Journal articles: 'Calvarial Suture'

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Moursi, Amr M., Phillip L. Winnard, Alissa V. Winnard, John M. Rubenstrunk, and Mark P. Mooney. "Fibroblast Growth Factor 2 Induces Increased Calvarial Osteoblast Proliferation and Cranial Suture Fusion." Cleft Palate-Craniofacial Journal 39, no. 5 (September 2002): 487–96. http://dx.doi.org/10.1597/1545-1569_2002_039_0487_fgfiic_2.0.co_2.

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Objective: Craniosynostosis has been associated with fibroblast growth factors (FGFs) and their receptors. The purpose of this study was to quantitatively determine the effect of FGF2 on rat calvarial osteoblasts and a rat cranial suture formation model. Design: Fetal rat calvarial osteoblasts were cultured with and without FGF2. Cell attachment and proliferation was determined by alamarBlue dye assay and cell morphology by toluidine-blue staining. In rat calvarial organ culture, postnatal day 15 rat calvariae with dura mater were placed in serum-free media with and without FGF2. A unique quantitative analysis of suture fusion was developed by obtaining measurements of suture bridging in histological serial sections at progressive stages of fusion. Results: Attachment for cells treated with FGF2 was similar to control. In contrast, proliferation was higher for cells treated with FGF2 while maintaining an osteoblastic morphology. After 5 days in organ culture, FGF2-treated posterior frontal sutures showed a dramatic increase in fusion, compared with untreated controls. This increased fusion was maintained throughout days 7 and 10 in culture. Also, fusion was enhanced on the dural side of the suture, as is normally observed in vivo, and the normal tissue architecture was maintained. Conclusions: These results indicate that FGF2 can promote rat osteoblast attachment and normal cell morphology as well as induce cell proliferation. In calvarial organ culture, FGF2 treatment produced an enhanced suture fusion. These results provide further support for a critical role for FGF2 in cranial suture development. These studies also present a new quantitative approach to evaluating the effect of suture-perturbing growth factors on cranial suture fusion.

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Kim, H. J., D. P. Rice, P. J. Kettunen, and I. Thesleff. "FGF-, BMP- and Shh-mediated signalling pathways in the regulation of cranial suture morphogenesis and calvarial bone development." Development 125, no. 7 (April 1, 1998): 1241–51. http://dx.doi.org/10.1242/dev.125.7.1241.

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The development of calvarial bones is tightly co-ordinated with the growth of the brain and needs harmonious interactions between different tissues within the calvarial sutures. Premature fusion of cranial sutures, known as craniosynostosis, presumably involves disturbance of these interactions. Mutations in the homeobox gene Msx2 as well as the FGF receptors cause human craniosynostosis syndromes. Our histological analysis of mouse calvarial development demonstrated morphological differences in the sagittal suture between embryonic and postnatal stages. In vitro culture of mouse calvaria showed that embryonic, but not postnatal, dura mater regulated suture patency. We next analysed by in situ hybridisation the expression of several genes, which are known to act in conserved signalling pathways, in the sagittal suture during embryonic (E15-E18) and postnatal stages (P1-P6). Msx1 and Msx2 were expressed in the sutural mesenchyme and the dura mater. FGFR2(BEK), as well as Bmp2 and Bmp4, were intensely expressed in the osteogenic fronts and Bmp4 also in the mesenchyme of the sagittal suture and in the dura mater. Fgf9 was expressed throughout the calvarial mesenchyme, the dura mater, the developing bones and the overlying skin, but Fgf4 was not detected in these tissues. Interestingly, Shh and Ptc started to be expressed in patched pattern along the osteogenic fronts at the end of embryonic development and, at this time, the expression of Bmp4 and sequentially those of Msx2 and Bmp2 were reduced, and they also acquired patched expression patterns. The expression of Msx2 in the dura mater disappeared after birth. <P> FGF and BMP signalling pathways were further examined in vitro, in E15 mouse calvarial explants. Interestingly, beads soaked in FGF4 accelerated sutural closure when placed on the osteogenic fronts, but had no such effect when placed on the mid-sutural mesenchyme. BMP4 beads caused an increase in tissue volume both when placed on the osteogenic fronts and on the mid-sutural area, but did not effect suture closure. BMP4 induced the expression of both Msx1 and Msx2 genes in sutural tissue, while FGF4 induced only Msx1. We suggest that the local application of FGF on the osteogenic fronts accelerating suture closure in vitro, mimics the pathogenesis of human craniosynostosis syndromes in which mutations in the FGF receptor genes apparently cause constitutive activation of the receptors. Taken together, our data suggest that conserved signalling pathways regulate tissue interactions during suture morphogenesis and intramembranous bone formation of the calvaria and that morphogenesis of mouse sagittal suture is controlled by different molecular mechanisms during the embryonic and postnatal stages. Signals from the dura mater may regulate the maintenance of sutural patency prenatally, whereas signals in the osteogenic fronts dominate after birth.

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Wilkinson, C. Corbett, Cesar A. Serrano, Brooke M. French, Sarah J. Graber, Emily Schmidt-Beuchat, Lígia Batista-Silverman, Noah P. Hubbell, and Nicholas V. Stence. "Fusion patterns of minor lateral calvarial sutures on volume-rendered CT reconstructions." Journal of Neurosurgery: Pediatrics 26, no. 2 (August 2020): 200–210. http://dx.doi.org/10.3171/2020.2.peds1952.

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OBJECTIVESeveral years ago, the authors treated an infant with sagittal and bilateral parietomastoid suture fusion. This made them curious about the normal course of fusion of “minor” lateral sutures (sphenoparietal, squamosal, parietomastoid). Accordingly, they investigated fusion of these sutures on 3D volume-rendered head CT reconstructions in a series of pediatric trauma patients.METHODSThe authors reviewed all volume-rendered head CT reconstructions obtained from 2010 through mid-2012 at Children’s Hospital Colorado in trauma patients aged 0–21 years. Each sphenoparietal, squamosal, and parietomastoid suture was graded as open, partially fused, or fused. In several individuals, one or more lateral sutures were fused atypically. In these patients, the cephalic index (CI) and cranial vault asymmetry index (CVAI) were calculated. In a separately reported study utilizing the same reconstructions, 21 subjects had fusion of the sagittal suture. Minor lateral sutures were assessed, including these 21 individuals, excluding them, and considering them as a separate subgroup.RESULTSAfter exclusions, 331 scans were reviewed. Typically, the earliest length of the minor lateral sutures to begin fusion was the anterior squamosal suture, often by 2 years of age. The next suture to begin fusion—and first to complete it—was the sphenoparietal. The last suture to begin and complete fusion was the parietomastoid. Six subjects (1.8%) had posterior (without anterior) fusion of one or more squamosal sutures. Six subjects (1.8%) had fusion or near-complete fusion of one squamosal and/or parietomastoid suture when the corresponding opposite suture was open or nearly open. The mean CI and CVAI values in these subjects and in age- and sex-matched controls were normal and not significantly different. No individuals had a fused parietomastoid suture with open squamosal and/or sphenoparietal sutures.CONCLUSIONSFusion and partial fusion of the sphenoparietal, squamosal, and parietomastoid sutures is common in children and adolescents. It usually does not represent craniosynostosis and does not require cranial surgery. The anterior squamosal suture is often the earliest length of these sutures to fuse. Fusion then spreads anteriorly to the sphenoparietal suture and posteriorly to the parietomastoid. The sphenoparietal suture is generally the earliest minor lateral suture to complete fusion, and the parietomastoid is the last. Atypical patterns of fusion include posterior (without anterior) squamosal suture fusion and asymmetrical squamosal and/or parietomastoid suture fusion. However, these atypical fusion patterns may not lead to atypical head shapes or a need for surgery.

