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PubMed1982

Cortical control of neurally-mediated arrhythmogenic properties of desacetyl lanatoside C: the role of the posterior hypothalamus.

Functional ablation of the cerebral cortex by cortical spreading depression (CSD) significantly increased the dose of desacetyl lanatoside C required to induce A-V block and ventricular fibrillation. To examine the role of the posterior hypothalamus in the increased resistance of decorticated rats to arrhythmia induced by toxic doses of desacetyl lanatoside C, four groups of animals were injected with this drug: group 1 rats had a craniotomy; group 2 rats had a craniotomy and functional decortication; group 3 rats had a craniotomy and a hypothalamic lesion; and group 4 rats had a craniotomy, hypothalamic lesion and functional decortication. The dose of drug required to induce A-V block and ventricular fibrillation was significantly less in group 1, than in groups 2,3 and 4, and there was no statistically significant difference between these last three groups. These results are consistent with the hypothesis that the increased resistance to arrhythmia induced by desacetyl lanatoside C in decorticated rats is mediated by the posterior hypothalamus.

Animals↗
PubMed2003

The conditional probabilities of survival in patients with anaplastic astrocytoma or glioblastoma multiforme.

BACKGROUND: By the use of conditional probabilities of survival, we studied the yearly survival rates for individual tumor survivors. METHODS: Conditional survival rate was estimated in 114 consecutive patients with anaplastic astrocytoma or glioblastoma multiforme. Conditional probabilities of surviving some years given survival to a specific period of time after craniotomy and 95% confidence intervals were calculated in the individual tumor survivors. RESULTS: The estimated median survival was 30 months for 45 patients with anaplastic astrocytoma and 12 months for 69 patients with glioblastoma multiforme. The conditional probabilities of surviving next one year given survival to 1 year, 2 years, 3 years, 4 years, or 5 years after craniotomy for anaplastic astrocytoma were 86.2%, 75.0%, 85.9%, 77.8%, or 85.7%, respectively; for glioblastoma multiforme 64.8%, 58.7%, 85.7%, 80.0%, or 75.0%, respectively. The conditional probability of surviving to 5 years given survival to 2 years after craniotomy for anaplastic astrocytoma, i.e., surviving an additional 3 years, was 50.1%, which was better than observed 5-year survival rate (28.6%); for glioblastoma multiforme it was 40.2%, which also was better than observed 5-year survival rate (12.4%). CONCLUSIONS: The conditional probability of survival was a good method to clinically predict yearly survival rate for individual tumor survivors. In addition, the method can estimate the probabilities of surviving next some years given survival to a specific period of time after craniotomy. It also showed a more encouraging result than observed survival rate in patients with supratentorial malignant astrocytomas.

Adult↗
PubMed1997

Stereotaxy reduces cost of brain tumor resection.

BACKGROUND: Health care professionals are under increasing pressure to contain the cost of health care. Simultaneously, medical technology continues to advance. Medical institutions must therefore consider the costs and benefits before using a new technology. Using a direct costing system, we determined the cost efficacy of stereotaxy applied to the resection of brain mass lesions. METHODS: Twenty-nine patients underwent a stereotactically guided craniotomy and brain tumor resection. Fifteen of them underwent general and fourteen received local anesthesia. Twelve other patients, comprising a historical reference group, underwent a standard craniotomy and brain tumor resection under general anesthesia. costs were determined for every hospital charge item in all patients. Cost efficiency was then compared between the two groups. RESULTS: Patients treated stereotactically incurred additional costs in frame placement and neuroimaging. These costs were offset by savings in operating room time, patient acuity, length of stay, respiratory care, and medications. Savings were greatest for patients who had local anesthesia. Overall, patients treated by stereotactic craniotomy had a total hospitalization cost of $8,495.19, whereas those treated with standard craniotomy incurred a cost of $11,365.23 (p < 0.001). CONCLUSION: Stereotaxy is cost effective for the surgical treatment of brain tumors. Accurate estimates of cost can justify the use of medical technology. Directly measured cost data is a useful index for any cost containment program.

Adolescent↗
PubMed1999

Venous thromboembolism occurs frequently in patients undergoing brain tumor surgery despite prophylaxis.

