Long Head Research Articles

Post Traumatic Epilepsy with Sequel of Frontal Contusion and Spontaneous Regression of Extradural Hematoma; Clinical Case and Review of the Literature

Post traumatic epilepsy are frequent complications of moderate and severe head injuries, they are found in hemorrhagic contusions and hematomas. Several isolated or associated mechanisms are involved in the occurrence of these convulsions (increased inflammatory markers, neuronal cell death, altered blood-brain barrier, changes in astrocytes, and glucose metabolism dysregulation changes in synaptic abundance and function).The first attacks can occur more than 2 years after the head trauma or after cranial surgery. Preventive treatment does not change the course of the disease. Treatment with Valproate and levetiracetam were also compared to phenytoin and no benefit was found in recovery.
 The particularity of our patient is the severe head trauma, with regressive frontal contusion with secular lesions, followed by the appearance at nearly three and a half months of the trauma of a fronto-parietal extradural hematoma with mass effect which resolved spontaneously. Two and three years after the trauma, he developed generalized epilepsy, suggesting post-traumatic epilepsy following the sequelae of the hemorrhagic contusion or the extradural hematoma, or the sequelae of these associated lesions. These seizures were treated with sodium valproate. This clinical case challenges clinicians to monitor in severe head injuries the occurrence of complications such as epilepsy that can occur beyond 2 years.

Pediatric Traumatic Brain Injury; Experience in Tertiary Care Hospitals of KPK, A Multi- Center Study

Objective: The present study examined the epidemiology, clinical features, and outcome of pediatric traumatic brain injuries (TBI) in tertiary care hospitals in Khyber Pakhtunkhwa (KPK) . Duration and Place of the Study: Duration of study was From February 2020 to February 2022.It was conducted in Neurosurgery Department, Khyber teaching hospital MTI, and Hayatabad medical complex Peshawar. Material and Methods: A total of Six hundred and forty-three pediatric patients, ages 01 to 11years, who had suffered traumatic brain injury were included in the study. All children were first seen at an emergency room, where they had a series of diagnostic tests and a physical examination. All necessary radiological studies were carried out under the watchful eye of the senior consultant neurosurgeon. In addition to demographic information, the pattern, treatment, and outcome of children with head injury were also recorded. Results: Among the 643 kids examined, 411 (or 65%) were boys, and 232 (or 35%) were girls. At presentation, the average age was 4.062 years. Among the children surveyed, 525 (82%) lived in an urban setting, while the remaining 117 (18%) lived in a rural region. Three hundred and seventy-eight (60%) of the children suffered a head injury secondary to fall, whereas just 207 (33%) had been involved in automobile accidents. 58% (374) had mild head injury and 185 29% had moderate head injuries, 84 (13%) had severe head injury. 12% (74) of patients underwent craniotomy for extra-dural hematoma. 46 (7.1%) of the children had depressed skull fracture which was surgically treated. 23 (3.5%) patient had acute sub-dural hematoma for which craniotomy was done. Rest of the 27(4.1%) children had traumatic sub-arachnoid hemorrhage and intracerebral bleed which were treated. Out of the total 76(11.6%) children did not recover and died, most of them presented with severe head injuries Conclusion: Most common cause for head injury in our setup was fall from height which was followed by motor vehicle accidents. Over half of the children presented mild to moderate head injuries. Over half were treated conservatively with good outcome. We had mortality of 11.6% with most having severe head injuries. Keywords: Mortality, Brain Injury, fall, Car Accidents, depressed skull fracture, extra-dural hematoma, acute sub-dural hematoma.

