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Metopic suture in fetuses with Apert syndrome at 22–27 weeks of gestation
Author(s) -
Faro C.,
Chaoui R.,
Wegrzyn P.,
Levaillant J. M.,
Benoit B.,
Nicolaides K. H.
Publication year - 2006
Publication title -
ultrasound in obstetrics and gynecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.202
H-Index - 141
eISSN - 1469-0705
pISSN - 0960-7692
DOI - 10.1002/uog.2648
Subject(s) - apert syndrome , frontal bossing , medicine , coronal suture , anatomy , coronal plane , fibrous joint , frontal bone , brachycephaly , skull , craniosynostosis , fetal head , fetus , pregnancy , biology , genetics
Objectives To examine the possible association of skull deformity and the development of the cranial sutures in fetuses with Apert syndrome. Methods Three‐dimensional (3D) ultrasound was used to examine the metopic and coronal sutures in seven fetuses with Apert syndrome at 22–27 weeks of gestation. The gap between the frontal bones in the transverse plane of the head at the level of the cavum septi pellucidi was measured and compared to findings in 120 anatomically normal fetuses undergoing routine ultrasound examination at 16–32 weeks. Results In the normal group, the gap between the frontal bones in the metopic suture at the level of the cavum septi pellucidi, decreased significantly with gestation from a mean of 2.2 mm (5th and 95th centiles: 1.5 mm and 2.9 mm) at 16 weeks to 0.9 mm (5th and 95th centiles: 0.3 mm and 1.6 mm) at 32 weeks. In the seven cases with Apert syndrome, two‐dimensional ultrasound examination demonstrated the characteristic features of frontal bossing, depressed nasal bridge and bilateral syndactyly. On 3D examination there was complete closure of the coronal suture and a wide gap in the metopic suture (15–23 mm). Conclusion In normal fetuses, cranial bones are believed to grow in response to the centrifugal pressure from the expanding brain and proximity of the dura to the suture is critical in maintaining its patency. In Apert syndrome, the frontal bossing may be a mere consequence of a genetically predetermined premature closure of the coronal suture. Alternatively, there is a genetically predetermined deformation of the brain, which in turn, through differential stretch of the dura in the temporal and frontal regions, causes premature closure of the coronal suture and impaired closure of the metopic suture. Copyright © 2005 ISUOG. Published by John Wiley & Sons, Ltd.