Most Neurosurgical Service patients at our hospital receive venous thromboembolism prophylaxis. In 1995-96, the rate of clinically overt venous thromboembolism was 3.7% among patients undergoing neurosurgery. However, rates were much higher when craniotomy was undertaken for brain tumor. Of 497 who underwent craniotomy for primary (429) or metastatic (68) brain tumor, 47 (9.5%) developed clinically overt venous thromboembolism: 7.5% after primary brain tumor resection and 19% after craniotomy for metastatic cancer. The high rate of venous thromboembolism in craniotomy patients with brain tumor warrants study of alternative measures for preventing thrombus, such as prophylaxis with low molecular weight heparin.

Brain Neoplasms↗
PubMed2001

Antiepileptogenesis and seizure prevention trials with antiepileptic drugs: meta-analysis of controlled trials.

PURPOSE: To synthesize evidence concerning the effect of antiepileptic drugs (AEDs) for seizure prevention and to contrast their effectiveness for provoked versus unprovoked seizures. METHODS: Medline, Embase, and The Cochrane Clinical Trials Register were the primary sources of trials, but all trials found were included. Minimal requirements: seizure-prevention outcome given as fraction of cases; AED or control assigned by random or quasi-random mechanism. Single abstracter. Aggregate relative risk and heterogeneity evaluated using Mantel-Haenszel analyses; random effects model used if heterogeneity was significant. RESULTS: Forty-seven trials evaluated seven drugs or combinations for preventing seizures associated with fever, alcohol, malaria, perinatal asphyxia, contrast media, tumors, craniotomy, and traumatic brain injury. Effective: Phenobarbital for recurrence of febrile seizures [relative risk (RR), 0.51; 95% confidence interval (CI), 0.32-0.82) and cerebral malaria (RR, 0.36; CI, 0.23-0.56). Diazepam for contrast media-associated seizures (RR, 0.10; CI, 0.01-0.79). Phenytoin for provoked seizures after craniotomy or traumatic brain injury (craniotomy: RR, 0.42; CI, 0.25-0.71; TBI: RR, 0.33; CI, 0.19-0.59). Carbamazepine for provoked seizures after traumatic brain injury (RR, 0.39; CI, 0.17-0.92). Lorazepam for alcohol-related seizures (RR, 0.12; CI, 0.04-0.40). More than 25% reduction ruled out valproate for unprovoked seizures after traumatic brain injury (RR, 1.28; CI, 0.76-2.16), and carbamazepine for unprovoked seizures after craniotomy (RR, 1.30; CI, 0.75-2.25). CONCLUSIONS: Effective or promising results predominate for provoked (acute, symptomatic) seizures. For unprovoked (epileptic) seizures, no drug has been shown to be effective, and some have had a clinically important effect ruled out.

Anticonvulsants↗
PubMed1988

Intraoperative development of contralateral epidural hematoma during evacuation of traumatic extraaxial hematoma.

Intraoperative development of an epidural hematoma contralateral to a craniotomy for acute traumatic extraaxial hematoma has been previously reported. This entity, however, has never been distinctly defined and differentiated from either the delayed or the bilateral acute epidural hematoma. We present 3 new cases of intraoperative contralateral acute epidural hematoma and review the 14 previously reported cases. The typical clinical presentation is a severe head injury with an acute extraaxial hematoma and severe ipsilateral brain displacement during craniotomy. If brain displacement is not noted at craniotomy, then the contralateral hematoma is manifested by immediate postoperative neurological deterioration or intractable elevated intracranial pressure. The presence of any of these signs makes an immediate postoperative CT scan or burr holes contralateral to the original craniotomy mandatory for early diagnosis. In addition to defining "intraoperative contralateral epidural hematoma," stricter definitions of the terms "delayed epidural hematoma" (no hematoma present on the initial CT scan but one present on a later scan) and "bilateral epidural hematomas" (present on the initial scan) are proposed.

Adolescent↗
PubMedDate not supplied

Endoscopic transsphenoidal biopsy of the sphenoid and clival mass.

