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Rethinking Virchow: An Examination of Abnormal Head Shape In The Absence of Craniosynostosis
Naran S, Ruane E, Losee JE, Goldstein JA
University of Pittsburgh
2016-01-29
Presenter: Sanjay Naran
Affidavit:
I certify that the material proposed for presentation in this abstract has not been published in any scientific journal or previously presented at a major meeting.
Director Name: Joseph Losee
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Craniomaxillofacial
Introduction: Since Virchow, we've assumed the tenant that skull deformity results from restriction of skull growth perpendicular to prematurely fused sutures and enhanced growth in a parallel plane. However, we present a series of pediatric patients with dolichocephaly in the absence of any craniosynostosis.
Methods: Retrospective review of patients seen at the Children's Hospital of Pittsburgh from 2013-2015 with a clinical diagnosis of dolichocephaly in the absence of any craniosynostosis.
Results: Ten patients were identified; 50% were male. Average age at diagnosis was 3.3±2.1 yrs (Range: 0.6-6.9). Average CI was 0.70±0.03 (Range: 0.67-0.73). Average head circumference percentile was 84.2±14.6 (Range: 55-98). All patients displayed dolichocephaly with varying degrees of bitemporal narrowing, posterior bulleting, and frontal bossing, and varying degrees of signs and symptoms of restricted head growth, including obstructive sleep apnea, neuromuscular delay and speech delay. Given a high suspicion for craniosynostosis, all patients underwent CT imaging. In all cases, there was no evidence of craniosynostosis. One patient underwent anterior cranial vault remodeling for significant frontal bossing and scaphocephaly, without complication and with significant improvement of head shape post-operatively.
Conclusion: We observe that Virchow's Law is not always followed, and that the exact mechanism of skull growth and formation of head shape remains elusive. Given our experience, we advocate obtaining CT scans on all of these patients, and argue that perhaps we should be surgically intervening in cases of severe head shape abnormalities, even in the absence of suture fusion or elevated ICP.