Outcome of Moderate and Severe Head Injury in Tikrit Teaching Hospital

Outcome of Moderate and Severe Head Injury in Tikrit Teaching Hospital

A preliminary analysis of replicating the biomechanics of helmet therapy for sagittal craniosynostosis

PurposeThe aim of this study was to investigate the biomechanics of endoscopically assisted strip craniectomy treatment for the management of sagittal craniosynostosis while undergoing three different durations of postoperative helmet therapy using a computational approach.MethodsA previously developed 3D model of a 4-month-old sagittal craniosynostosis patient was used. The strip craniectomy incisions were replicated across the segmented parietal bones. Areas across the calvarial were selected and constrained to represent the helmet placement after surgery. Skull growth was modelled and three variations of helmet therapy were investigated, where the timings of helmet removal alternated between 2, 5, and 8 months after surgery.ResultsThe predicted outcomes suggest that the prolonging of helmet placement has perhaps a beneficial impact on the postoperative long-term morphology of the skull. No considerable difference was found on the pattern of contact pressure at the interface of growing intracranial volume and the skull between the considered helmeting durations.ConclusionAlthough the validation of these simulations could not be performed, these simulations showed that the duration of helmet therapy after endoscopically assisted strip craniectomy influenced the cephalic index at 36 months. Further studies require to validate these preliminary findings yet this study can lay the foundations for further studies to advance our fundamental understanding of mechanics of helmet therapy.

Heatstroke and brachycephalic dogs – is there an increased risk?

PICO question Do dogs that are brachycephalic have an increased risk for developing heat-related illness compared to dogs that are not brachycephalics? Clinical bottom line Category of research Risk. Number and type of study designs reviewed Four studies were critically appraised. Three of these were cohort studies, one was a case-control study. Strength of evidence Moderate. Outcomes reported Brachycephalic dogs are at increased risk of developing heat-related illness and brachycephalic breeds are over-represented in presentations for heatstroke. Other factors named, such as body weight, also contributed to the risk of developing heat-related illness. Conclusion Dogs that are brachycephalic are likely to have an increased risk for developing heat-related illness compared to non-brachycephalic dogs. How to apply the evidence in practice The application of evidence into practice should take into account multiple factors, not limited to: individual clinical expertise, patient’s circumstances and owners’ values, country, location or clinic where you work, the individual case in front of you, the availability of therapies and resources. Knowledge Summaries are a resource to help reinforce or inform decision making. They do not override the responsibility or judgement of the practitioner to do what is best for the animal in their care.

Three-dimensional Analysis of Phenotypic Variation in Mercedes Benz Craniosynostosis

Background: Mercedes Benz craniosynostosis is a rare tri-sutural closure pattern of the bilateral lambdoid and sagittal sutures. Variation due to the predominant deformational driving force leads to short and long phenotypes. This study aims to evaluate the volumetric and craniometrics differences between phenotypes and compare them to controls. Methods: Three-dimensional pre-operative CT scans of 15 patients with Mercedes Benz craniosynostosis were retrospectively reviewed along with age and gender-matched controls. The intracranial volume of the anterior, middle, and posterior fossa was calculated. Craniometric measurements included cranial index, frontal bossing angle, occipital bossing angle, and occipital bone angle. Results: The short phenotype was present in 60% of patients, and the long phenotype in 40%. The short phenotype volume was significantly greater in the anterior and middle fossa ( P = .003; P = .002) and significantly less in the posterior fossa ( P < .001). The volumes were not significantly different in the long phenotype. The cranial index was significantly greater in the short phenotype when compared to both the long phenotype and controls ( P < .001; P = .006). Occipital bossing angle was significantly greater in the short phenotype than in controls( P = .029). The short phenotype had a significantly decreased occipital bone angle compared to the long phenotype and controls ( P < .001; P = .001). Conclusion: The short phenotype has increased anterior and middle fossa and decreased posterior fossa volume. Long phenotype had no significant differences in volume distribution. The short phenotype has increased cranial index, increased occipital bossing angle, and decreased occipital bone angle. Craniometric measures were not significantly different in the long phenotype.

Ocular surface physiology and aqueous tear secretion in cats of diverse cephalic conformations.