Abnormalities of the clivus/skull base occur most commonly as a result of disease spread from adjacent structures, but can also occur from primary involvement of the clivus. Traditionally, definitive diagnosis was made by CT guided biopsy or craniotomy. However, lesions can occur in this area that are not amenable to CT guided biopsy or craniotomy. Endoscopic transsphenoidal surgery can provide a safe method for obtaining a clival biopsy, debulking of tumor tissue, or definitive treatment without the morbidity and mortality of a craniotomy. This study was designed to describe our experience with the endoscopic approach to the skull base and clivus via the sphenoid sinus. A series of seven patients underwent endoscopic transsphenoidal biopsy of a sphenoid clival lesion. All patients avoided anticipated craniotomy, and definitive pathology was obtained in five of six patients. In two cases, excisional biopsy proved to be therapeutic. There were no deaths, and major complications included one CSF leak and one intraoperative hemorrhage, both of which were controlled immediately. The experience gained with these patients demonstrates the feasibility and safety of this new application of endoscopic sinus surgery for the diagnosis and possible treatment of lesions of the sphenoid and clivus.

Adult↗
PubMed1981

Hydrocephalus and infratentorial tumors. Incidence, clinical picture, and treatment.

One may consider that the child with hydrocephalus complicating a primary brain tumor has two distinctly different diseases: 1) a neoplasm, and 2) hydrocephalus. The hydrocephalus may be obstructive, communicating, or (in the case of choroid plexus papilloma) hypersecretory. This paper presents the incidence, symptomatology, and management of hydrocephalus associated with infratentorial brain tumors in 156 children and with pineal tumors in 21 children, all treated by the first author during the period 1967 to 1979. Medulloblastoma was the most commonly encountered tumor. Of 117 children with cerebellar-fourth ventricle tumors, 110 had hydrocephalus, whereas 11 of 34 with brain-stem tumors and all 21 with pineal tumors presented with hydrocephalus. Of the total 143 patients with hydrocephalus, shunts were inserted before craniotomy in 123, with the interval between shunt insertion and craniotomy for tumor removal ranging from 1 to 21 days. Eighteen of these children required shunt revisions after craniotomy; 36 of 80 patients followed for 6 months or more had their shunts permanently removed, but it was necessary to reinsert the shunt from 5 days to 13 months later in 30% of these patients. Only 25 patients remained permanently shunt-free. It is considered that the placement of shunts before craniotomy is justified by the extraordinarily high incidence of papilledema and visual impairment associated with hydrocephalus. "Upward herniation" and dissemination of neoplastic cells through the shunting system are theoretical contraindications to precraniotomy shunt insertion, although the former is rare (3%), and there is no statistical evidence to support the latter.

Adolescent↗
PubMed2002

[Keyhole microsurgery for acoustic neurinomas through suboccipital retrosigmoid sinus approach].

BACKGROUND AND OBJECTIVE: Acoustic neurinomas is one of the most common benign tumor in central nervous system, the main treatment is surgical resection. This study is to explore keyhole surgery with suboccipital retrosigmoid sinus approach for acoustic tumor resection and discuss how to improve the surgical skill and effect. METHODS: Thirteen cases of acoustic neurinomas from Sept. 2000 to Dec. 2001 in our department were operated using keyhole craniotomy technique through unilateral modified suboccipital retrosigmoid approach with "[symbol: see text]" incision. All patient underwent suboccipital craniotomy in order to maintain anatomical replacement, and the tumors (2.0-4.4 cm in diameter) were removed under microscope. RESULTS: Tumors were completed resected in 11 cases, subtotally removed in 2 cases. Eleven patients had obtained anatomic preservation of the facial nerves. Complete follow-up information was obtained in all patients for a period of 3-15 months after operation. House-Brackmann Score in 8 case were Grade I-II, 4 cases Grade III-IV, one case Grade V. Grades I and II facial nerve function were maintained in 61.5% of cases, measurable hearing was preserved in 53.8% of cases(7 cases), and 38.5% of cases maintained serviceable hearing. No severe permanent operative complications were found and no surgical mortality occurred. CONCLUSIONS: Microsurgery with keyhole craniotomy is a safe and effective method for treatment of patients with small and medium-size acoustic neuromas. The advantages of keyhole suboccipital craniotomy are anatomical replacement, less postoperative complications, and beneficial to patient's mental health.

Adult↗
PubMed1992

[Cerebral metastases. A study of a surgical series of 81 cases].

