CEREBRAL PERFUSION DEFECTS SECONDARY TO SIMPLE CRANIOSYNOSTOSIS

Premature fusion of multiple cranial sutures has been associated with increased intracranial pressure and the potential for mental impairmen t. Isolated craniosynostosis, however, has been thought to be a benign condition primarily reconstructed for aesthetic purposes. On the basi s of subjective developmental improvement postoperatively, an objectiv e radiographic analysis (single positron emission computed tomography [SPECT]) was used to assess differences in cerebral perfusion in the a reas compressed secondary to the fused cranial suture both before and after cranial reconstructive surgery in patients with simple craniosyn ostosis. Seven children with craniosynostosis, six boys and one girl ( age range, 3-28 months), were enrolled in this prospective study. Six of the seven had cranial asymmetry on preoperative cranial computed to mographic scans, and one had a symmetric defect and was used as a cont rol. Each subject had a preoperative SPECT scan approximately 3 to 5 d ays before the cranial reconstruction procedure and a follow-up scan 6 to 10 weeks postoperatively. Preoperative asymmetries in cerebral per fusion ranged from 0 to 30% (mean, 13%) in the areas compressed second ary to the premature suture fusion. In five patients cerebral blood fl ow, which was asymmetric before surgery, became symmetric after cranio facial reconstruction, and no new perfusion defects were documented. T he control patient and one other patient had symmetric perfusion both pre- and postoperatively. Craniosynostosis may be associated with decr eased cerebral blood flow as a result of the constriction of the brain from the prematurely fused suture. The correction of asymmetric crani al single-suture synostosis is more than a cosmetic procedure in that it allows for normalization of cerebral blood flow. This difference in blood flow supports early surgical intervention to prevent any potent ial central nervous system compromise secondary to abnormal blood flow .