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Wilkinson, C. Corbett, Nicholas V. Stence, Cesar A. Serrano, Sarah J. Graber, Lígia Batista-Silverman, Emily Schmidt-Beuchat, and Brooke M. French. "Fusion patterns of major calvarial sutures on volume-rendered CT reconstructions." Journal of Neurosurgery: Pediatrics 25, no. 5 (May 2020): 519–28. http://dx.doi.org/10.3171/2019.11.peds1953.

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OBJECTIVERecently, the authors investigated the normal course of fusion of minor lateral calvarial sutures on “3D” volume-rendered head CT reconstructions in pediatric trauma patients. While evaluating these reconstructions, they found many more fused sagittal sutures than expected given the currently accepted prevalence of sagittal craniosynostosis. In the present study, using the same set of head CT reconstructions, they investigated the course of fusion of the sagittal as well as the lambdoid, coronal, and metopic sutures.METHODSThey reviewed all volume-rendered head CT reconstructions performed in the period from 2010 through mid-2012 at Children’s Hospital Colorado for trauma patients aged 0–21 years. Each sagittal, lambdoid, coronal, or metopic suture was graded as open, partially fused, or fused. The cephalic index (CI) was calculated for subjects with fused and partially fused sagittal sutures.RESULTSAfter exclusions, 331 scans were reviewed. Twenty-one subjects (6%) had fusion or partial fusion of the sagittal suture. Four of the 21 also had fusion of the medial lambdoid and/or coronal sutures. In the 17 subjects (5%) with sagittal suture fusion and no medial fusion of adjacent sutures, the mean CI was 77.6. None of the 21 subjects had been previously diagnosed with craniosynostosis. Other than in the 21 subjects already mentioned, no other sagittal or lambdoid sutures were fused at all. Nor were other coronal sutures fused medially. Coronal sutures were commonly fused inferiorly early during the 2nd decade of life, and fusion progressed superiorly and medially as subjects became older; none were completely fused by 18 years of age. Fusion of the metopic suture was first seen at 3 months of life; fusion was often not complete until after 2 years.CONCLUSIONSThe sagittal and lambdoid sutures do not usually begin to fuse before 18 years of age. However, more sagittal sutures are fused before age 18 than expected given the currently accepted prevalence of craniosynostosis. This finding is of unknown significance, but likely many of them do not need surgery. The coronal suture often begins to fuse inferiorly early in the 2nd decade of life but does not usually complete fusion before 18 years of age. The metopic suture often starts to fuse by 3 months of age, but it may not completely fuse until after 2 years of age.

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Perlyn, Chad A., Gillian Morriss-Kay, Tron Darvann, Marissa Tenenbaum, and David M. Ornitz. "Model for the Pharmacologic Treatment of Crouzon Syndrome." Neurosurgery 59, no. 1 (July 1, 2006): 210–15. http://dx.doi.org/10.1227/01.neu.0000224323.53866.1e.

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Abstract OBJECTIVE Crouzon syndrome is caused by mutations in FGFR2 leading to constitutive activation of receptors in the absence of ligand binding. The syndrome is characterized by premature fusion of the cranial sutures that leads to abnormal skull shape, restricted brain growth, and increased intracranial pressure. Surgical remodeling of the cranial vault is currently used to treat affected infants. The purpose of this study was to develop a pharmacologic strategy using tyrosine kinase inhibition as a novel treatment for craniosynostotic syndromes caused by constitutive FGFR activation. METHODS Characterization of cranial suture fusion in Fgfr2C342Y/+ mutant mice, which carry the most common Crouzon mutation, was performed using MicroCT analysis from embryogenesis through maturation. Whole calvarial cultures from wild-type and Fgfr2C342Y/+ mice were then established and calvaria cultured for 2 weeks in the presence of DMSO control or PD173074, an FGFR tyrosine kinase inhibitor. Paraffin sections were prepared to show suture morphology and calcium deposition. RESULTS In untreated Fgfr2C342Y/+ cultures, the coronal suture fused bilaterally with loss of overlap between the frontal bone and parietal bone. Calvaria treated with PD173074 (2 (M) showed patency of the coronal suture and were without evidence of any synostosis. CONCLUSION: We report the successful use of PD173074 to prevent in-vitro suture fusion in a model for Crouzon syndrome. Further studies are underway to develop an in-vivo treatment protocol as a novel therapeutic modality for FGFR associated craniosynostotic syndromes.

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Moursi, Amr M., Phillip L. Winnard, Doug Fryer, and Mark P. Mooney. "Delivery of Transforming Growth Factor-β2-Perturbing Antibody in a Collagen Vehicle Inhibits Cranial Suture Fusion in Calvarial Organ Culture." Cleft Palate-Craniofacial Journal 40, no. 3 (May 2003): 225–32. http://dx.doi.org/10.1597/1545-1569_2003_040_0225_dotgfa_2.0.co_2.

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Objective To determine whether antibody perturbation of Tgf-β, delivered in a collagen gel, could inhibit cranial suture fusion. Design Attachment and proliferation of osteoblasts cultured on a collagen gel with or without anti-Tgf-β2 antibody were determined by AlamarBlue dye assay and cell morphology by toluidine-blue staining. In rat calvarial organ culture, collagen gel with and without anti-Tgf-β2 antibody was injected subperiosteally over the posterior frontal suture of postnatal day 15 rat calvariae. A quantitative analysis of suture fusion was used to measure suture bridging in histological serial sections at various time points. Results Attachment and proliferation for cells cultured on collagen gel with anti-Tgf-β2 antibody were similar to collagen gel controls. Although proliferation was lower than on tissue culture plastic, cells treated with anti-Tgf-β2 antibody maintained an osteoblastic morphology. After 7, 10, and 15 days in organ culture, anti-Tgf-β2 antibody treatment caused a reduction in the percent bridging of posterior frontal sutures, compared with controls. Sutures exposed to anti-Tgf-β2 antibody and fibroblast growth factor-2 concurrently did not show an inhibition of bony bridging. Conclusions These results support previous reports suggesting a role for Tgf-β2 in cranial suture fusion. In cell culture the collagen gel, both with and without anti-Tgf-β2 antibody, promoted similar osteoblast attachment, proliferation, and osteoblastic morphology. In organ culture anti-Tgf-β2 antibody was delivered in a bioactive state via a collagen gel to inhibit cranial suture fusion. Also, the results suggest that the inductive effect of fibroblast growth factor-2 is not dependent on Tgf-β2 activity. Together, these results provide further support for the role of Tgf-β2 in cranial suture fusion.

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Vastardis, H., J. B. Mulliken, and J. Glowacki. "Unilateral Coronal Synostosis: A Histomorphometric Study." Cleft Palate-Craniofacial Journal 41, no. 4 (July 2004): 439–46. http://dx.doi.org/10.1597/03-012.1.

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Objective This histomorphometric study compared the open and prematurely fused side of the coronal suture in subjects with unilateral coronal synostosis (UCS). Methods Sutures and parasutural bone were obtained from seven subjects with nonsyndromic UCS during operative correction at 3 to 24 months of age. Histological and cellular analyses were performed for the affected and open sutures. Specimens were examined by light and polarizing microscopy. Sutural patterns, osseous morphology, calvarial thickness, tartrate-resistant acid phosphatase (TRAP)-positive cells, and marrow spaces were evaluated histomorphologically, qualitatively, and semiquantitatively. Histomorphometry was performed to determine total projected area of marrow space as a percentage of unit area, total number of TRAP-positive cells per specimen, and perisutural cranial thickness. Results Polarizing microscopy showed that affected sutures were composed of more lamellar bone than the normal sutures. By light microscopy, the clinically fused sutures were 1.7-fold thicker (p < .02), had twofold larger marrow spaces (p < .0006), and contained sixfold more TRAP-positive osteoclasts in marrow spaces near the suture (p < .04) than the normal sutures. Quantitative analysis of the normal sutures revealed that calvarial thickness was greater with age and that there was an inverse correlation between medullary area and age. For the affected sutures, there was also an age-related increase in calvarial thickness. There were also trends for age-related declines in numbers of osteoclasts in both open and affected sides. Conclusions These results question the hypothesis that defective osteoclastic activity is pivotal in the pathogenesis of UCS and support the hypothesis that this condition results from abnormally active bony remodeling.