In this retrospective study, 81 patients operated by craniotomy for a brain metastasis are reviewed. Mean age is 56.3 years and most of the patients are male (71.6%). Clinically, 79% of the patients present a focal semiology, most frequently with neuropsychologic disturbances (43%); epilepsy is found in 31% of the cases. Symptoms related to intracranial hypertension (vomiting and headache) are present in 43% of the patients. On C.T.-scan, there is a solitary metastasis in 89% and the most common intracranial location is the frontal lobe (33.3%). The most frequent primary neoplasms are: bronchial adenocarcinoma in 19%, squamous carcinoma of the lung in 11%, melanoma in 12% and unknown origin in 18%. The surgical removal (as judged by the surgeon) is total in 70%, subtotal in 19% and partial in 11%. Standard operative mortality (30 days after craniotomy) is 7.4%. The postoperative course (till the patients leave our department) is excellent in 58% (complete neurologic recovery), steady in 20% (stability of symptoms and neurologic examination) and bad in 22%, with worsening of the neurological deficits. Most of the patients (84% of the patients who survive more than 30 days after the craniotomy) had postoperative whole brain radiotherapy with a hypofractionned schedule (total doses of 15 to 40 Gy with fractions of 200 to 650 cGy). Ten patients had surgery alone. Mean survival is 10.2 months with a follow-up of 12 months to 10 years. Ten patients survived over 18 months and one is still alive almost 4 years after his craniotomy. In this study, the survival is not modified by the primary lesion's histology.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1999

Endoscopic removal of cysticercal cysts within the fourth ventricle: technique and results.

There is no consensus as to the optimum management of patients who harbor cysticercal cysts within the fourth ventricle. Compared with the alternative treatment options of anthelmintic medication and/or cerebrospinal fluid shunting, the surgical removal of the cyst has the advantage of eliminating the inflammatory nidus and potentially obviating the need for a complication-prone shunt. Here, an endoscopic surgical approach is described and proposed as a superior alternative to the suboccipital craniotomy for removal of a fourth ventricle cyst. A retrospective analysis was conducted to compare five consecutive endoscopic cases with eight previous consecutive cases in which a suboccipital craniotomy was performed to remove fourth ventricle cysticercal cysts. Comparisons are made with regards to success in removing the cyst, length of operation, surgical blood loss, postoperative discomfort, and complications. A detailed description of the endoscopic technique is given. Endoscopic removal of all cysts within the fourth ventricle was successful in each case. The mean length of operative times was shorter and the blood loss was reduced with the endoscopic procedure compared with the suboccipital craniotomy (2.5 +/- 0.8 hours and 5.3 +/- 2.2 hours [p = 0.02], 19 +/- 4ml and 269 +/- 203 ml [p = 0.02], respectively). The endoscopic procedure was safe and associated with less postoperative discomfort in most patients. In properly selected patients, the endoscopic removal of cysticercal cysts located within the fourth ventricle is superior to the suboccipital craniotomy and should be considered as the primary treatment for this condition.

Journal Article↗
PubMed1991

[Acute subdural empyema due to peptostreptococcus].

A very rare case of acute subdural empyema due to peptostreptococcus was reported. A 11-year-old-girl was admitted to our hospital with high grade fever, unconsciousness and rt hemiparesis. CT scans showed the mass effect caused by the subdural empyema over the left frontotemporal region. Subdural empyema was evacuated by the craniotomy. Peptostreptococcus was found in the pus obtained during the operation. However, CT scans 10 days after the operation revealed another subdural empyema in the left frontal base and interhemispheric fissure, which was removed again by the craniotomy using coronal incision 14 days after the first operation. Frontal sinusitis was also demonstrated by CT scan. Killian's operation to the frontal sinusitis was performed by otorhinolaryngologists at the same time. Six weeks after the second operation, she was discharged without any neurological deficits. Peptostreptococcus is one of the indigenous microflora of the oral cavity, skin, gastrointestinal tract and genitourinary system and may be a causative microorganism in every type of human infection due to its abnormal localization. There is a controversy concerning surgical management subdural empyema. Both the burr hole drainage of pus and the craniotomy are advocated. Associated otorhinologic lesions must not be overlooked. Otorhinologic consultation should immediately be obtained so that the drainage of an infected paranasal or mastoid sinus can be performed at the time of craniotomy. This is critical to prevent the recurrence of the subdural empyema from further extension of the extracranial disease.

Acute Disease↗
PubMed1986

[Regional cerebral blood flow (rCBF) in patients with ruptured cerebral aneurysm: site of aneurysm and rCBF].

