Date of Award

January 2019

Document Type

Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

John Persing

Abstract

Objective: In this study we seek to clarify the neurological changes before and after whole vault cranioplasty (WVC) in patients born with sagittal craniosynostosis.

Methods: A case control study design was performed that included forty fMRI scans, from thirty-five individual patients. Functional MRI (fMRI) and diffusion tension imaging (DTI) data were analyzed with BioImageSuite (Yale University, USA). All nine functional brain networks were analyzed with appropriate regions of interest.

Results: Comparing functional MRI the infants after WVC vs. infants before WVC group, the after WVC group demonstrated an increased connectivity in the left frontoparietal (LFPN), secondary (V2) and third (V3) visual network (p<0.001). The right frontoparietal (RFPN) had decreased connectivity (p<0.001). There is also a decrease and increase in anisotropy in the cingulum and precuneus despite surgery, respectively (p<0.05). Adolescents treated with WVC compared to controls, demonstrated an increased connectivity in the SA and decreased connectivity in the RFPN relative to adolescent controls. ADHD has lower connectivity to BA11 (MNI: -12,26,-21), BA20 (MNI: 62,-24,-25), and BA21 (MNI: 62,-32,-23) compared to sNSC and controls (p<0.001). sNSC has a unique visuospatial defect, compared to ADHD, created by decreased connectivity to BA31 (MNI: -3,-68,37), BA7 (MNI: -4,-68,41), BA19 (MNI: 0,-83,31), visual association cortex (MNI: -4,-78,22), and primary visual cortex (MNI: 7,-74,21) (p<0.001).

Conclusions: Patients born with sagittal craniosynostosis have different connections in infancy in most of the cerebral networks compared to controls. There are specific connectivity changes that occur in the RFPN, LFPN, V2, and V3 networks, which are areas ultimately associated with executive function and emotional control, after surgery. Changes in white matter tract microstructure connections could be influential in changes in functional connectivity. As the child develops, much of the abnormal network connections, seen in infancy pre-operatively, correct after surgery (compared to age-matched controls). Some aberrancies, however in the SA and RFPN networks remain. Adolescent patients with sagittal nonsyndromic craniosynostosis have decreased connections in areas of visual processing and increased connections in areas of attention and auditory processing than patients with ADHD.

Comments

This thesis is restricted to Yale network users only. It will be made publicly available on 06/01/2022

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