77 - Developmental Anatomy of the Pediatric Skull Based on Three-Dimensional Computed Tomography

Poster Board Number: 77
There are separate poster presentation times for odd and even posters.
Odd poster #s – first hour
Even poster #s – second hour

Abstract Body : Introduction: Pediatric heads change rapidly in size and shape during growth, especially for children up to eight years old. This project was developed because of the gap in research about children's skull development and the need to define the craniometric measurements for the pediatric age group. This is to offer innovative material for neuroanatomy studies and better guidance for practicing pediatric care. This project aims to build the average skull model for children from zero to eight years old as the skull develops, standardizing the topography of cranial landmarks, skull shape and size, and cranial indices for each age group based on 3D Computed Tomography (CT) reformations.
Methods: Retrospective study of CT scan images performed from 2007 to 2017 on children aged one day to eight years old. After sorting the images into 17 age groups, geometric features, including skull size and shape, bone dimensions and suture closure, and their variation among the sample population, were quantified through a series of visual and statistical analyses.
Results: A total of 425 3D CT scans were analyzed. The statistical geometry models developed in this study provide a neuroanatomic basis for the pediatric skull for each age group. This study successfully presents a 3D visualization of the developmental cranial anatomy variations among children from zero to eight years old, depicting the closure of the sutures and fontanelles, changes in cranial size, and topography of cranial landmarks. The seventeen models are an innovative resource for teaching and learning pediatric neuroanatomy and better guidance for training and practicing pediatric neurosurgical care.
Conclusion: This study fills the gap in the literature by delivering seventeen 3D models of children's skulls as it develops. The visualization in a 3D perspective of the developmental characteristics of the skull facilitates understanding the particular characteristics of each age group's anatomy, which has been relatively unknown to this date. In addition, the descriptive analysis of the surgical landmarks confirms that the cranial referential points significantly change position over time as the child develops during the first year. However, whether or not the correlation of those points with the brain’s structures remains the same is still unknown.
Significance of the Study: The results of this project shed light on the importance of studying children's neuroanatomy more deeply by describing substantial skull variation as the child grows. The skull models resulting from the analysis of 3D CT scan reconstructions in this study are broadly applicable. They can be readily extended to a wide range of applications, such as teaching tools for the morphological development of children's skulls and as a reference for future studies on neurosurgical cranial approaches in children.
Future Direction: Identifying cranial landmarks allows comparison with intracranial corresponding brain structures, representing a worthwhile first step in providing objective parameters for pediatric neurosurgical procedures. This group will continue to build the neuroanatomy atlas by studying the development of the brain structure in the same age groups using Magnetic Resonance reconstructions, analyzing the topographic correlation between brain structures and the cranial points demonstrated in the present study. The 3D models will be implemented in the first pediatric neuroanatomy virtual atlas to teach pediatric neuroanatomy.