To investigate the relationship between the site of ruptured cerebral aneurysm and rCBF, 92 measurements of rCBF were conducted in 57 patients with ruptured cerebral aneurysm. Excluded from this study were patients with multiple aneurysms, intracerebral hematoma, and/or hydrocephalus. Twenty-four patients had the anterior communicating aneurysm (A-com), 20 patients had the internal carotid aneurysm (ICA), and 13 patients had the middle cerebral aneurysm (MCA). All patients underwent unilateral fronto-temporal craniotomy for clipping of the aneurysm and their rCBF measurements, using the xenon-133 inhalation method, were performed in the first three weeks after surgery. In each rCBF measurement, the hemispheric mean value of initial slope index (meanISI) was calculated in both cerebral hemispheres, that is, in the cerebral hemispheres ipsilateral and contralateral to craniotomy. The authors defined the "symmetry index of the meanISI (%): symmetry index" as the ratio of the meanISI in the cerebral hemisphere ipsilateral to craniotomy compared to the meanISI in the cerebral hemisphere contralateral to craniotomy. There was no significant relationship between the site of aneurysm and the meanISI in both hemispheres, and this result suggests that the site of aneurysm makes no difference in the incidence of vasospasm. In the postoperative first week, the "symmetry index" was 91.2 +/- 7.4% in MCA, 95.3 +/- 4.1% in ICA, and 97.9 +/- 8.2% in A-com; that is, MCA had significant asymmetry of meanCBF compared with A-com (p less than 0.05). In the second and third postoperative weeks, there was no significant relationship between the site of aneurysm and the asymmetry of meanCBF.(ABSTRACT TRUNCATED AT 250 WORDS)

Cerebrovascular Circulation↗
PubMed1985

Surgical treatment of brain metastases. Clinical and computerized tomography evaluation of the results of treatment.

The results of treatment of brain metastases in a series of 125 patients who underwent surgery with or without postoperative radiation from 1978 through 1982 were analyzed. The major sites of primary tumor included the lung (40%), melanoma-skin (11%), kidney (11%), colon (8%), soft tissue sarcoma (8%), breast (6%), and a variety of others (15%). At the time of craniotomy, disease was considered limited to the central nervous system in 63 patients (50%). After surgery, 83 patients (66%) were neurologically improved, and 26 (21%) had their deficits stabilized. The overall median survival was 12 months, and 25% lived 2 years. Eight patients (12%) are alive 5 years or more following surgery. Survival varied with site of primary tumor, location of brain metastasis, extent of systemic disease, and neurologic deficit at time of craniotomy. Over a follow-up period ranging from 18 months to 6 years, 42 patients (34%) developed either local recurrences or other sites of brain metastases. These data suggest that although craniotomy followed by radiation is highly effective in the initial treatment of selected patients with brain metastases, alternate therapies require investigation in view of the high central nervous system relapse rate in long-term survivors.

Adolescent↗
PubMed1983

Incidence and treatment of peripheral venous thrombosis in patients with glioma.

The incidence, prevention, and treatment of peripheral venous thrombosis were studied retrospectively in 381 patients with malignant glioma. Of 264 patients who did not receive antithrombotic prophylaxis, 97 (36.7%) developed clinical phlebitis confirmed by venography. Sixty-six cases occurred within 6 weeks of craniotomy. By contrast, only 12 (10%) of 117 patients who received intermittent pneumatic pressure to the calves during craniotomy developed phlebitis (4 patients with 6 weeks of the surgery). Of the 109 patients with venous thrombosis, 103 were treated with anticoagulants. Of the 6 patients treated conservatively, 3 died of pulmonary emboli. Intracranial hemorrhage occurred in 1.9% of the patients taking anticoagulants and in 2.2% of those who did not develop phlebitis. We conclude that patients with malignant gliomas have a high risk of developing peripheral venous thrombosis; that antithrombotic therapy reduces the incidence of thrombosis following craniotomy; and that, in patients who develop phlebitis, anticoagulation reduces the risk of pulmonary emboli without increasing the risk of intracranial hemorrhage.

Astrocytoma↗
PubMed2006

Cerebral metastases pathology after radiosurgery: a multicenter study.

