Niina Salokorpi

Experience with craniosynostosis treatment using posterior cranial vault distraction osteogenesis

Background: Craniosynostosis compromises the cranial vault volume, severely impede growth, and may lead to increased intracranial pressure (ICP). Posterior cranial vault (PCV) distraction osteogenesis (DO) offers an excellent treatment opportunity for this condition. This article intends to describe the outcomes of PCV DO. Materials and Methods: Nine males and seven female children indicated for PCV DO were included in the study. The single vector distraction devices with quick-disconnect distraction rods, a type of miniaturized hardware, was used in all cases. Result: Seven of the 16 patients had a history of one or more prior cranioplasty. All reoperations in this series were performed for the indication of raised ICP including five of the scaphocephaly patients and the syndromic patients. Clinical signs of raised ICP were present in all patients with either measured raised intracranial pressure or those with clinical signs of raised ICP preoperatively. There was substantial decrease in the ICP postoperatively. Discussion: The outcomes of this study were encouraging. Placing the distractor stems as flat as possible against the outer layer of the cranial bone seems to be a very important maneuver. This keeps the distractor stem less proud and less likely to sustain future trauma. Removal of the distractor stems keeps the devices further away from the risk of later traumatic dislodgement. Moreover, miniaturized distractors allow precise control of the rate and the amount of distraction.

Similar chemokine receptor profiles in lymphomas with central nervous system involvement – possible biomarkers for patient selection for central nervous system prophylaxis, a retrospective study

Central nervous system (CNS) relapse occurs in around 5% of diffuse large B‐cell lymphoma (DLBCL) cases. No biomarkers to identify high‐risk patients have been discovered. We evaluated the expression of lymphocyte‐guiding chemokine receptors in systemic and CNS lymphomas. Immunohistochemical staining for CXCR4, CXCR5, CCR7, CXCL12, and CXCL13 was performed on 89 tissue samples, including cases of primary central nervous system lymphoma (PCNSL), secondary CNS lymphoma (sCNSL), and systemic DLBCL. Also, 10 reactive lymph node samples were included. Immunoelectron microscopy was performed on two PCNSLs, one sCNSL, one systemic DLBCL, and one reactive lymph node samples, and staining was performed for CXCR4, CXCR5, CXCL12, and CXCL13. Chi‐square test was used to determine correlations between clinical parameters, diagnostic groups, and chemokine receptor expression. Strong nuclear CXCR4 positivity correlated with systemic DLBCL, whereas strong cytoplasmic CXCR5 positivity correlated with CNS involvement (P = 0.003 and P = 0.039). Immunoelectron microscopy revealed a nuclear CXCR4 staining in reactive lymph node, compared with cytoplasmic and membranous localization seen in CNS lymphomas. We found that CNS lymphoma presented a chemokine receptor profile different from systemic disease. Our findings give new information on the CNS tropism of DLBCL and, if confirmed, may contribute to more effective targeting of CNS prophylaxis among patients with DLBCL.

Integrin alpha 10, CD44, PTEN, cadherin-11 and lactoferrin expressions are potential biomarkers for selecting patients in need of central nervous system prophylaxis in diffuse large B-cell lymphoma

Summary In this work, we have studied the biology behind DLBCL central nervous system (CNS) tropism and potential biomarkers for CNS relapse prediction. We show that ITGA10, PTEN, CD44, cadherin-11 and lactoferrin levels are altered in CNS lymphomas.

Navigation-assisted Le Fort I osteotomy with midpalatal split to treat compressive pathologies of the craniovertebral junction.

This report describes the management of the case of an 11-year-old girl with serious compressive pathology of the craniocervical junction using a navigation-guided Le Fort I level maxillotomy and midline split. In this pediatric case, image guidance significantly enhanced intraoperative orientation and helped to determine the correct location of the horizontal osteotomy lines at the Le Fort I level.

Increases in Cranial Volume with Posterior Cranial Vault Distraction in 31 Consecutive Cases

BACKGROUND: Posterior cranial vault distraction (PCVD) is a technique widely used in surgical treatment of craniosynostosis when cranial expansion is required. It has proven to be safe and to allow a significant increase of intracranial volume. OBJECTIVE: To evaluate increases in intracranial volume as a result of PCVD performed in Oulu Craniofacial center using 2 different methods based on 3‐dimensional (3‐D) photogrammetric imaging or plain skull radiographs. METHODS: All children less than 16 yr of age who were treated by PCVD (n = 31) from 2009 to 2015 at the Oulu Craniofacial Center were included. All patients were followed at outpatient clinics with plain radiographs performed for follow‐up. In 5 patients, additional 3‐D photogrammetric imaging was done pre‐ and postoperatively. RESULTS: The mean intracranial volume increase was 25.0%, ranging from 16.9% to 39.4%. In 5 patients, the increase in volume was calculated from the photogrammetric 3‐D images comprising a mean of 17.4%. Volume calculations from cephalograms in the same patients gave a mean of 20.8%. Whether the distraction was a primary operation or patient had undergone previous cranioplasty did not influence the achieved volumetric results. There were no statistically significant differences in the distraction results between different diagnostic groups. CONCLUSION: PCVD is an effective surgical method to increase intracranial volume in a variety of clinical entities. Volumetric results of this procedure could be easily evaluated using 3‐D photogrammetric imaging or plane radiographs that expose the patients to only low ionizing radiation doses.