To describe normative ocular surface and aqueous tear testing data for cats of various cephalic conformation. Fifty-three healthy adult cats (11 British Shorthair, 11 Burmese, 10 Devon Rex, 10 Scottish Fold, and 11 Sphynx). Blink rate, corneal tactile sensation (CTS), and Schirmer tear test with or without topical anesthesia (STT-1, STT-2) and with nasolacrimal stimulation (NL-STT1, NL-STT2) were assessed. Palpebral fissure length (PFL) and skull morphology were measured, and cephalic index (CI) and craniofacial ratio (CFR) calculated. Mean ± SD test results were as follows: blink rate (5.0± 2.3 blinks/min), CTS (3.2± 0.7cm), STT-1 (11.2± 4.3 mm/min), STT-2 (6.7± 3.6 mm/min), NL-STT1 (13.4± 5.7 mm/min), NL-STT2 (13.5± 5.2 mm/min), and PFL (2.0± 0.2cm). Corneal sensitivity did not differ significantly among breeds (p= .152) but was negatively correlated with body weight (r= -.32, p= .019). STT-1 significantly differed among breeds (p< .001) and was lowest in Sphynx cats (8.7± 4.3 mm/min). A positive correlation was detected between STT-1 values at 30 and 60 s (r= .98; p< .001). The nasolacrimal reflex significantly increased STT in anesthetized and unanesthetized eyes (approximately +100% and +20%, respectively; p≤ .002). STT-1 tended to be higher in intact versus neutered cats (p= .062). Age did not impact any test result (p≥ .085). Normative data described here serve as a baseline for future studies assessing ocular surface disease in multiple feline breeds. Unlike dogs, brachycephalic cats did not have lower CTS or STT-1 than non-brachycephalic cats.

A New South American Freshwater Turtle of the Genus Mesoclemmys from the Brazilian Amazon (Testudines: Pleurodira: Chelidae)

We describe a new species of small chelid turtle from perennial streams in the Araguaia River subbasin near Serra das Andorinhas State Park, São Geraldo do Araguaia, Pará, Brazil. It is morphologically distinct and the smallest known member of the genus Mesoclemmys, with an average straight-line carapace length (CL) of 144 mm and maximum recorded CL of 170 mm. The species has a moderate head width of approximately 20% of CL. The carapace and dorsal soft parts are blackish, the plastron is light brownish yellow with a blackish brown central plastral figure, and the ventral soft parts are pale yellow. It has the largest femoral scutes of any Mesoclemmys and its plastral contact formula is Intergular > Anal > Humeral > Femoral > Abdominal > Pectoral > Gular. We describe the shell and skull morphology of the new species and performed genetic analysis using mitochondrial DNA (cytochrome c oxidase, subunits I [COI] and 16S) to build a phylogenetic tree for the genus, which placed the new species as sister to M. vanderhaegei.

Prevalence of incidental humeral intracondylar fissures in brachycephalic breed dogs in CT studies.

Humeral intracondylar fissures (HIF) have been predominantly reported in spaniel breeds and proposed to be possible risk factors for humeral condyle fractures (HCF). We hypothesized that the prevalence of incidental HIF in French Bulldogs may be greater than that of other brachycephalic breeds. A retrospective, observational, prevalence study was performed using CT examinations of French bulldogs and other brachycephalic breed dogs presenting for an unrelated condition. Two European College of Veterinary Diagnostic and Imaging-certified radiologists reviewed the images of the humeral condyles of these dogs. A classification system was devised to grade the findings. We considered a Score 1 to be normal, Score 2 to have centralised sclerosis, Score 3 to have a partial fissure and Score 4 to have a complete fissure. A total of 228 elbows were reviewed from 122 dogs. Of this population, 145 elbows were from French Bulldogs, 54 were from Pugs, and the remainder were from a mix of other brachycephalic breeds. The prevalence of HIF (score 3 or 4) in elbows of the French bulldog, pug and other breed groups was 6.9% (CI 2.8-11%), 5.6% (CI 0-11.7%), and 3.4% (CI 0-10.15%), respectively. At a dog level, the prevalence of HIF (score 3 or 4 present in at least one elbow) was found to be 11.8% (CI 4.6-19%) in French Bulldogs, 11.1% (CI 0-22.9%) in Pugs, and 5.26% (CI 0-15%) in the other breed group. There was no significant difference between the breed groups. The inter-reviewer reliability for CT scoring of HIF based on Cohen's weighted kappa was low at 0.19.

