Cerebral blood flow of the frontal lobe in untreated children with trigonocephaly vs healthy controls: an arterial spin labeling study

Background: Craniofacial surgery is the standard of treatment for children with moderate to severe trigonocephaly. However, assessing the risk of suboptimal neurodevelopment and added value of surgery is difficult in individual cases. In this study we aim to address the hypothesis that brain development is restricted in trigonocephaly patients by investigating cerebral blood flow in the frontal lobe.
Methods: Between 2018 and 2020, we prospectively included trigonocephaly patients for whom a surgical correction was considered in an MRI study measuring cerebral perfusion with arterial spin labeling (ASL). The mean value of cerebral blood flow (CBF) in the frontal lobe was calculated for each subject and compared between the trigonocephaly patients and healthy controls.
Results: MRI scans of 36 trigonocephaly patients (median age 0.5y, IQR 0.3, 11 females) were included and compared with 16 controls without cerebral pathology (median age 0.83y, IQR 0.56, 10 females). The mean CBF values in the frontal lobe of the trigonocephaly patients (73.0 ml/100g/min) did not appear to be significantly different in comparison with controls (70.5 ml/100g/min, p = 0.6479). The superior, middle, and inferior part of the frontal lobe showed no significant differences either.
Conclusions: Before surgery, the frontal lobe of trigonocephaly patients aged under 18 months old has a normal CBF. In addition to the previously reported very low prevalence of papilledema or impaired skull growth, this finding further supports our hypothesis that craniofacial surgery for trigonocephaly is rarely indicated for signs of raised intracranial pressure.