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Rice, D. P., T. Aberg, Y. Chan, Z. Tang, P. J. Kettunen, L. Pakarinen, R. E. Maxson, and I. Thesleff. "Integration of FGF and TWIST in calvarial bone and suture development." Development 127, no. 9 (May 1, 2000): 1845–55. http://dx.doi.org/10.1242/dev.127.9.1845.

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Mutations in the FGFR1-FGFR3 and TWIST genes are known to cause craniosynostosis, the former by constitutive activation and the latter by haploinsufficiency. Although clinically achieving the same end result, the premature fusion of the calvarial bones, it is not known whether these genes lie in the same or independent pathways during calvarial bone development and later in suture closure. We have previously shown that Fgfr2c is expressed at the osteogenic fronts of the developing calvarial bones and that, when FGF is applied via beads to the osteogenic fronts, suture closure is accelerated (Kim, H.-J., Rice, D. P. C., Kettunen, P. J. and Thesleff, I. (1998) Development 125, 1241–1251). In order to investigate further the role of FGF signalling during mouse calvarial bone and suture development, we have performed detailed expression analysis of the splicing variants of Fgfr1-Fgfr3 and Fgfr4, as well as their potential ligand Fgf2. The IIIc splice variants of Fgfr1-Fgfr3 as well as the IIIb variant of Fgfr2 being expressed by differentiating osteoblasts at the osteogenic fronts (E15). In comparison to Fgf9, Fgf2 showed a more restricted expression pattern being primarily expressed in the sutural mesenchyme between the osteogenic fronts. We also carried out a detailed expression analysis of the helix-loop-helix factors (HLH) Twist and Id1 during calvaria and suture development (E10-P6). Twist and Id1 were expressed by early preosteoblasts, in patterns that overlapped those of the FGF ligands, but as these cells differentiated their expression dramatically decreased. Signalling pathways were further studied in vitro, in E15 mouse calvarial explants. Beads soaked in FGF2 induced Twist and inhibited Bsp, a marker of functioning osteoblasts. Meanwhile, BMP2 upregulated Id1. Id1 is a dominant negative HLH thought to inhibit basic HLH such as Twist. In Drosophila, the FGF receptor FR1 is known to be downstream of Twist. We demonstrated that in Twist(+/)(−) mice, FGFR2 protein expression was altered. We propose a model of osteoblast differentiation integrating Twist and FGF in the same pathway, in which FGF acts both at early and late stages. Disruption of this pathway may lead to craniosynostosis.

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Hudgins, Roger J., Fernando D. Burstein, and William R. Boydston. "Total calvarial reconstruction for sagittal synostosis in older infants and children." Journal of Neurosurgery 78, no. 2 (February 1993): 199–204. http://dx.doi.org/10.3171/jns.1993.78.2.0199.

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✓ Premature closure of the sagittal suture is the most common form of craniosynostosis, but this condition occasionally goes unrecognized until the child is too old to undergo procedures that depend upon continued calvarial growth for success. As the entire calvaria is affected and thus misshapen by sagittal synostosis, late correction involves total calvarial reconstruction. The extensive nature of this undertaking has precluded its utilization despite the presence of significant deformities. Adapting the techniques and experience gained from craniofacial surgery, the authors performed total calvarial reconstruction on nine children with sagittal synostosis and subsequent scaphocephaly diagnosed after the age of 1 year. In each case the goals of shortening the anteroposterior length, widening the biparietal diameter, and reducing frontal and occipital deformities were met. Morbidity consisted of acute blood loss, postoperative hyponatremia, and in one case a residual skull defect. The rationale for this procedure and the techniques utilized are discussed.

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Reddy, Kesava, Harold Hoffman, and Derek Armstrong. "Delayed and Progressive Multiple Suture Craniosynostosis." Neurosurgery 26, no. 3 (March 1, 1990): 442–48. http://dx.doi.org/10.1227/00006123-199003000-00011.

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Abstract A considerable amount of information is available on various types of craniosynostoses. The patient exhibiting single suture synostosis that progresses to involve multiple sutures is distinctly uncommon, as is the patient exhibiting delayed synostosis involving all of the calvarial sutures. We report a group of 11 such patients with progressive and delayed holocalvarial synostosis. Most patients exhibited features of raised intracranial pressure or developmental delay, and in all patients symptoms were relieved after surgery. The diagnostic and therapeutic implications of this type of presentation in craniosynostosis are discussed.

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Burrows, Annie M., Mark P. Mooney, Timothy D. Smith, H. Wolfgang Losken, and Michael I. Siegel. "Growth of the Cranial Vault in Rabbits with Congenital Coronal Suture Synostosis." Cleft Palate-Craniofacial Journal 32, no. 3 (May 1995): 235–46. http://dx.doi.org/10.1597/1545-1569_1995_032_0235_gotcvi_2.3.co_2.

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Craniofacial growth data from craniosynostotic children have shown that suture immobilization results in predictable restrictions of cranial vault growth in a direction perpendicular to the affected suture and compensatory growth at sutures perpendicular to the affected one. This study tests these predictions by using rabbits with nonsyndromic congenital coronal suture synostosis. Data were collected from 96 rabbits divided into three groups: 42 unaffected litter mate controls, 33 partially synostosed rabbits, and 21 completely synostosed rabbits. Markers were placed bilaterally on either side of the vault sutures at 1.5 weeks of age. Serial radiographs were taken at 1.5, 6, 12, and 18 weeks of age for assessment of growth at the vault sutures and of various cranial landmarks. Results revealed that completely synostosed animals had significantly (p <.05) shorter cranial vaults, reduced growth at the coronal suture, and increased growth at the sagittal, frontal, and squamosal sutures compared with unaffected rabbits. Results also showed that the calvarial growth observed in this craniosynostotic rabbit model closely reflects predicted compensatory patterns seen in human clinical populations and that this rabbit model is valuable for understanding the pathogeneses and craniofacial growth patterns of humans with premature cranial suture synostosis.

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Mooney, Mark P., Annie M. Burrows, Timothy D. Smith, H. Wolfgang Losken, Lynne A. Opperman, Jason Dechant, Amy M. Kreithen, et al. "Correction of Coronal Suture Synostosis Using Suture and Dura Mater Allografts in Rabbits with Familial Craniosynostosis." Cleft Palate-Craniofacial Journal 38, no. 3 (May 2001): 206–25. http://dx.doi.org/10.1597/1545-1569_2001_038_0206_cocssu_2.0.co_2.