Myoclonic movements of the elbow and wrist as a rare complication of supracondylar humerus fracture in a child.

Supracondylar humerus fractures are associated with neurological complications. This report describes a child who suffered from persistent myoclonus-like movements of the elbow and wrist as a consequence of a previous displaced fracture. Symptoms were progressive. Seven years later, sensation was decreased in the ulnar nerve distribution. Palpation of the ulnar nerve exacerbated the myoclonic jerks. As symptoms progressed, electoneuromyography became abnormal. Cubital tunnel release and anterior transposition of the ulnar nerve were required to reach full recovery. Long-term outcome was excellent. In conclusion, myoclonus-like movements are a rare complication of supracondylar humerus fractures, resulting from ulnar nerve injury.

A new technique to facilitate optimal directions for cranial distractor implantation.

IntroductionWe describe a new technique in distraction cranioplasty procedure to facilitate the placement of cranial distractors in a correct position.ConclusionAvoiding conflict of the vectors when placing several distractors allows later attainment of the planned amount of distraction.

Quantitative and qualitative analysis of bone flap resorption in patients undergoing cranioplasty after decompressive craniectomy

OBJECTIVEAutologous bone cranioplasty after decompressive craniectomy entails a notable burden of difficult postoperative complications, such as infection and bone flap resorption (BFR), leading to mechanical failure. The prevalence and significance of asymptomatic BFR is currently unclear. The aim of this study was to radiologically monitor the long-term bone flap survival and bone quality change in patients undergoing autologous cranioplasty.METHODSThe authors identified all 45 patients who underwent autologous cranioplasty at Oulu University Hospital, Finland, between January 2004 and December 2014. Using perioperative and follow-up CT scans, the volumes and radiodensities of the intact bone flap prior to surgery and at follow-up were calculated. Relative changes in bone flap volume and radiodensity were then determined to assess cranioplasty survival. Sufficient CT scans were obtainable from 41 (91.1%) of the 45 patients.RESULTSThe 41 patients were followed up for a median duration of 3.79 years (25th and 75th percentiles = 1.55 and 6.66). Thirty-seven (90.2%) of the 41 patients had some degree of BFR and 13 (31.7%) had a remaining bone flap volume of less than 80%. Patients younger than 30 years of age had a mean decrease of 15.8% in bone flap volume compared with the rest of the cohort. Bone flap volume was not found to decrease linearly with the passing of time, however. The effects of lifestyle factors and comorbidities on BFR were nonsignificant.CONCLUSIONSIn this study BFR was a very common phenomenon, occurring at least to some degree in 90% of the patients. Decreases in bone volume were especially prominent in patients younger than 30 years of age. Because the progression of resorption during follow-up was nonlinear, routine follow-up CT scans appear unnecessary in monitoring the progression of BFR; instead, clinical follow-up with mechanical stability assessment is advised. Partial resorption is most likely a normal physiological phenomenon during the bone revitalization process.

Severe trampoline injuries: incidence and risk factors in children and adolescents

Introduction Severe trampoline injuries in children and adolescents are rare; however, minor injuries are common and their incidence is increasing. Severe injuries are most commonly head and neck injuries. They may result in long‐term morbidity. This study aimed to illustrate these severe injuries and to find out their incidence and risk factors. Materials and Methods This is a population‐based, prospective study in the Oulu region of Finland completed over 2 years (May 1, 2015 to April 31, 2017). All children (<16 years of age) with severe trampoline injuries were included. Cervical spine fractures, chest wall and skull fractures, lesions of internal organs, hip and knee dislocations, and permanent disorders of the peripheral veins or nerves were in prior defined as severe. Multiple jumpers, stunts, younger age, previous injuries, insufficient use of safety equipment, and lack of supervision were hypothesized as risk factors. Results There were 11 injured patients (10 boys). The annual incidence was 6.28/100,000 children <16 years of age. Mean age was 11.5 years. Severe injuries included five ligamentous cervical spine injuries and two sternal bone fractures. In addition, there were one lumbar spine ligament injury, two hip dislocations, and one severe axillary plexus nerve lesion. Eight out of 11 accidents were not seen by any adult and none of them happened under professional supervision. Most injuries (N = 8) happened by failed backflips. Conclusion Most severe injuries happened in unsuccessful flips. Children should have an adult supervisor and flips should not be attempted.