BACKGROUND: To the authors' knowledge, comprehensive human pathologic investigations that explore fundamental radiosurgical effects on metastatic brain tumors are sparse in the literature. The objective of this study was to analyze histopathologic findings in a set of clinically recurrent cerebral metastases after patients underwent stereotactic radiosurgery (SRS). METHODS: In a series of 7500 patients who underwent radiosurgery, 2020 patients (27%) harbored cerebral metastases. Eighteen of 2020 patients (0.9%) underwent subsequent craniotomy for tumor removal anywhere from 1 month to 59 months after they received high-dose irradiation. Histologic and immunohistochemical investigations were performed on the surgically resected tissue specimens. These specimens were within the radiosurgical treatment volume of the metastatic tumor. RESULTS: Light microscopy revealed 3 basic categories of histologic responses: acute-type, subacute-type, and chronic-type tissue reactions. A moderate-to-intense inflammatory cell reaction was seen in the tissue responses of well controlled neoplasms (i.e., in patients who had neoplasms that required craniotomy for recurrent disease > 5 months after SRS), whereas the inflammatory reaction was missing or sparse in poorly controlled neoplasms (patients who required craniotomy for recurrent disease < 5 months after SRS). This reaction was seen within the irradiated tumor volume and not in the peritumoral area nor in areas remote from the radiosurgical treatment volume. Immunohistochemical characterization demonstrated the presence of prominent CD68-positive macrophage and CD3-positive T-lymphocyte populations. A progressively severe vasculopathy also was observed with increasing time after radiosurgery. CONCLUSIONS: Although causality has not been established, a brisk inflammatory response and more severe vasculopathy were observed in lesions in which recurrences were more delayed.

Adult↗
PubMed2002

Treatment of unruptured cerebral aneurysms--a multi-center study of Japanese national hospitals.

The treatment and natural course of unruptured cerebral aneurysms were analyzed in 427 cases of unruptured cerebral aneurysm registered at five Japanese national hospitals. Of these cerebral aneurysms 295 were treated by craniotomy, and 22 with endovascular coil embolization. Neurological deterioration after treatment occurred in 31 (9.8%) of the 295 craniotomies and 3 (13.6%) of the 22 endovascular treatments. There was no subarachnoid hemorrhage (SAH) reported after the craniotomies whereas one case of SAH was reported after endovascular treatment. For 145 aneurysms in 110 cases, the natural course of the aneurysms was observed without surgical treatment. During the follow up period of in total 2,610 months (217.5 years), seven of these aneurysms ruptured, resulting in a rupture rate of 3.2%/year. Three of these seven aneurysms were less than 10 mm in diameter. The likelihood of an unruptured cerebral aneurysm to rupture was not exceedingly low. Since the risk of rupture and the morbidity related to surgical treatment cannot be predicted by size alone, the morphology, location and condition of the patients should be considered when treating unruptured cerebral aneurysms.

Adult↗
PubMed1996

Component bone marker displacements revealed by image-corrected cephalometric analysis. A lateral cephalometric study of the cranium in normal and craniosynostosis--an implant study.

Displacement of bony component anatomy has not been comprehensively described in human cranial development. In this study, tantalum implants were used to define cranial bone position on serial cephalometric surveys. Image correction (ICCA method) was used to eliminate artifactual shift of component markers before serial analysis was used to define implant movement. In addition, applicable normative standards were used to assess all case presentations. Three normal subjects comprised a normal mixed longitudinal sample aged 2 to 84 months. Two plagiocephaly subjects were studied, one from 6 to 77 months and the other from 16 to 44 months of age. Three syndromic craniosynostosis subjects demonstrated both abnormal and normalized growth following craniotomy, from 14 to 45, from 0.5 to 5.5, and from 2 to 75 months of age. A pattern of backward rotation of cranial component anatomy was observed in three normal subjects and two plagiocephaly subjects. The posterior fossa (PF) showed the greatest growth activity, with displacement adjustments throughout the study, and the anterior cranial fossa (ACF) least growth activity, with imperceptible frontal bone movement after age 3 years. After traditional bifrontal craniotomy, an abnormal displacement growth pattern was observed from age 14 to 45 months in the patient with syndromic craniosynostosis (Pfeiffer syndrome). Extensive fronto-parietal "bossing" and grossly deficient movement in the PF were observed. However, after a bifrontal craniotomy that also crossed lambdoid sutures, a normalized pattern of displacement growth was observed in two Apert syndrome patients. These two patients with extensive syndromic craniosynostosis had cranial component pattern adjustments as in the normal and plagiocephalic subjects.

Cephalometry↗