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Objective: Resynostosis following surgical correction of craniosynostosis is a common clinical correlate. Recent studies suggest that the dura mater is necessary to maintain suture patency. It has also been hypothesized that dura mater from synostotic individuals may provide aberrant biochemical signals to the osteogenic fronts of the calvaria, which result in premature suture fusion and subsequent resynostosis following surgery. This study was designed to test this hypothesis by surgically manipulating the coronal suture and dura mater in rabbits with familial craniosynostosis to prevent postsurgical resynostosis. Design: Craniofacial growth and histomorphometric data were collected from 129 rabbits: 72 normal controls and 57 rabbits with bilateral coronal suture synostosis (15 unoperated on controls; 13 surgical controls; 9 dura mater transplant only; 10 suture transplant only; and 10 suture and dura mater transplant). At 10 days of age, all rabbits had radiopaque amalgam markers placed on either side of the coronal, frontonasal, and anterior lambdoidal sutures. At 25 days of age, 42 synostosed rabbits had a 3 to 5-mm wide coronal suturectomy. Coronal sutures and/or underlying dura mater allografts were harvested from same-aged, wild-type, isohistogenic control rabbits and transplanted onto the dura mater of synostosed host rabbits. Serial radiographs were taken at 10, 25, 42, and 84 days of age, and the suturectomy sites were harvested at 84 days of age in 44 rabbits and serially sectioned for histomorphometric examination. Results: Results revealed that cranial vault growth was significantly (p < .05) improved following surgical release of the fused coronal suture compared with synostosed rabbits who were not operated on but was still significantly different (p < .05) from that of normal control rabbits. By 84 days of age, significant (p < .05) differences were noted in calvarial suture marker separation, cranial vault shape indices, and cranial base angles between rabbits with and without dura mater allografts, probably as a result of resynostosis of the suturectomy site or suture-only allografts. Qualitative histological examination revealed that at 84 days of age rabbits with suture and dura allografts had patent coronal sutures, suture-only allografts had fused coronal sutures with extensive endosteal hyperostosis, dura mater–only allografts had some new bone in the suturectomy site that resembled rudimentary osteogenic fronts, and suturectomy controls had extensive endosteal bone formation and resynostosis of the suturectomy site. Significantly (p < .05) more bone was found in the suturectomy sites of rabbits without dura mater allografts compared with rabbits with dura mater allografts. Conclusions: Results support the initial hypothesis that normal dura mater allografts will maintain suture or suturectomy site patency and allow unrestricted craniofacial growth. However, it is still unclear whether the dura mater from normal rabbits was providing biochemical signals to the transplanted sutures or suturectomy sites or simply acting as a barrier to prevent abnormal biochemical signals from the dura mater of synostosed rabbits from reaching the calvaria. The clinical and therapeutic implications of these procedures are discussed.

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Hong, L., and J. J. Mao. "Tissue-engineered Rabbit Cranial Suture from Autologous Fibroblasts and BMP2." Journal of Dental Research 83, no. 10 (October 2004): 751–56. http://dx.doi.org/10.1177/154405910408301003.

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Craniosynostosis is a congenital disorder of premature ossification of cranial sutures, occurring in one of approximately every 2500 live human births. This work addressed a hypothesis that a cranial suture can be tissue-engineered from autologous cells. Dermal fibroblasts were isolated subcutaneously from growing rabbits, culture-expanded, and seeded in a gelatin scaffold. We fabricated a composite tissue construct by sandwiching the fibroblast-seeded gelatin scaffold between two collagen sponges loaded with recombinant human BMP2. Surgically created, full-thickness parietal defects were filled with the composite tissue construct in the same rabbits from which dermal fibroblasts had been obtained. After four-week in vivo implantation, there was de novo formation of tissue-engineered cranial suture, microscopically reminiscent of the adjacent natural cranial suture. The tissue-engineered cranial suture showed radiolucency on radiographic images, in contrast to radio-opacity of microscopically ossified calvarial defects filled with fibroblast-free, BMP2-loaded constructs. This approach may be refined for tissue engineering of cranial sutures for craniosynostosis patients.

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Adamo, Matthew A., and Ian F. Pollack. "A single-center experience with symptomatic postoperative calvarial growth restriction after extended strip craniectomy for sagittal craniosynostosis." Journal of Neurosurgery: Pediatrics 5, no. 1 (January 2010): 131–35. http://dx.doi.org/10.3171/2009.8.peds09227.

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Object Sagittal synostosis accounts for the most common form of craniosynostosis, occurring with an incidence of 1 in 2000–5000 live births. In most cases of single-suture, nonsyndromic sagittal synostosis, a single operation is all that is required to achieve a reasonable cosmetic result. However, there are a number of patients who may experience symptomatic postoperative calvarial growth restriction secondary to fibrosis of newly formed bone and pericranium that replace the surgically removed sagittal suture, or due to fusion of other previously open sutures leading to increased intracranial pressure, necessitating a second operation. Methods A retrospective review was conducted of all cases involving infants who had undergone an extended sagittal strip craniectomy with bilateral parietal wedge osteotomies at our institution between 1990 and 2006 for single-suture, nonsyndromic sagittal craniosynostosis. The frequency with which subsequent operations were required for cranial growth restriction was then defined. Results There were a total of 164 patients with single-suture nonsyndromic sagittal synostosis. Follow-up data were available for 143 of these patients. The average age at time of initial operation was 5.25 months, and the mean duration of follow-up was 43.85 months. There were 2 patients (1.5%) who required a second operation for symptomatic postoperative calvarial growth restriction. Conclusions Recurrence of synostosis with resultant increased intracranial pressure in cases of single-suture, nonsyndromic sagittal craniosynostosis is an uncommon event, but does occur sporadically and unpredictably. Therefore, we recommend routine neurosurgical follow up for at least 5 years, with regular ophthalmological examinations to assess for papilledema.

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Rice, David, Ritva Rice, and Irma Thesleff. "Molecular Signalling during Calvarial Bone and Suture Development." Clinical Science 103, s47 (July 1, 2002): 71P. http://dx.doi.org/10.1042/cs103071pb.

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Rice, David P. C., Hyun-Jung Kim, and Irma Thesleff. "Apoptosis in murine calvarial bone and suture development." European Journal of Oral Sciences 107, no. 4 (August 1999): 265–75. http://dx.doi.org/10.1046/j.0909-8836.1999.eos107406.x.

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Yoshimatsu, Masako, Hideki Kitaura, Yuji Fujimura, Haruka Kohara, Yukiko Morita, and Noriaki Yoshida. "IL-12 Inhibits Lipopolysaccharide Stimulated Osteoclastogenesis in Mice." Journal of Immunology Research 2015 (2015): 1–8. http://dx.doi.org/10.1155/2015/214878.

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Lipopolysaccharide (LPS) is related to osteoclastogenesis in osteolytic diseases. Interleukin- (IL-) 12 is an inflammatory cytokine that plays a critical role in host defense. In this study, we investigated the effects of IL-12 on LPS-induced osteoclastogenesis. LPS was administered with or without IL-12 into the supracalvariae of mice, and alterations in the calvarial suture were evaluated histochemically. The number of osteoclasts in the calvarial suture and the mRNA level of tartrate-resistant acid phosphatase (TRAP), an osteoclast marker, were lower in mice administered LPS with IL-12 than in mice administered LPS alone. The serum level of tartrate-resistant acid phosphatase 5b (TRACP 5b), a bone resorption marker, was also lower in mice administered LPS with IL-12 than in mice administered LPS alone. These results revealed that IL-12 might inhibit LPS-induced osteoclastogenesis and bone resorption. In TdT-mediated dUTP-biotin nick end-labeling (TUNEL) assays, apoptotic changes in cells were recognized in the calvarial suture in mice administered LPS with IL-12. Furthermore, the mRNA levels of both Fas and FasL were increased in mice administered LPS with IL-12. Taken together, the findings demonstrate that LPS-induced osteoclastogenesis is inhibited by IL-12 and that this might arise through apoptotic changes in osteoclastogenesis-related cells induced by Fas/FasL interactions.

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Mooney, Mark P., Jocelyn M. Shand, Anne Burrows, Timothy D. Smith, John F. Caccamese, Gregory M. Cooper, James J. Cray, et al. "Rescue of Premature Coronal Suture Fusion with TGF-β2 Neutralizing Antibody in Rabbits with Delayed-Onset Synostosis." Cleft Palate-Craniofacial Journal 55, no. 6 (February 26, 2018): 844–55. http://dx.doi.org/10.1597/16-065.

