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Morphometric Analysis Of Cortical Gray Matter In Infants With Isolated Metopic Craniosynostosis
MyChi H. Le, M.D., Kristina J. Aldridge, PhD, Shawn E. Christ, PhD, Yuyan Luo, PhD, Diana L. Aviles, M.D., Kimberly K. Cole, BA, Arshad R. Muzaffar, M.D..
University of Missouri - Columbia, Columbia, MO, USA.

PURPOSE: Craniosynostosis (CSO) has been hypothesized to constrain the growth of the underlying brain. This constriction is thought to result in the region of the brain adjacent to the prematurely fused suture being predominantly affected. Previous work has shown altered morphology of the brain in infants with single suture CSO. Following this hypothesis, isolated metopic synostosis (IMS) should be associated with reduction of the underlying frontal lobe. Constriction of the growing brain may then result in cognitive deficits. In this study, we test two hypotheses: 1) overall brain size is reduced in IMS, and 2) frontal lobe size is reduced in IMS.
METHODS: Our study sample consists of magnetic resonance images (MRIs) acquired at the University of Missouri from infants between 30 and 64 weeks old, including infants with isolated metopic synostosis (IMS, N=10) and age-matched unaffected infants (UN, N=10). Three-dimensional reconstructions of the surface of the brain were produced from the MRIs using Amira 5.4© software. Volumes of the whole brain (WBV) and total cerebral cortical gray matter (CXV) were measured from these reconstructions. Frontal lobe gray matter (FCV) was then manually segmented from the CXV volume. FCV was defined as the cortical gray matter anterior to the central sulcus, superior to the cingulate sulcus on the medial surface, and superior to the Sylvian fissure on the lateral surface. These volumes were then statistically compared between IMS and UN using Mann-Whitney U tests.
RESULTS: WBV and CXV are slightly reduced in IMS relative to UN (<5%), though these differences are not statistically significantly different. FCV is slightly increased in IMS (approximately 8%). However, when FCV is considered as a percentage of CXV, it does not differ from that of the UN group (34.7% and 35.2% of CXV, respectively).
CONCLUSION: Our results suggest that overall brain size and total cortical gray matter may be slightly reduced in infants with IMS. However, the proportion of gray matter that comprises the frontal lobe appears similar in infants with IMS and UN. These results are consistent with the hypothesis that premature fusion of the metopic suture affects the overall shape of the brain, but it does not affect the relative size of the frontal lobe gray matter. These findings challenge the conventional wisdom that CSO results in restriction of growth of the underlying brain in the region of the fused suture. Further investigation into the functional implications of this finding is warranted.


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