52 Chapter 3 by comparing preoperative frontal lobe cerebral blood flow of young children with moderate to severe trigonocephaly with cerebral blood flow of aged-matched, healthy controls. Brain perfusion was assessed in several brain regions, focusing mostly on the frontal lobe because of the shape of the skull in trigonocephaly patients and the increased prevalence of behavior and cognitive disorders. Based on the very low prevalence of papilledema or impaired skull growth in trigonocephaly compared to other craniosynostosis patients, we hypothesized that there would be no abnormalities in frontal lobe perfusion in the first 2 years of life.2, 3 PATIENTS AND METHODS The Ethics Committee of the Erasmus Medical Center approved this prospective imaging study in patients with trigonocephaly (METC-2018-124), which is part of ongoing work at the Dutch Craniofacial Center. This study was conducted according to the principles of the Declaration of Helsinki. Study Population Magnetic resonance imaging scans from children with metopic synostosis for whom a surgical correction was considered were included over a period of 2 years (2018 to 2020). Surgery is only considered for moderate and severe presentation, mainly defined by the forehead shape in a bird’s eye view and considered present if the lateral orbital rim is visible and the midline ridge is significantly prominent. This is illustrated by Birgfeld et al. in Figure 5.16 Children were less than 2 years of age at the time of the magnetic resonance imaging brain study. The control group consisted of subjects undergoing magnetic resonance imaging for clinical reasons. These subjects were included when the following conditions were met: (1) the subjects were found to have no neurological pathology of the head and neck area on imaging, (2) the subjects were free of any neurological or psychological morbidity on follow-up, and (3) the subjects’ magnetic resonance imaging data were of sufficient quality to be used for research. Magnetic Resonance Imaging Acquisition All brain magnetic resonance imaging data were acquired with a 1.5T scanner (General Electric Healthcare, Chicago, Ill.), including pseudocontinuous arterial spin labeling sequence with the following imaging parameters: threedimensional fast spin echo spiral readout with a stack of eight spirals with three signal averages, repetition/echo time of 4604 msec/10.7 msec, voxel size of 3.75 × 3.75 × 4.0 mm3, field of view at 24.0 × 24.0 cm, labeling duration of 1450 msec, postlabeling delay of 1025 msec, five background suppression pulses, and an inversion recovery M0 scan for calibration. This protocol was identical in both trigonocephaly patients and controls. Both groups underwent deep sedation or anesthesia during the magnetic resonance imaging procedure, which included using sevoflurane or propofol.
RkJQdWJsaXNoZXIy MTk4NDMw