THE TURRICEPHALY INDEX: a validated method for recording turricephaly and its natural history in Apert syndrome.

Publication date: Available online 25 December 2018

Source: Journal of Cranio-Maxillofacial Surgery

Author(s): Justine O'Hara, Ben Way, Alessandro Borghi, Paul G. Koops, Deborah Chua, Richard D. Hayward

Abstract

Introduction

We present the CT scan-derived turricephaly index (TI) as a quotient of the maximal occipito-frontal length of the skull to the distance from the centre of the sella to the highest point on the vertex as a validated tool for assessing turricephaly and evaluating surgical techniques aimed at reducing it.

Materials and Methods

Measurements taken from CTs of non-operated children with Apert syndrome and age-matched controls were analysed using Centricity PACS system (from the lateral scout image) and the thick-sliced Osirix tool. CTs from non-operated children with Apert syndrome were used to investigate the natural history of their turricephaly both as a group and individually.

Results

There was statistically significant agreement between measurements taken from the CT scout and Osirix for 42 control children (R² =0.97) and 42 children with Apert syndrome (R² = 0.98) and between two separate observers. There was a statistically significant difference (p<0.001) between CT scout-derived TI value between controls (1.73±0.12, range 1.46 – 1.99) and Apert children (1.42±0.15, range 1.13 – 1.73). Analysis of 113 CTs of 65 non-operated children with Apert syndrome showed a decrease in turricephaly with age (positive spearman correlation: r = 0.50, p<0.001). Analysis of 37 CTs of those with multiple (>2) CT's showed a similar decrease in turricephaly in the individual child (p<0.001).

Conclusions

TI derived from the CT scout view provides a simple, objective and validated method for assessing turricephaly. We recommend it for monitoring and for the prospective evaluation of reconstructive techniques in children with complex/syndromic craniosynostosis.

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