One-piece fronto-orbital distraction osteogenesis without bandeau in patients with coronal craniosynostosis: A five-year follow-up retrospective study of 45 consecutive patients

This study aimed to review the surgical outcomes, complications, and long-term relapses in patients with unilateral or bilateral coronal craniosynostosis, who underwent one-piece fronto-orbital distraction osteogenesis (FODO) without bandeau.The cephalic index, frontal angle, and supraorbital symmetry ratio were measured on the initial and follow-up computed tomography images. Esthetic outcomes were evaluated using the Whitaker classification.45 patients were included in this study. The average follow-up interval was 5.4 ± 1.1 years (range 2.5–8.5 years). In patients with bilateral coronal craniosynostosis, the frontal angle decreased with a relapse ratio of −2.8 ± 4.3% during long-term follow-up compared with that during short-term follow-up (p = 0.028). In patients with unilateral coronal craniosynostosis, the supraorbital symmetry ratio decreased slightly, with a relapse ratio of −3.8 ± 2.6% during long-term follow-up (p = 0.017). Complications included dural tears during osteotomy (n = 2), early distractor removal (n = 2), and wound problems (n = 3).Within the limitations of the study it seems that one-piece fronto-orbital distraction osteogenesis (FODO) generates successful and sustainable results even in the long term. Therefore, this treatment option should be considered for patients with unilateral and bilateral coronal craniosynostoses whenever appropriate.

Neuroprotective effects of Vaccinium myrtillus on damage-related brain injury

Traumatic brain injury may trigger the secondary brain injury, which has the potential to be reversible and thus preventable. Anthocyanins are phylotherapeutic plants, which are reported to exhibit anti-inflammatory properties. This study aimed to evaluate the therapeutic efficiency of an anthocyanin, namely Vaccinium myrtillus, to alleviate secondary brain injury and identify possible mechanism of actions.It is hypothesized that lipid peroxidation and Na+ -K+ -ATPase activity may be involved in neuronal ischemia. Thus, brain tissue Malondialdehyde content, Na+ -K+ -ATPase content, and cleaved caspase-3 content was investigated following moderate head trauma in a rat model. Twenty-four Sprague-Dawley male rats were allocated into four groups: Control, Trauma, Solvent-Control, and Treatment.Trauma and Solvent-Control groups showed more prominent brain edema, neuronal ischemia, vascular congestion, increase in brain tissue Malondialdehyde and cleaved caspase-3 levels, and decreased Na+-K+-ATPase activity compared to the Control group. Although the Treatment group had comparable histological signs to the Trauma and Solvent-Control groups, Malondialdehyde level and Na+-K+-ATPase activity was similar to Control group, and cleaved caspase-3 levels were lower compared to Trauma and Solvent-Control groups. We conclude that anthocyanin extracts may alleviate secondary brain injury via anti-oxidative and anti-apoptotic mechanisms.

Spring forces and calvarial thickness predict cephalic index changes following spring-mediated cranioplasty for sagittal craniosynostosis.

Variables interacting to predict outcomes following spring-mediated cranioplasty (SMC) for non-syndromic craniosynostosis, including spring parameters and calvarial thickness, are poorly understood. This study assessed interactions between spring parameters and calvarial thickness to predict changes in cephalic index (CI) following SMC. Patients undergoing SMC for non-syndromic sagittal craniosynostosis at our institution between 2014 and 2021 were included. Calvarial thickness was determined from patient preoperative CTs using Materalise Mimics at 27 points in relation to the sagittal suture. Linear mixed effects models were used to determine interactions between anterior, middle, and posterior calvarial thickness with spring force and length. Sixty-nine patients undergoing surgery at mean age 3.7months were included in this study. Stronger posterior spring force interacted with thinner posterior calvarial thickness to predict greater changes in CI at 3months postoperatively (p = 0.022). When evaluating spring force and calvarial thickness set distances from the sagittal suture, stronger posterior spring force interacted with thinner posterior calvarial thickness 5mm (p = 0.043) and 10mm (p = 0.036) from the sagittal suture to predict changes in CI. Interactions between spring parameters and calvarial thickness in the anterior and middle positions did not significantly predict changes in CI. Stronger posterior spring force interacted with thinner posterior calvaria to predict greater changes in CI 3months following SMC for non-syndromic sagittal craniosynostosis. These results suggest dynamic interactions between several variables may impact outcomes following SMC.