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Objectives: An overexpression of Tgf-β2 leads to calvarial hyperostosis and suture fusion in individuals with craniosynostosis. Inhibition of Tgf-β2 may help rescue fusing sutures and restore normal growth. The present study was designed to test this hypothesis. Design: Twenty-eight New Zealand White rabbits with delayed-onset coronal synostosis had radiopaque markers placed on either side of the coronal sutures at 10 days of age. The rabbits were randomly assigned to: (1) sham control rabbits (n = 10), (2) rabbits with control IgG (100 μg/suture) delivered in a collagen vehicle (n = 9), and (3) rabbits with Tgf-β2 neutralizing antibody (100 μg/suture) delivered in a collagen vehicle (n = 9). Longitudinal growth data were collected at 10, 25, 42, and 84 days of age. Sutures were harvested at 84 days of age for histomorphometry. Results: Radiographic analysis showed significantly greater ( P < .05) coronal suture marker separation, craniofacial length, cranial vault length, height, shape indices, cranial base length, and more lordotic cranial base angles in rabbits treated with anti-Tgf-β2 antibody than in controls at 42 and 84 days of age. Histologically, rabbits treated with anti-Tgf-β2 antibody at 84 days of age had patent and significantly ( P < .05) wider coronal sutures and greater sutural area compared to controls. Conclusions: These data support our hypothesis that antagonism of Tgf-β2 may rescue fusing coronal sutures and facilitate craniofacial growth in this rabbit model. These findings also suggest that cytokine therapy may have clinical significance in infants with progressive postgestational craniosynostosis.

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Lana-Elola, Eva, Ritva Rice, Agamemnon E. Grigoriadis, and David P. C. Rice. "Cell fate specification during calvarial bone and suture development." Developmental Biology 311, no. 2 (November 2007): 335–46. http://dx.doi.org/10.1016/j.ydbio.2007.08.028.

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Idowu, Olufemi Emmanuel, Oluwole Olarinmoye Oyeleye, Sunday Sokunle Soyemi, and Jeuel Ogooluwa Idowu. "Anatomic variations of Calvarial intrasutural bones: An autopsy study." Anatomy Journal of Africa 11, no. 1 (August 15, 2022): 2086–91. http://dx.doi.org/10.4314/aja.v11i1.8.

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Calvarial intrasutural bones (CIB) incidences are known to vary in different populations. The objective of this study was to determine the frequency, location, number and gender difference if any, of CIB in Nigerian skulls. This descriptive observational study included 96 adult skulls. Out of 96 subjects, 58 were males and 38 were females (M:F=1.5:1). The mean age was 50.2±16.5 years (19-83 years). Most of the skulls studied (56%) had CIB. Sixty percent of the males and 50% of the females had CIB (p=0.318). The lambdoid suture (33.3%) and lambda (20.8%) area were the most common sites for CIB. When present, CIB were mainly on the right (43.8%). The bregma, pterion and coronal suture were rare sites for CIB in this study population. These results established that CIB are common in adult Nigerian skulls and that there is no significant association between presence of CIB with gender or age. This variation should be taken into consideration in patient evaluation and surgical planning.

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Atsawasuwan, P., M. Ouibaidin, B. Dalal, H. Khan, and A. Mohammed. "Calvarial bone development and suture closure in Dicer -deficient mice." Orthodontics & Craniofacial Research 20 (June 2017): 26–31. http://dx.doi.org/10.1111/ocr.12169.

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Ruge, John R., Tadanori Tomita, Thomas P. Naidich, Yoon S. Hahn, and David G. McLone. "Scalp and Calvarial Masses of Infants and Children." Neurosurgery 22, no. 6P1-P2 (June 1, 1988): 1037–42. http://dx.doi.org/10.1227/00006123-198806010-00011.

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Abstract Review of 70 children presenting with a solitary nontraumatic lump on the head revealed that 61% ofthe lesions were dermoid tumor, 9% were cephalhematoma deformans, 1% were eosinophilic granuloma, and 4% were occult menin goceles and encephaloceles. Most of the dermoid cysts occurred along sutural lines, but some did not. One of the eosinophilic granulomas was located over the sagittal suture. Seventeen per cent of the “lumps” had significant intracranial extension. An additional 20% of the lumps extended intracranially, but only to the dura mater. Work-up of these lesions should include initial plain skull roentgenograms to assess multiplicity and appropriate computed tomographic scans to assess possible intracranial extension.

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Mehta, Vivek A., Chetan Bettegowda, George I. Jallo, and Edward S. Ahn. "The evolution of surgical management for craniosynostosis." Neurosurgical Focus 29, no. 6 (December 2010): E5. http://dx.doi.org/10.3171/2010.9.focus10204.

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Craniosynostosis, the premature closure of cranial sutures, has been known to exist for centuries, but modern surgical management has only emerged and evolved over the past 100 years. The success of surgery for this condition has been based on the recognition of scientific principles that dictate brain and cranial growth in early infancy and childhood. The evolution of strip craniectomies and suturectomies to extensive calvarial remodeling and endoscopic suturectomies has been driven by a growing understanding of how a prematurely fused cranial suture can affect the growth and shape of the entire skull. In this review, the authors discuss the early descriptions of craniosynostosis, describe the scientific principles upon which surgical intervention was based, and briefly summarize the eras of surgical management and their evolution to present day.

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Potter, Amiee, and Jennifer Rhodes. "Differential MicroRNA Expression in Patent and Synostotic Human Infant Calvarial Suture." Plastic and Reconstructive Surgery 128 (October 2011): 99. http://dx.doi.org/10.1097/01.prs.0000406327.78801.50.

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Tschakaloff, Alexander, H. Wolfgang Losken, Mark P. Mooney, Michael I. Siegel, Albert Losken, and Jennifer Swan. "Internal Calvarial Bone Distraction in Rabbits with Experimental Coronal Suture Immobilization." Journal of Craniofacial Surgery 5, no. 5 (November 1994): 318–26. http://dx.doi.org/10.1097/00001665-199411000-00011.

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Lalikos, Janice F., Alexander Tschakaloff, Mark P. Mooney, H. Wolfgang Losken, Michael I. Siegel, Albert Losken, Pietra Reitz, and Missy Wright. "Internal Calvarial Bone Distraction in Rabbits with Experimental Coronal Suture Immobilization." Plastic and Reconstructive Surgery 96, no. 3 (September 1995): 689–98. http://dx.doi.org/10.1097/00006534-199509000-00023.

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Zhang, Qi Feng, Shu Juan Zou, Meng Chun Qi, Yang Xi Chen, and Zhi He Zhao. "Effect of a Single Period of Mechanical Strain on Gene Expression Patterns of Ets1 and Cbfa1 in Murine Calvarial Sutural Osteoblast-Like Cells." Key Engineering Materials 330-332 (February 2007): 1105–8. http://dx.doi.org/10.4028/www.scientific.net/kem.330-332.1105.

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Cranial sutures produce new bone at the sutural edges of the bone fronts in response to external stimuli. Little is known regarding the mechanism of osteogenesis in cranial sutures. Ets1 and Cbfa1 are two important osteogenic transcription factors regulating the differentiation and maturation of osteoblasts. But their function in cranial sutures is not still elucidated. We have investigated the gene expression of Ets1 and Cbfa1 in rat’s calvarial sutural osteoblast-like cells under a single period of mechanical strain. The cells were isolated from the cranial suture of SD rats and cultured in vitro, and subjected to a single 40 minutes mechanical strain using a four-point bending apparatus. The gene expression patterns of Ets1 and Cbfa1 were examined by RT-PCR. Both mRNA levels of Ets1 and Cbfa1 have increased significantly within 6 and 12 hours respectively after mechanical strain were applied, and the increase returned to control level thereafter. However, Ets1 and Cbfa1 exhibited different temporal expression patterns: Ets1 expressed immediately after the mechanical loading and reached the maximum transcription at 0.5h; whereas Cbfa1 experienced a latency period first, then increased slowly within 2 hours, and reached the maximum transcription at 6 h. The maximum transcription of Cbfa1 was about 2.58 fold of that of Ets1. Ets1and Cbfa1 may play different roles in regulating bone matrix protein expressions in osteoblast-like cells during suture distraction and their function is time-dependent. High frequency distraction (>2times/24h) is favourable to the maximal expression of the two genes.

