Observable Differences in Symmetry and Volume of Jugular Foramen in Children with Craniosynostosis

Craniosynostosis is the premature fusion of one or more calvarial sutures. Craniosynostosis can present as part of a genetic syndrome, as in Apert or Crouzon Syndrome, or it may be an isolated finding in non‐syndromic patients. The premature closure of these sutures can lead to morphologic and physiologic anomalies. Synostotic patients present with craniofacial malformations, increased intracranial pressure and intracranial hypertension. These patients often present with anomalous vascular and osseous anatomy, specifically, large emissary veins and stenotic cranial foramina. CT scans were used to generate three‐dimensional models of the patients. The jugular foramen was manually modeled, using the intracranial foramen and the level of the odontoid process as anatomical landmarks. Each measurement was repeated three times to ensure consistency. This case series serves as a basis for continued research into the anomalous anatomy of synostotic patients. When compared to their normal counterparts, synostotic patients present with markedly asymmetric jugular foramina. A high degree of variability was observed between patients, and bilaterally within each patient. Large differences in shape and volume are noted between the right and left foramen. At this point, due to the small size of the study, inferences about the patient population at large cannot be made. However, some general similarities were observed. Our preliminary data show that in all subjects, the right jugular foramen was longer and wider than the left. It was noted that the right foramen has a more curved trajectory, moving in the posterior to anterior direction, while the left is relatively straight. This may be related to the left jugular foramen's apparent propensity to merge with the carotid canal. The observed anomalies likely contribute to the physiologic sequelae of craniosynostosis. We hypothesize that the right jugular foramen is consistently larger due to the backwards pulse pressure coming from the right atrium of the developing fetus. We propose that the timing of the pathophysiologic insult determines the character of the osseous anomaly. Measuring the surface area two‐dimensionally leads to an incomplete and potentially inaccurate representation of the jugular foramen in synostotic patients due to the irregularity of caliber throughout the jugular foramen's course. It is proposed that this osseous irregularity is in part due to diminished post‐natal remodeling. We propose that the most appropriate and rigorous method for examining the jugular foramen in synostotic patients is by obtaining the volume of the jugular foramen by three‐dimensional modeling. This abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal .