Craniosynostosis in Infancy: 3D CT Diagnosis and Cranial Remodeling Surgical Technique.
DOI:
https://doi.org/10.36557/2674-8169.2025v7n12p1419-1433Keywords:
Craniosynostosis, computed tomography, cranial remodeling.Abstract
Introduction: Infant craniosynostosis requires timely diagnosis and precise anatomical characterization to guide surgical correction. 3D CT has been the confirmatory standard, though radiation risks drive optimization strategies. Objective: To review 3D CT diagnosis and cranial remodeling surgical techniques. Methodology: A search was conducted in PubMed/MEDLINE using MeSH terms and free text for craniosynostosis, CT/3D, dose reduction, and surgery; selection in two phases by independent reviewers, standardized extraction, and narrative synthesis. Results: Imaging studies support that 3D CT maintains diagnostic utility with significant dose reductions when advanced reconstructions are employed; sutural ultrasound is proposed as an initial alternative in selected infants. In surgery, minimally invasive techniques show less bleeding/transfusion and shorter stays compared to open approaches, with acceptable morphological outcomes in appropriate candidates; in complex cases, posterior vault expansion provides volumetric and functional benefits within staged strategies. Discussion: Evidence favors staged diagnostic pathways and standardized ultra-low protocols, and suggests that surgical choice depends on age, phenotype, resources, and follow-up. Methodological heterogeneity limits direct comparisons and underscores the need for uniform morphometric and functional outcomes. Conclusion: The combination of optimized 3D CT and individualized technical selection allows for balancing diagnostic precision, safety, and surgical outcomes.
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Barreto IL, Tuna IS, Rajderkar DA, Ching JA, Governale LS. Pediatric craniosynostosis computed tomography: an institutional experience in reducing radiation dose while maintaining diagnostic image quality. Pediatr Radiol. enero de 2022;52(1):85-96.
Lyoo Y, Choi YH, Lee SB, Lee S, Cho YJ, Shin SM, et al. Ultra-low-dose computed tomography with deep learning reconstruction for craniosynostosis at radiation doses comparable to skull radiographs: a pilot study. Pediatr Radiol. octubre de 2023;53(11):2260-8.
Ernst CW, Hulstaert TL, Belsack D, Buls N, Van Gompel G, Nieboer KH, et al. Dedicated sub 0.1 mSv 3DCT using MBIR in children with suspected craniosynostosis: quality assessment. Eur Radiol. marzo de 2016;26(3):892-9.
Ravindra VM, Awad AW, Baker CM, Lee A, Anderson RCE, Gociman B, et al. Preoperative imaging patterns and intracranial findings in single-suture craniosynostosis: a study from the Synostosis Research Group. J Neurosurg Pediatr. 1 de septiembre de 2021;28(3):344-50.
Whittall I, Lambert WA, Moote DJ, Bookland MJ, Martin JE, Hughes CD, et al. Postnatal diagnosis of single-suture craniosynostosis with cranial ultrasound: a systematic review. Childs Nerv Syst. diciembre de 2021;37(12):3705-14.
Lang SS, Meier PM, Paden WZ, Storm PB, Heuer GG, Bartlett SP, et al. Spring-mediated cranioplasty versus endoscopic strip craniectomy for sagittal craniosynostosis. J Neurosurg Pediatr. 1 de octubre de 2021;28(4):416-24.
Marji FP, Block LM, Anstadt EE, Dvoracek LA, Bruce MK, Williams AA, et al. Posterior Cranial Vault Distraction Osteogenesis Utilizing a Posterior-Superior Distraction Vector in the Treatment of Mercedes Benz Pattern Craniosynostosis. J Craniofac Surg. 1 de septiembre de 2021;32(6):2059-63.
Valetopoulou A, Constantinides M, Eccles S, Ong J, Hayward R, Dunaway D, et al. Endoscopic strip craniectomy with molding helmet therapy versus spring-assisted cranioplasty for nonsyndromic single-suture sagittal craniosynostosis: a systematic review. J Neurosurg Pediatr. 1 de octubre de 2022;30(4):455-62.
Breakey RWF, Mercan E, van de Lande LS, Sidpra J, Birgfeld C, Lee A, et al. Two-Center Review of Posterior Vault Expansion following a Staged or Expectant Treatment of Crouzon and Apert Craniosynostosis. Plast Reconstr Surg. 1 de marzo de 2023;151(3):615-26.
Elawadly A, Smith L, Borghi A, Nouby R, Silva AHD, Dunaway DJ, et al. 3-Dimensional Morphometric Outcomes After Endoscopic Strip Craniectomy for Unicoronal Synostosis. J Craniofac Surg. 1 de febrero de 2023;34(1):322-31.
Hall KM, Besachio DA, Moore MD, Mora AJ, Carter WR. Effectiveness of screening for craniosynostosis with ultrasound: a retrospective review. Pediatr Radiol. mayo de 2017;47(5):606-12.
Kaasalainen T, Palmu K, Lampinen A, Reijonen V, Leikola J, Kivisaari R, et al. Limiting CT radiation dose in children with craniosynostosis: phantom study using model-based iterative reconstruction. Pediatr Radiol [Internet]. 1 de septiembre de 2015;45(10):1544-53. Disponible en: https://doi.org/10.1007/s00247-015-3348-2
Kaasalainen T, Männistö V, Mäkelä T, Suojanen J, Nuorala A, Heliövaara A, et al. Postoperative computed tomography imaging of pediatric patients with craniosynostosis: radiation dose and image quality comparison between multi-slice computed tomography and O-arm cone-beam computed tomography. Pediatr Radiol [Internet]. 2023;53(8):1704-12. Disponible en: https://pmc.ncbi.nlm.nih.gov/articles/PMC10359214/
Montoya JC, Eckel LJ, DeLone DR, Kotsenas AL, Diehn FE, Yu L, et al. Low-Dose CT for Craniosynostosis: Preserving Diagnostic Benefit with Substantial Radiation Dose Reduction. AJNR Am J Neuroradiol. abril de 2017;38(4):672-7.
Neverauskiene A, Maciusovic M, Burkanas M, Griciene B, Petkevicius L, Zaleckas L, et al. Image based simulation of the low dose computed tomography images suggests 13 mAs 120 kV suitability for non-syndromic craniosynostosis diagnosis without iterative reconstruction algorithms. Eur J Radiol. agosto de 2018;105:168-74.
Raposo-Amaral CE, de Oliveira YM, Denadai R, Raposo-Amaral CA, Ghizoni E. Syndrome-related outcomes following posterior vault distraction osteogenesis. Childs Nerv Syst. junio de 2021;37(6):2001-9.
Yan H, Abel TJ, Alotaibi NM, Anderson M, Niazi TN, Weil AG, et al. A systematic review and meta-analysis of endoscopic versus open treatment of craniosynostosis. Part 1: the sagittal suture. J Neurosurg Pediatr. octubre de 2018;22(4):352-60.
Kim JW, Kim KH, Phi JH, Lee JY, Koh EJ, Kim BJ, et al. Neurocognitive outcomes and associated clinical factors 5 years after surgery in children with craniosynostosis. J Neurosurg Pediatr. 1 de junio de 2024;33(6):602-9.
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Copyright (c) 2025 Lenin Mauricio Ruiz Guamanquispe , Gary Fabián Sánchez Choez , Karen Lizbeth Palma Cobeña , Fredy Leonardo Vera Jumbo , Scarleth Nathaly Alarcón Idrovo
This work is licensed under a Creative Commons Attribution 4.0 International License.
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