166 Chapter 10 GENERAL DISCUSSION This thesis was designed to study the primary genetic cause of abnormal brain development and the secondary effects of ICH on the brain in craniosynostosis patients. Differentiation between primary and secondary brain anomalies in children with craniosynostosis is important to define the best treatment strategy. Identification of primary, inborn disorders of the brain can prevent overtreatment, as it is unlikely that surgery will be of benefit. We focused on answering the following questions: - To what extent do primary brain abnormalities exist in non-operated isolated and syndromic craniosynostosis, looking at intracerebral blood flow and brain microstructures? (Part I) - Are there any secondary effects of ICH and treatment on the brain of operated syndromic craniosynostosis patients, focusing on ventriculomegaly, Chiari and cortical thickness? (Part II) We will discuss brain imaging in the pediatric craniosynostosis setting and the questions of the studies of this thesis. Finally, we will have a gander on the future perspectives. The use of brain imaging in the pediatric setting Magnetic resonance imaging (MRI) is an excellent tool to image and investigate the brain and is frequently used to design a personalized treatment plan for children with craniosynostosis. However, brain imaging in the first 2 postnatal years is challenging. Myelination is rapidly changing, which makes it hard to differentiate anatomically between grey and white matter on a T1w scan. Also, the skull malformations of the craniosynostosis patients provide an extra anatomical challenge. Because of these challenges, brain imaging studies for the pediatric setting are based on manual Arterial Spin Labeling (ASL) Regions of Interest (ROI) delineations of cortical regions and DTI could only be used by drawing tracts manually.1-4 In this thesis, we used a new technique of ASL registration to investigate the pediatric cerebral blood flow (CBF) and we used the new automated FSL as an automatic DTI delineation. These techniques are chosen because of the high reproducibility potential and regional accuracy. Yet, there are different points to remark. Large pediatric ASL studies and therefore standardized CBF values in pediatric patients are lacking. Also, to date, normal ranges of DTI measurements in children under the age of 4 years do not exist in literature. Lastly, both ASL as well as DTI are dependent on many
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