Abstract: Incidental Findings and Their Clinical Significance In Preoperative CT For Single Suture Non Syndromic Craniosynostosis (Plastic Surgery 2013)

Monday, October 14, 2013: 10:15 AM

Keshav T Magge, MD , Plastic Surgery, Children's National Medical Center, Washington, DC

Suresh N Magge, MD , Neurosurgery, Children's National Medical Center, Washington, DC

Robert Keating, MD , Neurosurgery, Children's National Medical Center, Washington, DC

John Myseros, MD , Neurosurgery, Children's National Medical Center, Washington, DC

Michael J. Boyajian, MD , Plastic and Reconstructive Surgery, Children's National Medical Center, Washington, DC

Tina M Sauerhammer, MD , Plastic Surgery, Children's National Medical Center, Washington, DC

Gary F Rogers, MD, JD, MBA, MPH , Department of Plastic Surgery, Children's National Medical Center, Washington, DC

Albert K Oh, MD , Plastic Surgery, Children's National Medical Center, Washington, DC

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BACKGROUND AND PURPOSE:

While the diagnosis of single suture nonsyndromic craniosynostosis (SSNSC) can usually be made by clinical examination, computed tomography (CT) is often used in preoperative evaluation. The prudence of this practice has been questioned in light of recent studies that document a small, but measurable, increased risk of malignancy from CT-associated radiation exposure. The purpose of this study was to examine whether preoperative CT images for patients with SSNSC provided any clinically important information beyond the presence of the craniosynostosis.

METHODS: We performed a retrospective analysis of all patients with SSNSC undergoing cranial vault remodeling at our center from 3/99-3/11. Only patients with complete preoperative CT scans available for review were included. Blinded to the patients’ diagnosis and radiologists’ official report, staff pediatric neurosurgeons analyzed the CT images and documented site of synostosis and any incidental findings.

RESULTS: Of 231 patients, 80 met inclusion criteria. Sites of synostosis included: sagittal (51 patients), coronal (17 patients), metopic (11 patients), and frontosphenoidal (1 patient). Clinical diagnosis correlated with radiographic site of fusion in all patients except the patient with frontosphenoidal synostosis. Incidental findings were documented in over 50% of patients including: prominent extra-axial CSF (n=36 patients; 45%).; ventriculomegaly (n=5; 6.25%); choroid fissure cyst (n=2) cavum septum pellucidum (n=2), Chiari malformation (n=1), and prominent perivascular space (clinically non-significant finding, n=1). Incidental findings led to additional follow up or management in 5 patients (6.25%).

CONCLUSIONS: Our findings support the use of preoperative imaging in this population to identify intracranial anomalies that cannot be discerned by clinical exam. Some of these findings are not clinically important, but may increase the likelihood of operative complications (e.g., prominent extra-axial CSF and increased subdural bleeding risk). While CT bears some elevated cancer risk, it does not require general anesthesia, which may cause neural apoptosis.

22265 Incidental Findings and Their Clinical Significance In Preoperative CT For Single Suture Non Syndromic Craniosynostosis