Evaluating Cranial Growth in Japanese Infants Using a Three-dimensional Scanner: Relationship between Growth-related Parameters and Deformational Plagiocephaly.

In this study, we aimed to evaluate the longitudinal changes in the cranial shape of healthy Japanese infants using a three-dimensional scanner and construct a normal values database for the growth process. Preterm infants (gestational age < 37 weeks), infants with neonatal asphyxia (5-minute Apgar score of <7), and patients who started helmet therapy for deformational plagiocephaly were excluded from this study. The first scan was performed at approximately 1 month of age, followed by two scans conducted at 3 and 6 months of age. The parameters considered were as follows: cranial length, width, height, circumference, volume, cranial vault asymmetry index, and cephalic index. A cranial vault asymmetry index >5% was defined as deformational plagiocephaly. Changes in each parameter were examined using repeated-measures analysis of variance classified by sex and deformational plagiocephaly status. The rate of increase in each parameter was also examined. In total, 88 infants (45 boys and 43 girls) were included in this study. All growth-related parameters were noted to increase linearly with time. Sex differences were observed in all parameters except cranial length. Deformational plagiocephaly was found to have no effect on growth-related parameters. Cranial volume increased by 60% from 1 to 6 months of age. The growth almost uniformly influenced the rate of increase in volume in each coordinate axis direction. Overall, the mean trends in three-dimensional parameters in infants up to 6 months of age were obtained using a three-dimensional scanner. These trends could be used as a guide by medical professionals involved in cranioplasty.

A multi-institutional survey on calvarial vault remodeling techniques for sagittal synostosis and outcomes analysis for patients treated at 12 months and older.

Surgical treatment of sagittal craniosynostosis is challenging in older patients. This study aimed to assess the effect of increasing age on open surgical technique selection and patient outcomes using the multi-institutional Synostosis Research Group (SynRG) collaboration. Surgeons in SynRG were surveyed for key influences on their preferred open calvarial vault remodeling techniques at various patient ages: < 6, 6-12, and > 12 months. The SynRG database was then queried for open repairs of nonsyndromic sagittal craniosynostosis performed for patients older than 12 months of age. Perioperative measures, complications, and preoperative and postoperative cephalic indices were reviewed. All surgeons preferred to treat patients at an earlier age, and most (89%) believed that less-optimal outcomes were achieved at ages older than 12 months. The modified pi procedure was the dominant technique in those younger than 12 months, while more involved open surgical techniques were performed for older patients, with a wide variety of open calvarial vault remodeling techniques used. Forty-four patients met inclusion criteria, with a mean (± SD) age at surgery of 29 ± 16 months. Eleven patients underwent parietal reshaping, 10 parietal-occipital switch, 9 clamshell craniotomy, 7 geometric parietal expansion, 6 modified pi procedure, and 1 parietal distraction. There were no readmissions, complications, or mortality within 30 days postoperatively. Patients' cephalic indices improved a mean of 6.4% ± 4.0%, with a mean postoperative cephalic index of 74.2% ± 4.9%. Differences in postoperative cephalic index (p < 0.04) and hospital length of stay (p = 0.01) were significant between technique cohorts. Post hoc Tukey-Kramer analysis identified the parietal reshaping technique as being significantly associated with a reduced hospital length of stay. Patient age is an important driver in technique selection, with surgeons selecting a more involved calvarial vault remodeling technique in older children. A variety of surgical techniques were analyzed, with the parietal reshaping technique being significantly associated with reduced length of stay; however, multiple perioperative factors may be contributory and require further analysis. When performed at high-volume centers by experienced pediatric neurosurgeons and craniofacial surgeons, open calvarial vault techniques can be a safe method for treating sagittal craniosynostosis in older children.

