Convolutional neural network-based classification of craniosynostosis and suture lines from multi-view cranial X-rays.

Early and precise diagnosis of craniosynostosis (CSO), which involves premature fusion of cranial sutures in infants, is crucial for effective treatment. Although computed topography offers detailed imaging, its high radiation poses risks, especially to children. Therefore, we propose a deep-learning model for CSO and suture-line classification using 2D cranial X-rays that minimises radiation-exposure risks and offers reliable diagnoses.

New Simple 3-Dimensional Computed Tomogram Classification Leading to Successful Conservative Treatment in 51 Atlanto-Axial Rotatory Fixation Children.

Objective: to present a new and easy classification of atlanto-axial rotatory fixation (AARF) and to investigate the efficiency of conservative treatment of AARF.

Background: Although there is a precise definition and diagnostic classification of AARF, there is still significant difficulty in measuring the atlas and axis angles because all of the atlas or axis cannot be seen in a certain 2-dimensional computed tomogram image. In addition, some recent case reports showed that long-term conservative treatment can reduce pediatric AARFs, even that are severe or chronic.

Abusive Head Traumas in 4 Infants.

Pediatric abusive head trauma (AHT) is a serious, repeated child abuse that causes grave brain damage. In Korea, AHT cases have been reported rarely, especially infants. We present 4 cases of AHT in infants diagnosed in our institution during last 2 years.

Relationships between Head Circumference Percentile, Lumbar Puncture Pressure, and Cerebrospinal Fluid Space in Young Children: Increased Cerebrospinal Space and Pressure May Result in Compensatory Enlargement of Head Circumference Only in the Infant Period.

Background: The aim of this study was to retrospectively evaluate and analyze the relationships between head circumference percentile (HCP), lumbar puncture pressure (LPP), and cerebrospinal fluid (CSF) space.

Methods: The 88 patients were divided into 3 age groups (group 1, up to 12 months; group 2, 12-36 months; group 3, 36-72 months).

Results: In group 1 (n = 40), there was a significant positive correlation of the HCP with the LPP (r =0.

Trimming of Absorbable Plates and Screws through Smoothing by Multiple Sonic Activation Procedures Can Increase Local Tissue Reactions in Children with Cranial Fixations.

Objective: The aim of this paper was to investigate the local reactions due to the melting of absorbable plates and screws after trimming through smoothing by multiple sonic activation procedures (MSAP).

Background: Drilling or smoothing by MSAP is performed for the trimming of the absorbable plates and screws for cranial fixation in children. Compared to drilling, smoothing by MSAP is suspected to more commonly cause local tissue reactions; thus, the issue was examined herein.

Correlation of Neonatal Birth-Associated Greenstick Skull Fractures with Perinatal Factors and Long-Term Outcome: Children with a Greater Number of Greenstick Skull Fractures Showed Poor Results in Terms of Long-Term Neurodevelopment.

Objective: Skull fractures caused by birth injury are mainly compression and linear fractures, but the incidence is known to be rare. It has been recently suggested, however, that greenstick fractures (GSFs) are more common than compression or linear fractures that are detected through 3-dimensional reconstructed computed tomography. Therefore, this study was conducted to determine the correlation of GSF with perinatal factors, the accompanying head injury factors, and the long-term outcomes in neonates.

Continuous Intracranial Pressure Monitoring in 24 Microcephalic Children with Developmental Delay: A Significant Portion of Microcephalic Children with Developmental Delay Have High Intracranial Pressure.

Objective: The new direct gradual cranial expansion surgical technique has been used to treat children with postshunt microcephaly and slit ventricle syndrome. To evaluate the feasibility of this new surgical treatment, we studied intracranial pressure (ICP) in microcephalic children with developmental delay.

Methods: Mean ICP, age, sex, head size, and developmental assessments were compared in 24 microcephalic children with developmental delay who had had continuous ICP monitoring.

Neurodevelopmental Prognostic Factors in 73 Neonates with the Birth Head Injury.

Objective: The objective of this study was to reinterpret the neurodevelopmental prognostic factors that are associated with birth head injury by performing a long-term follow-up.

