Department of Surgery, Division of Plastic Surgery, Yale Medical School.
Department of Diagnostic Radiology, Yale University School of Medicine, PO Box 208042.
J Craniofac Surg. 2021;32(5):1721-1726. doi: 10.1097/SCS.0000000000007505.
In this study, the authors seek to clarify the neurological changes before and after whole vault cranioplasty (WVC) in patients born with sagittal craniosynostosis.
A case control study design was performed that included thirty functional MRI scans, from 25 individual patients. Functional MRI and diffusion tension imaging data were analyzed with BioImageSuite (Yale University, USA). 9 functional brain networks were analyzed, with appropriate correlated functional regions of the brain and utilized for analysis.
Comparing functional MRI the infants after WVC versus infants before WVC group, the after WVC group demonstrated an increased connectivity in the left frontoparietal, secondary (V2), and third (V3) visual networks (P < 0.001). The right frontoparietal (RFPN) had decreased connectivity (P < 0.001). There is also a decrease and increase in anisotropy in the cingulum and precuneus despite surgery, respectively (P < 0.05). Adolescents treated with WVC compared to controls, demonstrated an increased connectivity in the salience and decreased connectivity in the RFPN relative to adolescent controls.
Patients born with sagittal craniosynostosis have different connections in infancy in most of the defined cerebral networks compared to controls. After surgery, there are specific connectivity changes that occur in the RFPN, left frontoparietal, V2, and V3 networks, which are areas associated with executive function and emotional control. Changes identified in white matter tract microstructure connections could be influential in changes in functional connectivity. Although, as a child with sagittal craniosynostosis develops, much of the abnormal network connections, seen in infancy preoperatively, corrects to some degree after surgery. However, some aberrancies in the salience and RFPN networks remain potentially affecting executive functioning.
本研究旨在阐明矢状缝早闭患者行颅穹窿重建术（WVC）前后的神经变化。
采用病例对照研究设计，纳入 25 名患者的 30 例功能性磁共振成像（fMRI）扫描。使用 BioImageSuite（美国耶鲁大学）分析 fMRI 和弥散张量成像数据。分析了 9 个功能脑网络，包括大脑适当的相关功能区域。
与 WVC 前的婴儿相比，WVC 后的婴儿在左额顶枕叶、次要（V2）和第三（V3）视觉网络中的连接增加（P<0.001）。右侧额顶枕叶（RFPN）的连接减少（P<0.001）。尽管手术存在，扣带和楔前叶的各向异性分别减少和增加（P<0.05）。与对照青少年相比，接受 WVC 治疗的青少年在突显网络中表现出连接增加，而在 RFPN 中连接减少。
与对照组相比，患有矢状缝早闭的患者在婴儿期的大多数定义明确的大脑网络中具有不同的连接。手术后，RFPN、左额顶枕叶、V2 和 V3 网络的连接发生特定变化，这些区域与执行功能和情绪控制有关。白质束微观结构连接变化可能对功能连接变化产生影响。尽管随着矢状缝早闭患儿的发育，术前婴儿期出现的许多异常网络连接在一定程度上得到纠正，但在突显和 RFPN 网络中仍存在一些异常，可能潜在地影响执行功能。