Cerebral Perfusion and Functional Outcome in Pediatric Head Injury Patients.

To evaluate the usefulness and degree of perfusion abnormalities in pediatric head injury patients by using computed tomography perfusion (CTP) and to assess its co-relation with neurologic outcome based on Glasgow Outcome Scale Extended Pediatric revision (GOSE-P). Prospective evaluation of pediatric head injury patients who were taken for CTP after admission and then on discharge. We evaluated 5 regions of interest: orbitofrontal cortex, internal capsule, thalamus, caudate nucleus, and sensorimotor cortex for cerebral blood perfusion. The patient's clinical and radiologic findings were analyzed, correlated with cerebral blood flow (CBF) and MTT (mean transient time), and the outcome assessed using the GOSE-P scale on 3-month follow-up. Both CBF and MTT showed a correlation with the GOSE-P scale. In mild head injury patients, the Pearson correlation of GOSE-P with mean CBF and mean MTT was -0.11 and 0.56, respectively (P < 0.05) in the sensorimotor cortex; in moderate head injury patients the Pearson correlation of GOSE-P with mean CBF in the caudate nucleus and mean MTT in the internal capsule was -0.32 and 0.36, respectively (P < 0.05); and in severe head injury patients, the Pearson correlation of GOSE-P with mean CBF and mean MTT was -0.78 and 0.56, respectively (P < 0.05) in the caudate nucleus, which had the highest Pearson co-relation among the regions studied. We conclude that CBF and MTT are 2 important radiologic parameters that can be used as prognostic indicators in pediatric head injury patients.

A Clinical Study on the Surgical Management of Third Eyelid Gland Prolapse in Dogs

Background: The current study was undertaken to evaluate the clinical efficacy of two different surgical methods for management of third eyelid gland prolapse in dogs. Methods: The study was conducted on 14 eyes of 11 dogs presented with third eyelid gland prolapse for surgical treatment. Two groups dogs were subjected to clinical and ophthalmic examination based on the surgical technique used i.e., Group I (n=8) in which modified Morgan’s pocket technique, Group II (n=6) in which modified orbital rim anchorage technique was used. Among the breeds brachycephalic dogs (54.54%, n=6) followed by mesocephalic dogs (45.45%, n=5). The modified Morgan’s pocket technique was adopted in 8 eyes of 7 dogs (1 bilateral, 6 unilateral) and the modified orbital rim anchorage technique was performed in 6 eyes of 4 dogs (2 bilateral, 2 unilateral). In Group I, the mean pre-operative Schirmer tear test value was 16.87±0.72 mm/min and in Group II, it was 17.33±0.67 mm/min, both values increased on 30th Post-operative day. Statistical analysis revealed that there was no significant difference between the two groups (p greater than 0.05), but there were significant differences within each group (p less than 0.05). The fluorescein dye test was repeated on 1st,7th,14th, 30th days post-operatively and found positive in the left eye of one dog with the reduced bilateral cherry eye on 7th post-operative day in group I. Third eyelid mobility was normal post-operatively in all the cases of group I. Whereas in group II, it is restricted in all the cases. Three cases regained normal contour by the 10th post-operative day whereas 5 cases by the 14th postoperative day in group I. In group II, 3 cases regained normal contour by 12th post-operative day and 3 cases regained by 14th post-operative day. One case in the group I tested positive for superficial corneal ulcer on the 7th post-operative day. One dog in group I had a recurrence after 45 days of repositioning. One dog in group II with reduced bilateral cherry eye had a recurrence in the left eye 30 days after surgery. Result: Present study, Modified Morgan’s pocket technique was considered superior over the modified orbital rim anchorage technique in view of technical feasibility and unrestricted third eyelid mobility.

