1 / 23

Significance of Beaten Copper Appearance on Skull Radiographs in Children with Isolated Sagittal Synostosis

Significance of Beaten Copper Appearance on Skull Radiographs in Children with Isolated Sagittal Synostosis . Deepak Agrawal, Paul Steinbok, D Cochrane Division of Neurosurgery, UBC and BC Children’s Hospital, Vancouver, Canada. Raised ICP in Single suture Synostosis.

albert
Download Presentation

Significance of Beaten Copper Appearance on Skull Radiographs in Children with Isolated Sagittal Synostosis

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Significance of Beaten Copper Appearance on Skull Radiographs in Children with Isolated Sagittal Synostosis Deepak Agrawal, Paul Steinbok, D Cochrane Division of Neurosurgery, UBC and BC Children’s Hospital, Vancouver, Canada

  2. Raised ICP in Single suture Synostosis • Noted in 14% - 24% of the children Renier D, Sainte-Rose C, Marchac D, Hirsch JF: Intracranial pressure in craniostenosis. J Neurosurg 57:370-377, 1982. • Another 38% have ‘borderline’ ICP Thompson DN, Malcolm GP, Jones BM, Harkness WJ, Hayward RD: Intracranial pressure in single-suture craniosynostosis. Pediatr Neurosurg 22:235-240, 1995.

  3. Measuring ICP problematic • Absence of normative values • Ethical considerations • Increase in ICP in children with single suture craniosynostosis is low-grade and chronic Camfield PR, Camfield CS: Neurological aspects of craniosynostosis, in Cohen MM (ed) Craniosynostosis: diagnosis, evaluation, and management. New York, Raven Press, 1986, pp 215-226.

  4. In absence of ICP monitoring… Indirect E/O raised ICP • Symptoms of ↑ICP • Beaten Copper Appearance (BCA) on skull radiographs

  5. Symptoms of chronic↑ICP • Headache-Classical symptom • Head banging, episodic screaming

  6. Beaten Copper Appearance (BCA) • Thought to correspond to the gyral pattern of the underlying brain • Significance has been debated, but is generally felt to be a ‘normal’ finding in children Du Boulay G: The significance of digital impressions in children's skulls. Acta Radiol 46:112-122, 1956.

  7. Although the authors concluded BCA to be normal in children with craniosynostosis • However, in children <18 months, BCA highly specific for ↑ICP

  8. Also…. • Raised ICP was defined as >15mmHg even in infants (normal <5mmHg) • No attempt made to correlate with symptoms of ↑ICP

  9. OBJECTIVE Look for any correlation between BCA and symptoms suggestive of intracranial hypertension in children operated for isolated sagittal synostosis

  10. Materials & Methods • Retrospective study (1987-2000) • Children operated for isolated sagittal synostosis • Postoperative skull radiographs available

  11. COHORTS BCA Group • Children who had beaten-copper appearance on skull radiographs at follow up Non-BCA Group • Children who did not have this finding

  12. BCA SCORE • Depth (0 = none, 1 = mild to moderate, 2 = severe) • Extent (0 = none, 1 = ≤ 50%, 2 = >50%) • + 4 • =7

  13. Study Design

  14. Operative procedure • 39 children - vertex craniectomy plus parietal osteotomies and/or craniectomies. • 9 children operated in a delayed fashion (after eight months of age)

  15. Operative procedure • N=4 replacement of the strip of bone over the sagittal suture • N=5 cranial vault remodeling

  16. RESULTS Median age at surgery: • 4.8 months -BCA group • 4 months -Non-BCA group • Radiological follow up 4 - 156 months (mean of 36.2 months)

  17. Results • 40/48 had preoperative skull X-rays & none had BCA preoperatively • 9/20 (45%) symptomatic in BCA group • 3/28 (10.7 %) symptomatic in the non-BCA group (p=0.00684)

  18. BCA Score • In 18/20 (90%) children the BCA was ‘diffuse’ with five (25%) children having the maximum possible score of 8. • 28.6% (n=6) of the children with follow up radiographs done at ≤ 18 months of age had BCA • No difference was found between the mean BCA score in the symptomatic (score of 5.77) and non-symptomatic (score of 5.90) children (p=0.722)

  19. BCA in various age groups

  20. 16 months postop 30 months postop

  21. Head Growth Curve • 5/48 (10.41%) children had deceleration in head growth in the follow up period, of which only one child was symptomatic for raised ICP and that child had BCA as well. • Deceleration on the head growth curve was not predictive of possible raised ICP (symptoms + BCA) in our patients.

  22. CONCLUSIONS • Significant number of children with BCA on radiographs develop symptoms suggestive of raised ICP following surgical treatment for sagittal synostosis in infancy • 28.6% of the children ≤ 18 months of age in our study had BCA • Prolonged follow up may be warranted in this group of patients.

  23. THANK YOU

More Related