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Losken, Wolfgang H., Mark P. Mooney, Josef Zoldos, Alexander Tschakaloff, Annie M. Burrows, Timothy D. Smith, Gregory M. Cooper, Rusen M. Kapucu, and Michael I. Siegel. "Internal Calvarial Bone Distraction in Rabbits with Delayed-Onset Coronal Suture Synostosis." Plastic and Reconstructive Surgery 102, no. 4 (September 1998): 1109–19. http://dx.doi.org/10.1097/00006534-199809020-00029.

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Losken, Wolfgang H., Mark P. Mooney, Josef Zoldos, Alexander Tschakaloff, Annie M. Burrows, Timothy D. Smith, Gregory M. Cooper, Rusen M. Kapucu, Michael I. Siegel, and John A. Persing. "Internal Calvarial Bone Distraction in Rabbits with Delayed-Onset Coronal Suture Synostosis." Plastic and Reconstructive Surgery 102, no. 4 (September 1998): 1120–21. http://dx.doi.org/10.1097/00006534-199809020-00030.

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Losken, H. Wolfgang, Mark P. Mooney, Josef Zoldos, Alexander Tschakaloff, Annie M. Burrows, Timothy D. Smith, Gregory M. Cooper, M. Rusen Kapucu, and Michael I. Siegel. "Internal Calvarial Bone Distraction in Rabbits with Delayed-Onset Coronal Suture Synostosis." Plastic & Reconstructive Surgery 102, no. 4 (September 1998): 1109–19. http://dx.doi.org/10.1097/00006534-199809040-00029.

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Persing, John A. "Internal Calvarial Bone Distraction in Rabbits with Delayed-Onset Coronal Suture Synostosis." Plastic & Reconstructive Surgery 102, no. 4 (September 1998): 1120–21. http://dx.doi.org/10.1097/00006534-199809040-00030.

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Mirando, Anthony J., Takamitsu Maruyama, Jiang Fu, Hsiao-Man Yu, and Wei Hsu. "β-catenin/cyclin D1 mediated development of suture mesenchyme in calvarial morphogenesis." BMC Developmental Biology 10, no. 1 (2010): 116. http://dx.doi.org/10.1186/1471-213x-10-116.

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Coussens, Anna K., Christopher R. Wilkinson, Ian P. Hughes, C. Phillip Morris, Angela van Daal, Peter J. Anderson, and Barry C. Powell. "Unravelling the molecular control of calvarial suture fusion in children with craniosynostosis." BMC Genomics 8, no. 1 (2007): 458. http://dx.doi.org/10.1186/1471-2164-8-458.

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Choi, Han J., Rohana K. De Silva, Darryl C. Tong, Harsha L. De Silva, Robert M. Love, and Josie Athens. "The Thickness of Parietal Bones in a New Zealand Sample of Cadaveric Skulls in Relation to Calvarial Bone Graft." Craniomaxillofacial Trauma & Reconstruction 6, no. 2 (June 2013): 115–20. http://dx.doi.org/10.1055/s-0033-1343788.

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ObjectivesTo evaluate the average thickness of the parietal bones in their different regions to identify the ideal site(s) for calvarial bone graft harvest.Methods and MaterialsThickness of the parietal bones of 25 wet cranial vaults of New Zealand European origin was measured in 135 different locations using an electronic caliper. Analyses to identify the ideal harvest sites were conducted so that the sites fit the features of an ideal harvest site described in the literature as: (1) 6 mm of minimum thickness and (2) 2 cm away from the midline.Results and ConclusionThe overall average thickness was 6.69 ± 0.22 mm. The average thickness at different sites within the same bone ranged from 2.85 to 6.93 mm. In keeping with previous studies, the report observed a progressive thickening of the parietal bone in medial and posterior directions. Of the 135 different locations measured, only 20% exceeded an average thickness of 6 mm as well as being 2 cm away from the sagittal midline. These locations were mainly located between 6 to 11 cm posterior to the coronal suture and 2 to 5 cm away from the sagittal suture.ConclusionHarvesting the calvarial bone graft in the area 6 to 11 cm posterior to the coronal suture and 2 cm away from the midline is recommended based on our study using cadaveric cranial vaults of New Zealand Europeans.

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Mommaerts, Maurice Y., Patrick F. J. Staels, and Jan W. Casselman. "The Faith of a Coronal Suture Grafted onto Midline Synostosis Inducing Dura and Deprived from Tensile Stress." Cleft Palate-Craniofacial Journal 38, no. 5 (September 2001): 533–37. http://dx.doi.org/10.1597/1545-1569_2001_038_0533_tfoacs_2.0.co_2.

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Objective: To discuss possible reasons for the synostosis of a coronal suture that was transplanted onto synostosis inducing dura in a scaphocephalic human cranium. Design: Case report. Setting: Supraregional teaching hospital, center for craniofacial anomalies. Patient: A bathmocephalic boy, followed from age 7½ to 26 months. Intervention: Radical synostosectomy, radial osteotomies in the parietal bone with outward fracturing of the barrel staves, and left-sided coronal suture transplantation onto the midline was undertaken at the age of 11 months. Methods: Computer tomography and clinical follow-up. Results: The sutural graft, initially deprived from tensile stress and quickly exposed to the anomalous dura, turned synostotic in one year. Conclusions: Both cell signaling and biomechanical theories on calvarial morphogenesis, sutural development, and synostosis can apply. An animal experiment is recommended to test which hypothesis prevails.

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Chae, Gyung Joon, Sang Bae Lee, Ui Won Jung, Yong Keun Lee, Chong Kwan Kim, and Seong Ho Choi. "The Effects of Antibiotics Blended Chitosan Membranes on the Calvarial Critical Size Defect in Sprague Dawley Rats." Key Engineering Materials 342-343 (July 2007): 857–60. http://dx.doi.org/10.4028/www.scientific.net/kem.342-343.857.

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The purpose of this study was to evaluate the osteogenesis of tetracycline blended chitosan membranes on the calvarial critical size defect in Sprague Dawley. An 8 mm surgical defect was created with a trephine bur in the area of the midsagittal suture. Forty rats were divided into four groups: negative control group, positive control group and two experimental groups. Three types of membranes were made and a comparative study was done. One type of non-woven membrane was made by chitosan for positive control. The other two types of non-woven membranes were made by immersing non-woven chitosan into either the tetracycline solution or the chitosan-tetracycline solution. Histologic analysis was done at 2 weeks and 8 weeks of healing periods. We concluded that that the use of tetracycline blended chitosan membrane on the calvarial defects in rats has a significant effect on the regeneration of bone tissue in itself. In addition it implicates that tetracycline blended chitosan membrane may be useful for guided tissue regeneration.

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Moursi, Amr M., Phillip L. Winnard, Alissa V. Winnard, John M. Rubenstrunk, and Mark P. Mooney. "Fibroblast Growth Factor 2 Induces Increased Calvarial Osteoblast Proliferation and Cranial Suture Fusion." Cleft Palate-Craniofacial Journal 39, no. 5 (September 2002): 487–96. http://dx.doi.org/10.1597/1545-1569(2002)039<0487:fgfiic>2.0.co;2.

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Shakir, Sameer, Zoe M. MacIsaac, Sanjay Naran, Darren M. Smith, Michael R. Bykowski, James J. Cray, Timothy K. Craft, et al. "Transforming Growth Factor Beta 1 Augments Calvarial Defect Healing and Promotes Suture Regeneration." Tissue Engineering Part A 21, no. 5-6 (March 2015): 939–47. http://dx.doi.org/10.1089/ten.tea.2014.0189.

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Rice, D. P. C. "Molecular mechanisms in calvarial bone and suture development, and their relation to craniosynostosis." European Journal of Orthodontics 25, no. 2 (April 1, 2003): 139–48. http://dx.doi.org/10.1093/ejo/25.2.139.

