awisnia
09-07-2008, 04:18 PM
Hi,
I've been searching the web for info on mild metopic cases (my son has the metopic ridge, no official diagnosis yet). I found this site - at the bottom are links to full texts of 2 papers (abstracts below): http://www2.regalia.nir.jp/~graham/tri-e.html
Paper 1 Abstract
Introduction: It has been believed that isolated, mild trigonocephaly rarely presents with clinical symptoms.
Patients and methods: We diagnosed and operated on 65 patients with mild trigonocephaly and developmental delay up to July 2000. There were 47 boys and 18 girls in our series. All patients had symptoms such as delay in language development, hyperactivity, autistic tendencies, and motor dysfunctions. Their facial features were characterized by a metopic ridge, depressed temples, heel-shaped rather than keel-shaped forehead, and slight hypotelorism. The most important physical sign was the palpable metopic ridge. Most patients did not exhibit any symptoms until they were more than 1 year old. Fifteen patients showed regression in language acquisition and use. Three-dimensional computed tomography revealed the metopic ridge, depressed pterional regions, hypotelorism, and small anterior fossae. Magnetic resonance imaging was performed on all patients and demonstrated no abnormal findings in the brain. Single-photon emission computed tomography (SPECT) was performed on 83% of patients and revealed decreased cerebral blood flow (CBF) in the frontal lobes of 76% of those patients. Decompressive cranioplasty of the frontal bone involving the skull base was performed on all patients.
Results: In most (61 out of 65) patients a degree of postoperative improvement in clinical symptoms was noted, especially in behavioral problems. Postoperative SPECT demonstrated increased CBF in the frontal lobes in 95% of the patients.
Conclusion: Based on these results, it can be postulated that mild trigonocephaly is frequently associated with developmental delays and that these symptoms can be improved to a certain degree by decompressive cranioplasty.
Paper 2 Abstract
Introduction: We report the surgical results in patients with mild trigonocephaly and clinical symptoms. Since high intracranial pressure (ICP) was noted during surgery in our previous patient series, we began to record intraoperative ICP. The importance of treating mild trigonocephaly with clinical symptoms is stressed.
Patients and methods: Fifty-six children (44 boys, 12 girls) in whom ICP was measured were diagnosed with mild trigonocephaly (nonsyndromic type) with symptoms such as language delay, hyperactivity, autistic tendencies, self-mutilation, motor delay, etc. Their ages ranged from 2 to 8 (mean 5.1) years. ICP was measured after a burr hole was made under endotracheal general anesthesia and a sensor was inserted in the right frontal lobe epidurally immediately in front of the right coronal suture. The first recordings were made at around 30 mmHg of PCO2 as for neuroanesthesia, and the second were at around 40 mmHg of PCO2 as during natural breathing. We also investigated which factors accounted for the improvement of clinical symptoms.
Results: The first ICP records at 29.1 mmHg of PCO2 indicated a mean ICP of 13.3 mmHg. The second changed to a mean 38.2 mmHg of PCO2 for an increased mean ICP of 19.8 mmHg. The pulse pressures were a mean 7.1 mmHg in the first recordings and 8.5 mmHg in the second. The mean ICP and pulse pressure were thus high in these children. Clinically, 30 out of 56 patients improved markedly and 22 improved slightly, while 4 did not exhibit any change. Factors
contributing to improvement were younger age, relatively higher development
quotient, marked digital impressions on skull X-rays, abnormal findings on SPECT, and moderate degree of trigonocephaly.
Conclusion: Although our patients had mild trigonocephaly, their ICP and pulse pressure were high. Decompressive cranioplasty in cases of mild trigonocephaly is feasible.
I've been searching the web for info on mild metopic cases (my son has the metopic ridge, no official diagnosis yet). I found this site - at the bottom are links to full texts of 2 papers (abstracts below): http://www2.regalia.nir.jp/~graham/tri-e.html
Paper 1 Abstract
Introduction: It has been believed that isolated, mild trigonocephaly rarely presents with clinical symptoms.
Patients and methods: We diagnosed and operated on 65 patients with mild trigonocephaly and developmental delay up to July 2000. There were 47 boys and 18 girls in our series. All patients had symptoms such as delay in language development, hyperactivity, autistic tendencies, and motor dysfunctions. Their facial features were characterized by a metopic ridge, depressed temples, heel-shaped rather than keel-shaped forehead, and slight hypotelorism. The most important physical sign was the palpable metopic ridge. Most patients did not exhibit any symptoms until they were more than 1 year old. Fifteen patients showed regression in language acquisition and use. Three-dimensional computed tomography revealed the metopic ridge, depressed pterional regions, hypotelorism, and small anterior fossae. Magnetic resonance imaging was performed on all patients and demonstrated no abnormal findings in the brain. Single-photon emission computed tomography (SPECT) was performed on 83% of patients and revealed decreased cerebral blood flow (CBF) in the frontal lobes of 76% of those patients. Decompressive cranioplasty of the frontal bone involving the skull base was performed on all patients.
Results: In most (61 out of 65) patients a degree of postoperative improvement in clinical symptoms was noted, especially in behavioral problems. Postoperative SPECT demonstrated increased CBF in the frontal lobes in 95% of the patients.
Conclusion: Based on these results, it can be postulated that mild trigonocephaly is frequently associated with developmental delays and that these symptoms can be improved to a certain degree by decompressive cranioplasty.
Paper 2 Abstract
Introduction: We report the surgical results in patients with mild trigonocephaly and clinical symptoms. Since high intracranial pressure (ICP) was noted during surgery in our previous patient series, we began to record intraoperative ICP. The importance of treating mild trigonocephaly with clinical symptoms is stressed.
Patients and methods: Fifty-six children (44 boys, 12 girls) in whom ICP was measured were diagnosed with mild trigonocephaly (nonsyndromic type) with symptoms such as language delay, hyperactivity, autistic tendencies, self-mutilation, motor delay, etc. Their ages ranged from 2 to 8 (mean 5.1) years. ICP was measured after a burr hole was made under endotracheal general anesthesia and a sensor was inserted in the right frontal lobe epidurally immediately in front of the right coronal suture. The first recordings were made at around 30 mmHg of PCO2 as for neuroanesthesia, and the second were at around 40 mmHg of PCO2 as during natural breathing. We also investigated which factors accounted for the improvement of clinical symptoms.
Results: The first ICP records at 29.1 mmHg of PCO2 indicated a mean ICP of 13.3 mmHg. The second changed to a mean 38.2 mmHg of PCO2 for an increased mean ICP of 19.8 mmHg. The pulse pressures were a mean 7.1 mmHg in the first recordings and 8.5 mmHg in the second. The mean ICP and pulse pressure were thus high in these children. Clinically, 30 out of 56 patients improved markedly and 22 improved slightly, while 4 did not exhibit any change. Factors
contributing to improvement were younger age, relatively higher development
quotient, marked digital impressions on skull X-rays, abnormal findings on SPECT, and moderate degree of trigonocephaly.
Conclusion: Although our patients had mild trigonocephaly, their ICP and pulse pressure were high. Decompressive cranioplasty in cases of mild trigonocephaly is feasible.