Methods: Seventy-three neonates with head injuries were retrospectively analyzed after a duration of 10.0±7.

Image quality assessment of silent T PROPELLER sequence for brain imaging in infants.

Objective: Infants are vulnerable to high acoustic noise. Acoustic noise generated by MR scanning can be reduced by a silent sequence. The purpose of this study is to compare the image quality of the conventional and silent T2 PROPELLER sequences for brain imaging in infants.

Reappraisal of Pediatric Diastatic Skull Fractures in the 3-Dimensional CT Era: Clinical Characteristics and Comparison of Diagnostic Accuracy of Simple Skull X-Ray, 2-Dimensional CT, and 3-Dimensional CT.

Background: Diastatic skull fractures (DSFs) in children are difficult to detect in skull radiographs before they develop into growing skull fractures; therefore, little information is available on this topic. However, recent advances in 3-dimensional (3D) computed tomography (CT) imaging technology have enabled more accurate diagnoses of almost all forms of skull fracture. The present study was undertaken to document the clinical characteristics of DSFs in children and to determine whether 3D CT enhances diagnostic accuracy.

The Total Calvarial Transsutural Distraction Osteogenesis for 26 Children with Slit Ventricle, Craniosynostosis, or Microcephaly After Shunt Operation.

Objective: Among shunt complications, the postshunt slit ventricle (PSSV) and the postshunt craniosynostosis (PSCS) may be managed by shunt valve upgrade and/or cranial expansion surgery. Here, we analyzed 26 children with PSSV, PSCS, or microcephaly who received simple generalized cranial expansion (ie, total calvarial transsutural distraction osteogenesis [TC-TSuDO]).

Methods: Among 254 children with shunt surgery, 26 children received TC-TSuDO.

Lumbar Puncture Pressures During Childhood in 262 Children with Craniosynostosis.

Objective: The aim of this study was to analyze age-dependent lumbar puncture pressures (LPPs) measured in 262 children with craniosynostosis to provide information that assists in determining surgery.

Methods: From 1 July 2005 to 30 June 2014, 262 children with craniosynostosis diagnosed at the Department of Neurosurgery, Ajou University Hospital, underwent LPP measurement. These children were compared with respect to age, gender, birth weight, head circumference at the time of birth, gestational age, LPP, and developmental assessments.

Long-term results of remodelling the facial bones with a soft moulding helmet in beagles: the "reciprocally stimulated growth" hypothesis.

Facial deformity is often seen in infants with deformational plagiocephaly and it usually improves with conservative management. However, we know of few studies of the effect of helmet treatment on the facial skeleton. Our aim therefore was to find out its long-term effects on skull remodelling, and on the shape of the face.

Transsutural distraction osteogenesis for 285 children with craniosynostosis: a single-institution experience.

OBJECT Although distraction osteogenesis (DO) requires a secondary procedure in the surgical correction of craniosynostosis, it is relatively simple, requires less transfusion, results in a shorter intensive care unit stay, and is quite safe. Because of these positive factors, various DO techniques have been developed. However, there is disagreement regarding the superiority of DO.

The Total Calvarial Remodeling with Transsutural Distraction Osteogenesis of 21 Cases of Craniosynostosis: New, Efficient, Safe and Natural Method in Craniosynostosis Surgery.

Introduction: The majority of the present distraction osteogenesis techniques involve local site expansion that only produces localized decompression and affords limited decompression and cosmetic results. We designed a new surgical procedure, total calvarial transsutural distraction osteogenesis (TSuDO).

Methods: We performed total calvarial TSuDO surgical procedures in 21 children.

Abducens Nerve Palsy Following Expansion Cranioplasty with Distraction Osteogenesis.

Childhood abducens nerve palsy can occur as a result of trauma, tumour, vasculopathic disease, elevated intracranial pressure, infection, inflammation, and congenital or idiopathic causes. The authors present two cases of unilateral abduction deficit secondary to a recent trans-sutural distraction osteogenesis (TSuDO) operation for craniosynostosis. After distractor removal, the problem resolved spontaneously over 2-4 months in both cases.

