Scaphocephaly in a select South African population: a morphometric analysis of the cranial fossae and ventricular access points.
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Date
2021
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Abstract
Scaphocephaly is a cranial deformity that results from premature fusion of the sagittal suture and
is characterized by an elongated and narrowed skull. Patients with this condition present with
varying clinical features including frontal bossing and occipital protrusion. This study comprised
two subsets, analysing different aspects related to this cranial deformity. Most morphological and
morphometrical studies in patients with scaphocephaly focus on the cranial vault. Literature on
the morphometry of the cranial base and its fossae in these patients is sparse. Therefore, the first
subset aimed to analyse and compare the morphometry of the cranial fossae in patients with
scaphocephaly. Due to varying cranial morphology among patients with these deformities,
ventricular access using conventional techniques is often a challenge. Although ventricular access
may not be frequently required in paediatric scaphocephalic patients, it is vital that an ideal
location of the access points be established for safe ventricular catheterization. Accordingly, the
second subset aimed to document the morphometry of Kocher’s and Frazier’s points in
scaphocephalic patients using known craniometric and surface anatomical landmarks.
Dimensions of the anterior, middle and posterior cranial fossae (ACF, MCF and PCF) were
measured using select anatomical landmarks on computed tomography (CT) scans of 24
consecutive patients diagnosed with scaphocephaly between 2014 and 2020, and 14 non-affected/
normal paediatric patients selected as controls. Parameters of Kocher’s and Frazier’s points were
measured in relation to known cranial surface anatomical landmarks on scans of the
scaphocephalic patients utilized in subset 1. The study found that ACF and PCF are most affected
in scaphocephalic patients, with elongation along the anteroposterior (AP) plane (lengths) (ACF,
p=0.041 and PCF, p=0.018). Minimal changes were observed in the transverse plane (widths) in
scaphocephaly versus non-affected/normal controls. Regarding subset 2, Kocher’s point was
located between 91.6mm and 140mm posterior to the nasion, and between 20.5mm and 34.6mm
lateral to the midline in patients with scaphocephaly. Frazier’s point was located between 60.9mm
and 82.8mm superior to the inion, and 25.9mm and 41.4mm lateral to the midline. Parameters
measured in the AP plane were found to be more affected than those measured lateral from the
midline.
This study contributes to the literature by providing novel morphometric data based on a select
South African population. Data obtained could aid craniofacial surgeons in understanding which
cranial fossa is most affected in scaphocephaly and to what extent, to decide on the most
appropriate method of treatment. Additionally, the study concluded that the traditional landmarks
used for ventricular access are relatively unreliable in scaphocephalic patients. This study
provides data for neurosurgical consideration regarding ventricular catheterization procedures in
patients with scaphocephaly.
Description
Masters Degree. University of KwaZulu-Natal, Durban.