Rostral nasopharyngeal CT measurements in Chihuahuas and Pomeranians are smaller than those measured in Dachshunds.

Chihuahuas and Pomeranians are often afflicted with obstructive upper respiratory tract disease. Previous computed tomographic (CT) studies have described the dimensions and abnormalities of different parts of the upper respiratory tract in brachycephalic dogs. However, Chihuahuas and Pomeranians were not included. The objective of this study was to determine the transverse-sectional (TSA) dimensions of the nasopharynx, cricoid, and trachea of Chihuahuas and Pomeranians, and investigate whether or not Chihuahuas and Pomeranians had smaller airway dimensions than another non-brachycephalic breed (Dachshund). A retrospective, descriptive, single-center cross-sectional cohort study was performed. CT studies of 88 dogs were included (42 Chihuahuas, 29 Dachshunds, and 17 Pomeranians). The TSA of the rostral, mid, and caudal aspect of the nasopharynx, the cricoid and trachea at the level of C4 were determined. For all these locations, TSA/weight, nasopharynx/cricoid, nasopharynx/trachea, and cricoid/trachea ratios were determined. The rostral nasopharynx was the smallest part of the upper airways in Chihuahuas and Pomeranians. Chihuahuas had significantly smaller rostral nasopharynx TSA/weight ratios compared to Dachshunds (P<0.0001). The rostral nasopharynx TSA/cricoid ratio and the rostral nasoharynx/trachea ratio for Chihuahuas were significantly smaller than both that of Pomeranians (P<0.0001 and P=0.00027) and Dachshunds (P<0.0001 and P=0.00084). Pomeranians had significantly smaller cricoid TSA/weight ratios compared to Chihuahuas (P=0.0014) and Dachshunds (P=0.00028). This study demonstrated that the nasopharynx is narrow in Chihuahuas and Pomeranians, with the smallest dimensions located at the rostral part of the nasopharynx.

Suture Fusion, Cephalic Index, and Head Shape in Non-syndromic Sagittal Craniosynostosis

INTRODUCTION: Sagittal craniosynostosis may present with complete or partial fusion of the sagittal suture.1 Previous studies describe high heterogeneity of phenotypic presentation for non-syndromic sagittal craniosynostosis in absence of particularly compelling evidence explaining such heterogeneity.1 One postulation for variation in head shape at presentation is degree and location of suture fusion; however, relationships between extent of sagittal suture fusion and head shape are currently poorly described.1 The aim of this study was to characterize the degree of sagittal suture fusion in a cohort of patients with non-syndromic sagittal craniosynostosis and determine associations with CI and head shape, including frontal bossing and occipital bulleting. METHODS: Patients with non-syndromic sagittal craniosynostosis at a tertiary care center with available CT imaging between 2014 and 2021 were retrospectively included in this study. Three-dimensional CT head images were imported into Materialise Mimics and parietal bones were manually isolated. The ‘measure’ tool was used to measure the distance of fused suture. The percentage of total sagittal suture fusion was quantified by dividing the distance of fused suture by the total length of the sagittal suture. Similar calculations were performed for anterior and posterior halves, and anterior, middle, and posterior thirds. Degree of sagittal suture fusion was compared to head shape characteristics, including cephalic index (CI), frontal bossing, and occipital bulleting, with Mann-Whitney U tests, Spearman’s correlations, and univariate and multivariate linear and logistic regression models. RESULTS: Ninety patients (69 male) were included in this retrospective study. The sagittal suture was on average 85.6 ± 20.1% fused, and 45 (50.0%) patients demonstrated complete fusion of the sagittal suture. CI was associated with increased degree of fusion for the anterior one-half (ρ = 0.26, p = 0.033) and anterior one-third (ρ = 0.30, p = 0.012) of the sagittal suture. Complete fusion of the anterior one-third of the sagittal suture predicted higher CI (β = 13.86, SE = 6.99, z = -0.25, p = 0.047). Logistic regression models revealed percentage of middle one-third sagittal suture fusion predicted the presence of frontal bossing (β = 2.42, SE = 0.96, z = 2.53, p = 0.012). Total degree of sagittal suture fusion was not predictive of CI or head shape in any analysis (all p > 0.05). CONCLUSION: Percentage of total sagittal suture fusion was not associated with CI or head shape in patients with non-syndromic sagittal craniosynostosis in this cohort. Decreased fusion of the anterior one-third of the sagittal suture was paradoxically associated with higher CI and more severe scaphocephalic head shape. These findings raise additional questions regarding suture fusion and head-shape morphology, and further research is needed to substantiate these results in patients with non-syndromic sagittal craniosynostosis. These findings may have implications for understanding suture fusion patterns in other variations of craniosynostosis. REFERENCE: 1. Di Rocco, F., Gleizal, A., Szathmari, A., Beuriat, P. A., Paulus, C., & Mottolese, C. (2019). Sagittal suture craniosynostosis or craniosynostoses? The heterogeneity of the most common premature fusion of the cranial sutures. Neurochirurgie, 65(5), 232-238.

