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Dear Editor:
We read with great interest the recent paper by Schweitzer et al. recently published in Child’s Nervous System [1]. The authors review their experience with routine skull X-rays in the evaluation of craniosynostosis (CS). They describe 127 cases, of which most were single-suture CS (such as sagittal, metopic, and coronal), and describe the typical X-ray findings. The authors stress the advantage of X-rays over CT scans in regard to radiation exposure.
Despite the recommendations by the authors, we think that clinical diagnosis is the main diagnostic tool needed to make a definite diagnosis of single-suture CS. In our opinion, there is no place for any imaging (including X-rays) for such cases.
The role of X-rays for demonstrating “blood vessels” within the bone has limited clinical impact and adds to unnecessary radiation exposure of babies.
In our view, imaging should be spared for non-typical cases, such as those with anterior plagiocephaly that do not fit “classical” coronal synostosis. We recently published our experience with frontosphenoid synostosis and highlighted the importance of 3D-CT for this pathology [2].
For all typical CS, including diagnosis of benign positional plagiocephaly (BPP), we think that any imaging poses unnecessary cost burden on the medical system and exposes babies to unnecessary radiation.
References
Schweitzer T, Kunz F, Meyer-Marcotty P, Muller-Richter UD, Bohm H, Wirth C, Ernestus RI, Linz C (2015) Diagnostic features of prematurely fused cranial sutures on plain skull X-rays. Child’s Nervous system : ChNS : Official Journal of the International Society for Pediatric Neurosurgery 31:2071–2080
Bot G, Leshem D, Shiran SI, Ben-Shachar S, Constantini S, Roth J (2015) Frontosphenoid synostosis: an unusual cause of anterior plagiocephaly. The Journal of Craniofacial surgery 26:174–175
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Roth, J., Constantini, S. X-rays for diagnosis of craniosynostosis. Childs Nerv Syst 32, 13 (2016). https://doi.org/10.1007/s00381-015-2953-6
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DOI: https://doi.org/10.1007/s00381-015-2953-6