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Radiologic findings in children with absent/fused cranial sutures. Analysis of prevalence of incidental sagittal craniosynostosis: is it more common than we expect?
Mallory Wampler, MD
Meghan Brown, MD
Niyant Patel, MD
Summa Health
2024-02-01
Presenter: Mallory Wampler, MD
Affidavit:
Ananth Murthy, MD
Director Name: Ananth Murthy, MD
Author Category: Fellow Plastic Surgery
Presentation Category: Clinical
Abstract Category: Craniomaxillofacial
Introduction: Postnatal development of craniosynostosis can lead to either normal or subtly pathologic phenotypes. This study aims to determine the incidence, demographics, radiologic findings, and morphologic changes associated with fused cranial sutures.
Methods: Children undergoing head CT in our emergency department in 2019 were included, excluding those previously diagnosed with craniosynostosis, VP shunts, and age > 21. CT scans were assessed for sutural appearance, inner table changes, tonsillar herniation, sella, ventricle size, optic nerve diameter, and sulcal effacement. The primary outcome was radiographically absent suture excluding the metopic (RASEM).
Results: Among 678 patients (286F, 391M), 146 (21.5%) were black, and 500 (73.8%) were white. Mean age of non-fused suture (NFS) group was 7.7 years and RASEM group was 10.9 years. RASEM was found in 7.8%, with 5.4% having isolated sagittal suture absence. RASEM correlated with male sex (43M vs. 10F, p < 0.001). Optic average was higher in RASEM (5.4 vs. 4.9). Neurological complaints (10.5% vs. 5.7%, p = 0.022), inner table changes (25.4% vs. 5.8% for change = 1 vs. change = 0, p < 0.001) were associated with RASEM. Multivariate analysis identified positive associations with RASEM for males, African American race, increased optic nerve thickness, severe inner table changes, and neurological chief complaints (p < 0.001).
Conclusion: This study reveals a 7.8% incidence of RASEM in children under 21 years. Significant associations with RASEM include male sex, African American race, neurological chief complaints, inner table changes, and increased optic nerve thickness.