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Al-Benna, S. "A new method to pass a suture through an outer table calvarial tunnel." Annals of The Royal College of Surgeons of England 97, no. 4 (May 2015): 315–16. http://dx.doi.org/10.1308/rcsann.2015.97.4.315b.

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Mooney, Mark P., H. Wolfgang Losken, Alexander Tschakaloff, Michael I. Siegel, Albert Losken, and Janice F. Lalikos. "Congenital Bilateral Coronal Suture Synostosis in a Rabbit and Craniofacial Growth Comparisons with Experimental Models." Cleft Palate-Craniofacial Journal 30, no. 2 (March 1993): 121–28. http://dx.doi.org/10.1597/1545-1569_1993_030_0121_cbcssi_2.3.co_2.

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Experimental rabbit models of postnatal coronal suture (CS) synostosis have helped make significant contributions towards the understanding and surgical management of human congenital craniosynostosis. The present study compares craniofacial growth patterns in animals with experimental CS immobilization and in a rabbit born in our laboratory with congenital CS synostosis. The study sample consisted of 10 sham controls, 14 experimental animals with bilateral CS immobilization, and one animal with congenital, bilateral CS synostosis. At 1.5 weeks of age, all animals had amalgam markers placed on either side of the frontonasal, coronal, and anterior lambdoid sutures. At this time, the experimental animals had bilateral CS immobilization using methyl-methacrylate. Serial lateral head x-rays were taken at 1.5, 6, 12, and 18 weeks of age. Results revealed that by 1.5 weeks of age the congenital animal already exhibited changes in the cranial vault, cranial base, midface, and orthocephalic cranial base angles compared to controls. By 6 weeks of age, animals with experimental immobilization showed compensatory growth patterns similar to the congenital animal, particularly at the calvarial sutures and upper midface. This pattern continued through 18 weeks. Results showed that experimental, postnatal CS immobilization produced similar craniofacial growth patterns to those observed for our single congenital animal, but to a lesser degree, and therefore validates, in part, findings from experimental rabbit models of synostosis.

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Jimenez, David F., and Constance M. Barone. "Endoscopy-assisted wide-vertex craniectomy, “barrel-stave” osteotomies, and postoperative helmet molding therapy in the early management of sagittal suture craniosynostosis." Neurosurgical Focus 9, no. 3 (September 2000): 1–6. http://dx.doi.org/10.3171/foc.2000.9.3.3.

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Object The purpose of this study was to assess the efficacy, safety, associated complications, and outcome in patients with sagittal suture craniosynostosis in whom endoscopy-assisted wide-vertex craniotomy and “barrel-stave” osteotomy were performed. Methods During a 4-year period, 59 patients with sagittal suture synostosis underwent endoscopy-assisted wide-vertex craniectomies, barrel stave–like osteotomies, and postoperatively were fitted with custom-made molding helmets. Data on operative time, blood loss, transfusion rates, hospital length of stay, complications, and hospital charges were collected prospectively. The mean patient age at the time of surgery was 3.7 months. The average blood loss was 31.8 ml; and only one patient required an intraoperative blood transfusion. Nine patients received transfusions of donor blood postoperatively. The mean operative time was 50 minutes, and all but three patients were discharged from the hospital the morning following surgery. There were no intraoperative complications. Normocephaly as well as normal cephalic indices were observed at latest follow up. Conclusions The authors conclude that early treatment of infants with sagittal suture craniosynostosis by using minimally invasive, endoscopy-assisted wide-vertex craniectomies provides excellent results and a significantly lower morbidity rate than traditional calvarial vault reconstructive procedures.

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Cetas, Justin S., Morad Nasseri, Targol Saedi, Anna A. Kuang, and Nathan R. Selden. "Delayed intracranial hypertension after cranial vault remodeling for nonsyndromic single-suture synostosis." Journal of Neurosurgery: Pediatrics 11, no. 6 (June 2013): 661–66. http://dx.doi.org/10.3171/2013.3.peds12525.

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Object Delayed intracranial hypertension may occur after cranial vault remodeling for synostosis and may result in visual loss and developmental delay. Delayed intracranial hypertension is relatively common in children with syndromic, multisuture synostosis, but the incidence is poorly defined in children with single-suture nonsyndromic synostosis. This study evaluates the frequency of reoperation for delayed intracranial hypertension after single-suture synostosis repair. Methods Patients who had undergone cranial vault remodeling for nonsyndromic single-suture synostosis and were treated at a single tertiary pediatric hospital between July 2000 and December 2010 were analyzed for the occurrence of delayed intracranial hypertension and reoperation for cranial vault remodeling. Results Eighty-one patients with clinical follow-up of at least 3 years were analyzed from a total of 156 consecutive patients. The average patient age at the initial operation was 9.1 months. Five (6.2%) of 81 patients presented with delayed clinical and ophthalmological signs and symptoms of intracranial hypertension following initial cranial vault reconstruction, confirmed indirectly in each case by CT findings and directly by intracranial pressure monitoring. These 5 patients underwent repeat cranial vault reconstruction. Conclusions Calvarial growth restriction and intracranial hypertension occur sporadically following primary cranial vault reconstruction for single-suture nonsyndromic cranial synostosis. In this series, delayed intracranial hypertension occurred only in male patients who underwent primary repair of isolated sagittal synostoses at an age less than or equal to 5 months.

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Sharman, Jack, Desiderio Rodrigues, Simon McGuirk, Mohini Panikkar, Hiroshi Nishikawa, Steve Dover, Martin Evans, and Nicholas White. "Supratentorial vs infratentorial posterior calvarial distraction osteogenesis for the increase of ICV in children with syndromic or multi-suture craniosynostosis: a retrospective cohort study." Child's Nervous System 37, no. 5 (February 5, 2021): 1677–85. http://dx.doi.org/10.1007/s00381-021-05064-4.

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Abstract Purpose Craniosynostosis is the premature and pathological fusion of calvarial sutures. One modality of surgical treatment of syndromic craniosynostosis is posterior calvarial distraction (PCD). This can be either supratentorial or infratentorial. Currently, supratentorial PCD may be regarded as safer but produces a smaller increase in calvarial volume compared to infratentorial PCD. This study quantifies and compares the effectiveness of supratentorial and infratentorial PCD to help guide surgical decision-making. Methods The CT and/or MRI scans of 47 cases of craniosynostosis who underwent PCD from the Birmingham Children’s Hospital (BCH) were converted to sagittal series multi-planar reformatted (MPR) scans for the manual calculation of ICV. The 47 cases were classified as having undergone either supratentorial or infratentorial PCD using lateral plain film radiographs, with 28 and 32 pairs of pre- and post-operative CT/MRI scans reviewed respectively. Results A statistically significant difference between supratentorial and infratentorial PCD was observed for the increase in supratentorial volume (STV) (P = 0.0458) and total intracranial volume (TICV) (P = 0.0437), but not for the increase in infratentorial volume (ITV) (P = 0.0697). The relationship for each volume trended towards convergence but was not achieved before the physical limit of 30 mm distraction had been reached. Intraclass correlation coefficient values for agreement of MRI and CT scans for STV, ITV and total ICV were 0.852, 0.864 and 0.854 respectively. Conclusion Our evidence suggests that supratentorial PCD is more effective for increasing ICV in a clinical setting. CT and MRI imaging modalities are acceptably clinically interchangeable for calculating ICV in craniosynostosis.

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Bonfield, Christopher M., Lesley M. Foley, Shinjini Kundu, Wendy Fellows-Mayle, T. Kevin Hitchens, Gustavo K. Rohde, Ramesh Grandhi, and Mark P. Mooney. "The influence of surgical correction on white matter microstructural integrity in rabbits with familial coronal suture craniosynostosis." Neurosurgical Focus 38, no. 5 (May 2015): E3. http://dx.doi.org/10.3171/2015.2.focus14849.

