123 Cortical Thickness | Crouzon across tissue classes on MRI data, which allow for greater resolution than voxel size. Previous validation of FreeSurfer has demonstrated cortical thickness measurement to be statistically indistinguishable from traditional neuropathology techniques on histological analysis.26, 27, 30 Furthermore, FreeSurfer analysis has been applied with accuracy to a variety of neuropathologies, across a variety of ages.27, 29, 42 In this study we confirmed successful processing through manual inspection of all surfaces generated by the FreeSurfer pipeline on each scan to ensure the reliability of our data. Despite variable effects of synostosis pattern on regional cortical thickness seen in this study, we observed similar global and regional thicknesses in both frontal-first and occipital-first cranial vault expansion groups. Evaluation of effect size due to suture involvement showed frontal lobe thinning in coronal and lambdoid synostosis cases, suggesting that turribrachycephaly may adversely influence frontal cortex development. Lambdoid synostosis was also associated with a pronounced thinning effect in the cingulate gyri, likely attributable to increased ICH rates due to crowding of the posterior fossa. This explanation seems most likely, given the buried nature of the cingulate cortex as well as its associations with the cerebellum, and frequent tonsillar herniation seen in lambdoid CP cases.43, 44 Future studies should evaluate the effect of primary cranial vault expansion type as well as synostosis pattern on neuropsychological and functional outcomes such as hearing as well as investigate potential vascular causes of cingulate thinning observed in this study. 7
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