<< Back to the abstract archive
Isolated postshunt metopic synostosis: A case report and review of literature
Abouhassan W(1), Murthy AS(2)
(1)Division of Plastic, Reconstructive, & Hand/Burn Surgery, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
(2)Division of Pe
Division of Plastic, Reconstructive, & Hand/Burn Surgery, Department of Surgery, University of Cinci
2012-02-15
Presenter: William Abouhassan, MD
Affidavit:
The entirety of the above work represents the work of the resident as it pertains to scholarly activity during plastic surgery training.
Director Name: W. John Kitzmiller, MD
Author Category: Chief Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Craniomaxillofacial
How does this presentation meet the established conference educational objectives?
1. Conference participants will be able to demonstrate knowledge of current concepts in plastic and reconstructive surgery, particularly addressing cranial defects in metopic synostosis.
2. Participants will be able to assess data on managing patient complications and how to improve the care of patients with cranial suture complications following ventriculoperitoneal shunting.
3. Participants will address clinical science research, techniques, and procedures relevant to plastic and reconstructive surgery as it pertains to shunt induced craniosynostosis and subsequent cranial vault remodeling.
How will your presentation be used by practicing physicians in the audience?
1. Practicing physicians will be able to familiarize themselves with shunt induced craniosynostosis and obtain data based on the literature review of cases noted in the presentation.
2. Craniofacial surgeons will be able to assess data on managing patient complications and how to improve the care of patients after shunt induced craniosynostosis.
3. Pediatric plastic and craniofacial surgeons will be exposed to technique and procedures relevant to shunt induced craniosynostosis and subsequent cranial vault remodeling
BACKGROUND: Postshunt craniosynostosis is an uncommon complication after shunting procedures for congenital hydrocephalus. The sagittal suture is most commonly involved, though secondary synostosis of other sutures has been described. To date, no reports document involvement of an isolated metopic suture. We report a case of a child with myelomeningocele and normocephaly at the time of birth. She underwent ventricular shunting for Chiari malformation and hydrocephalus at three days of age. An immediate postoperative CT scan confirmed all sutures were open. She presented to the craniofacial clinic with trigonocephaly and CT scan confirmation of metopic synostosis at 17 months of age. Serial CT scans document an open metopic suture at two months, closed metopic suture at five months, and trigonocephaly at eleven months with concomitant slit ventricle syndrome and collapsed lateral and third ventricles. METHODS: An Ovid MEDLINE search within the dates of 1948 to December Week 4 2011, utilizing the keywords "synostosis AND shunt" was carried out. A tabulation of all patients and their respective synostosis patterns were recorded. RESULTS: We identified six case series' and one case report over 43 years (1966-2009). 55 patients with 56 suture synostosis patterns were identified (one patient underwent a second cranial reconstruction for identification of a separate, newly formed synostosis).
CONCLUSIONS: Ventricular shunt drainage in treating hydrocephalus may lead to synostosis and cranial deformity. To date, no reports exist documenting isolated metopic synostosis as the initial presentation following ventricular shunting. We report the first case of metopic synostosis after ventricular shunting for hydrocephalus.