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OBJECT Craniosynostosis is a condition in which one or more of the calvarial sutures fuses prematurely. In addition to the cosmetic ramifications attributable to premature suture fusion, aberrations in neurophysiological parameters are seen, which may result in more significant damage. This work examines the microstructural integrity of white matter, using diffusion tensor imaging (DTI) in a homogeneous strain of rabbits with simple, familial coronal suture synostosis before and after surgical correction. METHODS After diagnosis, rabbits were assigned to different groups: wild-type (WT), rabbits with early-onset complete fusion of the coronal suture (BC), and rabbits that had undergone surgical correction with suturectomy (BC-SU) at 10 days of age. Fixed rabbit heads were imaged at 12, 25, or 42 days of life using a 4.7-T, 40-cm bore Avance scanner with a 7.2-cm radiofrequency coil. For DTI, a 3D spin echo sequence was used with a diffusion gradient (b = 2000 sec/mm2) applied in 6 directions. RESULTS As age increased from 12 to 42 days, the DTI differences between WT and BC groups became more pronounced (p < 0.05, 1-way ANOVA), especially in the corpus callosum, cingulum, and fimbriae. Suturectomy resulted in rabbits with no significant differences compared with WT animals, as assessed by DTI of white matter tracts. Also, it was possible to predict to which group an animal belonged (WT, BC, and BC-SU) with high accuracy based on imaging data alone using a linear support vector machine classifier. The ability to predict to which group the animal belonged improved as the age of the animal increased (71% accurate at 12 days and 100% accurate at 42 days). CONCLUSIONS Craniosynostosis results in characteristic changes of major white matter tracts, with differences becoming more apparent as the age of the rabbits increases. Early suturectomy (at 10 days of life) appears to mitigate these differences.

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Fellows-Mayle, Wendy, T. Kevin Hitchens, Elena Simplaceanu, Joyce Horner, Timothy Barbano, Joseph E. Losee, H. Wolfgang Losken, Michael I. Siegel, and Mark P. Mooney. "Testing Causal Mechanisms of Nonsyndromic Craniosynostosis Using Path Analysis of Cranial Contents in Rabbits with Uncorrected Craniosynostosis." Cleft Palate-Craniofacial Journal 43, no. 5 (September 2006): 524–31. http://dx.doi.org/10.1597/05-107.

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Objective: Various causal mechanisms of familial nonsyndromic craniosynostosis have been presented. One hypothesis suggests that overproduction of bone at the suture is the primary origin of craniosynostosis, which affects brain and cranial growth secondarily through altered intracranial pressure (Primary Suture Fusion Model). Other hypotheses suggest that decreased cranial base growth or abnormal brain growth are the primary cause of craniosynostosis (Cranial Base, Brain Parenchyma Models, respectively). This study was designed to investigate which model best describes neurocranial changes associated with craniosynostosis in a rabbit model through multivariate path analysis. Design: Serial magnetic resonance imaging scans and intracranial pressure measurements were obtained at 10, 25, and 42 days of age from 18 rabbits: six controls, six with delayed-onset synostosis, and six with early-onset synostosis. Five variables were collected from each rabbit: calvarial thickness at the affected suture, cranial base length, brain volume, cerebrospinal fluid volume, and intracranial pressure. This data set was used to test causal pathway relationships generated by the proposed models. Goodness of fit was measured by experimental group for each model. Results: Primary Suture Fusion Model best explained the variables in both delayed-onset and early-onset synostotic rabbits (Goodness of fit = 93%, 97%, respectively). Cranial Base Model (Goodness of fit = 94%) best explained the data in control rabbits. Conclusion: Results suggest that the primary site of craniosynostosis in craniosynostotic rabbits is most likely the synostosed suture. Other cranial vault anomalies are most likely secondary compensatory changes. Results of the present study may provide insight regarding the causal pathway of craniosynostosis.

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Duff, Thomas A., and Roger C. Mixter. "Midline craniectomy for sagittal suture synostosis: Comparative efficacy of two barriers to calvarial reclosure." Surgical Neurology 35, no. 5 (May 1991): 350–54. http://dx.doi.org/10.1016/0090-3019(91)90043-9.

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Frolov, Andrey, Craig Lawson, Joshua Olatunde, James T. Goodrich, and John R. Martin III. "Sagittal Craniosynostosis with Uncommon Anatomical Pathologies in a 56-Year-Old Male Cadaver." Case Reports in Pathology 2019 (December 8, 2019): 1–8. http://dx.doi.org/10.1155/2019/8034021.

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Sagittal craniosynostosis (CS) is a pathologic condition that results in premature fusion of the sagittal suture, restricting the transverse growth of the skull leading in some cases to elevated intracranial pressure and neurodevelopmental delay. There is still much to be learned about the etiology of CS. Here, we report a case of 56-year-old male cadaver that we describe as sagittal CS with torus palatinus being an additional anomaly. The craniotomy was unsuccessful (cephalic index, CI = 56) and resulted in abnormal vertical outgrowth of the craniotomized bone strip. The histological analysis of the latter revealed atypical, noncompensatory massive bone overproduction. Exome sequencing of DNA extracted from the cadaveric tissue specimen performed on the Next Generation Sequencing (NGS) platform yielded 81 genetic variants identified as pathologic. Nine of those variants could be directly linked to CS with five of them targeting RhoA GTPase signaling, with a potential to make it sustained in nature. The latter could trigger upregulated calvarial osteogenesis leading to premature suture fusion, skull bone thickening, and craniotomized bone strip outgrowth observed in the present case.

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Pindrik, Jonathan, Joseph Molenda, Rafael Uribe-Cardenas, Amir H. Dorafshar, and Edward S. Ahn. "Normative ranges of anthropometric cranial indices and metopic suture closure during infancy." Journal of Neurosurgery: Pediatrics 18, no. 6 (December 2016): 667–73. http://dx.doi.org/10.3171/2016.5.peds14336.

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Abstract:

OBJECTIVE Subjective evaluations typically guide craniosynostosis repair. This study provides normative values of anthropometric cranial indices that are clinically useful for the evaluation of multiple types of craniosynostosis and introduces 2 new indices that are useful in the evaluation and management of metopic and bicoronal synostosis. The authors hypothesize that normative values of the new indices as well as for established measures like the cephalic index can be drawn from the evaluation of CT scans of normal individuals. METHODS High-resolution 3D CT scans obtained in normal infants (age 0–24 months) were retrospectively reviewed. Calvarial measurements obtained from advanced imaging visualization software were used to compute cranial indices. Additionally, metopic sutures were evaluated for patency or closure. RESULTS A total of 312 participants were included in the study. Each monthly age group (total 24) included 12–18 patients, yielding 324 head CT scans studied. The mean cephalic index decreased from 0.85 at age 0–3 months to 0.81 at 19–24 months, the mean frontoparietal index decreased from 0.68 to 0.65, the metopic index from 0.59 to 0.55, and the towering index remained comparatively uniform at 0.64 and 0.65. Trends were statistically significant for all measured indices. There were no significant differences found in mean cranial indices between sexes in any age group. Metopic suture closure frequency for ages 3, 6, and 9 months were 38.5%, 69.2%, and 100.0%, respectively. CONCLUSIONS Radiographically acquired normative values for anthropometric cranial indices during infancy can be used as standards for guiding preoperative decision making, surgical correction, and postoperative helmeting in various forms of craniosynostosis. Metopic and towering indices represent new cranial indices that are potentially useful for the clinical evaluation of metopic and bicoronal synostoses, respectively. The present study additionally shows that metopic suture closure appears ubiquitous after 9 months of age.

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Uhm, Ki Il, Se Hwee Hwang, and Bong Gun Choi. "Cleft Lip Nose Correction with Onlay Calvarial Bone Graft and Suture Suspension in Oriental Patients." Plastic & Reconstructive Surgery 105, no. 2 (February 2000): 499–503. http://dx.doi.org/10.1097/00006534-200002000-00003.

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Journal articles on the topic 'Calvarial Suture'

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