Hypothesis for intracranial hypertension in slit ventricle syndrome: new concept of capillary absorption laziness in the hydrocephalic patients with long-term shunts.

Many theories have been postulated to date regarding mechanisms involved in intracranial hypertension in patients with long-term, shunt-induced slit ventricle syndrome (SVS), but it still seems difficult to define this entity more clearly. Many hypotheses have attempted to explain the causes of SVS as chronic or intermittent catheter obstruction, brain compliance change, and ventricular herniation and distortion, but this theory does not explain clearly the reason why extraventricular pressure (EVP) is increased and intraventricular pressure (IVP) is low or frequently negative. The authors attempt to postulate a hypothesis by addressing new concept of capillary absorption laziness which results in dissociation of EVP with IVP.

Clinical comparison of the predictive value of the simple skull x-ray and 3 dimensional computed tomography for skull fractures of children.

Objective: In the pediatric population the skull has not yet undergone ossification and it is assumed that the diagnostic rate of skull fractures by simple X-rays are lower than that of adults. It has been recently proposed that the diagnostic rates of skull fractures by 3-dimensional computer tomography (3D-CT) are higher than simple X-rays. The authors therefore attempted to compare the diagnostic rates of pediatric skull fractures by simple X-rays and 3D-CTs with respect to the type of fracture.

Effect of ultrasound treatment on brain edema in a traumatic brain injury model with the weight drop method.

Background: For the treatment of traumatic brain edema, an efficient modality has not yet emerged. There have been many studies to date which have reported the employment of low-frequency ultrasound for blood-brain barrier disruption (BBBD). However, the authors have observed that low-intensity ultrasound increases water permeability without cellular damage in cartilage cells.

Molecular genetic analysis of TWIST1 and FGFR3 genes in Korean patients with coronal synostosis: identification of three novel TWIST1 mutations.

Background: Craniosynostosis is very heterogeneous in terms of its causes, presentation, and management. In particular, coronal synostosis evidences a higher tendency to be genetically caused, and TWIST1 and FGFR3 have been identified as major causative genes. The authors analyzed the clinical and molecular characteristics of Korean patients with coronal synostosis in this study.

Quantitative analysis of developmental process of cranial suture in korean infants.

Objective: The purpose of this study was to elucidate the anatomical development of physiologic suture closure processes in infants using three dimensional reconstructed computed tomography (CT).

Methods: A consecutive series of 243 infants under 12 months of age who underwent three dimensional CT were included in this study. Four major cranial sutures (sagittal, coronal, lambdoidal and metopic suture) were classified into four suture closure grades (grade 0=no closure along the whole length, grade 1=partial or intermittent closure, grade 2=complete closure with visible suture line, grade 3=complete fusion (ossification) without visible suture line), and measured for its closure degree (suture closure rates; defined as percentage of the length of closed suture line divided by the total length of suture line).

The trans-sutural distraction osteogenesis for 22 cases of craniosynostosis: a new, easy, safe, and efficient method in craniosynostosis surgery.

Background: Distraction osteogenesis for the treatment of craniosynostosis is becoming more widely used as it is simple, there are less transfusions, and a decreased incidence of complications, although a secondary procedure for the removal of the distractors is necessary. However, to date all previous procedures have still been complicated. The authors present a novel trans-sutural distraction osteogenesis method (TSuDO) for the treatment of all types of craniosynostosis.

New understanding of the role of cerebrospinal fluid: offsetting of arterial and brain pulsation and self-dissipation of cerebrospinal fluid pulsatile flow energy.

Many theories have been postulated to date regarding the mechanisms involved in the absorption of the intracranial arterial blood flow energy in the intracranial space, but it is as yet nor clearly defined. The blood flow energy that is transmitted from the heart formulates the cerebrospinal fluid (CSF) pulsatile flow, and is known to constitute the major energy of the CSF flow, while the bulk flow carries only small energy. The intracranial space that is enclosed in a solid cranium and is an isolate system as in the Monroe-Kellie doctrine, and the authors propose to re-analyze the Monroe-Kellie doctrine concept in terms of energy transfer and dissipation of the Windkessel effect.