Investigation of the effect of cranial vault surgery on parenchymal perfusion before and after surgery in craniosynostosis patients

Objective: Craniosynostosis is the most common craniofacial developmental disorder after cleft palate, which occurs with premature closure of cranial sutures during the development of the skull. As a result of premature closure of cranial sutures, the deterioration of growth and development in the cranium changes the shape of the head then affect neurological functions. With the surgical treatment applied to the patients, it is aimed to continue the physiological growth and development of the brain tissue with the volumetric expansion created in the skull and the improvement in cerebral blood flow. In our study, it is aimed to examine the effect of surgery on brain perfusion with ASL sequence perfusion MRI taken before surgery and 12 weeks after surgery in cases of non-syndromic craniosynostosis treated in our clinic. Materials and Methods: The study was conducted between 28.12.2021-16.09.2022 with 10 patients who evaluated preoperatively and treated surgically at the Neurosurgery Clinic of Ankara City Hospital. After the recommendation of surgical treatment to the patients, preoperative anesthesia preparations and perfusion MRI scans were performed. After surgical treatment and discharge from hospital, perfusion MRI scans were performed 12 week after surgery. The preoperative and postoperative images obtained were evaluated comparatively at the workstation. Statistical analysis of the data was performed using IBM SPSS Statistics v23 software. The statistical significance value was accepted as p≤0.05. Results: After the exclusion of patients who did not appropriate the study criteria, the results of 9 patients were examined. Open surgical reconstruction performed for 5 patients and endoscopic surgery performed for 4 patients. MRI scans taken preoperatively and 87 days as avarege postoperatively. After surgery, there is perfusion enhacement in 7 patients and a perfusion impairment in 2 patients. About the average perfusion rates, the results were found to be statistically significant in four of the seven patients in whom an increase was detected (p≤0.05 ), while the results were found to be statistically significant in one of the patients in whom a decrease was observed. (p≤0.05) Conclusion: Surgical treatment is effective on brain perfusion in patients with non-syndromic craniosynostosis. Perfusion alteration may be different according to surgical technique, patient age at the time of surgery and type of craniosynostosis. In addition to cosmetic improvement, surgical treatment can also be effective in changing neurological functions. ASL sequence perfusion MRI, which does not require contrast and is non-invasive, is a successful method of demonstrating the quantitative effectiveness of surgery in patients with craniosynostosis. Keywords: Craniosynostosis, Non-syndromic, Preoperative, Postoperative, ASL, MRI, Perfusion, Cerebral Blood Flow