Springs Forces and Parietal Bone Thickness Interact to Predict Changes in Cephalic Index following Spring-Mediated Cranioplasty for Non-Syndromic Sagittal Craniosynostosis

Springs Forces and Parietal Bone Thickness Interact to Predict Changes in Cephalic Index following Spring-Mediated Cranioplasty for Non-Syndromic Sagittal Craniosynostosis

Medical Management versus PACK-CXL in Dogs with Infectious Keratitis: A Randomized Controlled Trial Protocol.

Simple SummaryInfected corneal ulcers are a common and painful disease, usually caused by bacteria in dogs. Short-nosed dog breeds are predisposed to corneal ulcers. Treatment aims to eliminate bacteria, stop the enzymatic tissue melting process in the cornea, and allow for normal healing to resume. Success of treatment largely depends on the effectivity of the applied medications, possibly including antibiotics. In the context of globally growing antibiotic resistance, non-antibiotic-based treatment alternatives are desirable. Photoactivated Chromophore for Keratitis-Corneal Cross-linking (PACK-CXL) reduces enzymatic tissue melting and damages multiple targets within microorganisms, resulting in corneal stabilization and non-antibiotic-based elimination of bacteria. A confirmatory clinical study providing unbiased evidence of PACK-CXL effectiveness in dogs is currently lacking. We therefore aim to conduct such a study and determine whether PACK-CXL is a viable alternative to conventional state-of-the-art medical therapy for corneal ulcer treatment in dogs. Here we present the randomized controlled clinical trial study protocol. Registering trials favors sound statistical analysis and prevents publication bias. The trial results will be published after successful trial conclusion.Infectious keratitis is a common and painful disease, usually caused by bacteria in dogs. Brachycephalic breeds are at increased risk. Despite medical therapy, enzymatic corneal melting can lead to ulcer perforation and globe loss. Treatment alternatives are needed due to an increase in antibiotic resistance and growing popularity of brachycephalic dogs. Photoactivated Chromophore for Keratitis-Corneal Cross-linking (PACK-CXL) reduces enzymatic collagenolysis and damages multiple targets within microorganisms, resulting in corneal tissue stabilization and elimination of bacteria, irrespective of their antibiotic resistance status. A randomized controlled trial providing evidence of PACK-CXL effectiveness in dogs is lacking. We aim to determine whether PACK-CXL is a viable alternative to conventional medical therapy for canine infectious keratitis. Two hundred-and-seventy client-owned dogs with presumed infectious keratitis will be allocated to two equally sized treatment groups (PACK-CXL or medical therapy) in a masked, randomized, controlled, multicenter trial in eleven clinics. The primary outcome measure is treatment success defined as complete epithelial closure within 28 days. The sample size is based on a group sequential design with two interim analyses, which will be overseen by a Data Safety and Monitoring Board. Ethical approvals have been obtained. The study protocol is preregistered at preclinicaltrials.eu. Publishing trial protocols improves study reproducibility and reduces publication bias.