craniosynostosis. Clin Plast Surg 2019;46:141-55.
• Speltz ML, Kapp-Simon KA, Cunningham M, Marsh J, Dawson G. Single-suture craniosynostosis: a review of neurobehavioral research and theory. J Pediatr Psychol 2004;29:651-68.
• Panikratova YR, Vlasova RM, Akhutina TV, Korneev AA, Sinitsyn VE, Pechenkova EV. Functional connectivity of the dorsolateral prefrontal cortex contributes to different components of executive functions. Int J Psychophysiol 2020;151:70-9.
• Chirchiglia D, Chirchiglia P, Marotta R, Pugliese D, Guzzi G, Lavano S. The dorsolateral prefrontal cortex, the apathetic syndrome, and free will. Act Nerv Super (Praha) 2019;61:136-41.
• Wu RT, Gabrick KS, Singh A, Taylor JA, Bartlett SP, Steinbacher DM, vd. Cognitive and behavioral outcomes of cranially-mature unilateral coronal craniosynostosis. Plast Reconstr Surgery–Global Open 2019;7:47-8.