4th Congress of Asian-Australasian Society for Pediatric Neurosurgery (AASPN2023)

Dec. 13, Room C
Educational session 1: From basic to advanced management—neuroendoscopic tumorsurgery

Tubular brain tumor surgery
Yoshiki Arakawa
Department of Neurosurgery, Kyoto University

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4th Congress of Asian-Australasian Society for Pediatric Neurosurgery (AASPN2023)

Dec. 13, Room A
Symposium 3: Plagiocephaly: positional or synostotic? diagnosis &management

Diagnosis and management of positional plagiocephaly
Atsuko Harada,1 Toyoko Okamoto2, Shigeo Kyutoku3, Koichi Ueda2
1

Department of Pediatric Neurosurgery, Takatsuki General Hospital
Department of Plastic and Reconstructive Surgery, Osaka Medical and Pharmaceutical University
3Division of Reconstructive Plastic Surgery, Nara City Hospital
2

In Japan, it is believed that babies' head deformities heal spontaneously and have not been aconcern, but in recent years, interest in the shape of the head has increased due to Westerninfluence. Along with this, American-made cranial molding helmets have been introduced to Japan,
followed by the spread of Japanese-made helmets. We report here the diagnosis and treatment of
positional plagiocephaly (PP) in Japan.
The diagnosis of PP begins with a visual examination. The severity is determined by the Argenta
classification with the position of the ears, forehead, and cheeks. If only flattening of the back of thehead is observed, it is classified as grade 1. If forward displacement of the ear is added, it becomes
grade 2. If protrusion of the forehead is added, it becomes grade 3. If protrusion of the cheek isadded, it becomes grade 4. If deformation towards the temporal or parietal of the head is added, itbecomes grade 5. Next, a craniometer is used to measure the anterior-posterior diameter, left-rightdiameter, and diagonal diameter at a 30-degree angle. The difference between the left and rightsides (Cranial asymmetry: CA), its ratio (cranial vault asymmetry index: CVAI), and the cephalic index(CI) are calculated. The severity of PP is determined by CA and CVAI, while positional brachycephaly(PB) is determined by CI. Craniosynostosis must also be differentiated from PP. According to theguidelines published in Neurosurgery in 2016, imaging rarely necessary for diagnosing PP. However,distinguishing between early-onset or early infancy unilateral lambdoid synostosis (ULS) and PP
can be difficult. This is because early infancy with ULS exhibits PP characteristics such as forward
displacement of the affected ear and protrusion of the forehead. Observation of the baby’s ears frombehind can help with differentiation. In ULS, the affected ear deviates downward. Additionally, noninvasive suture ultrasound can be useful.
Treatment options for PP include repositioning education, positioning pillows, physical therapy, andhelmet therapy. The effectiveness of conservative treatment has been demonstrated, and helmet
therapy is also recommended for moderate to severe cases of PP in older infants in the guidelines.
But, while conservative treatment is covered by health insurance in Japan, helmet therapy is not. In
our hospital, conservative treatment is provided for infants under 3 months old or with mild symptoms
or who do not wish to undergo helmet therapy. Helmet therapy is offered to severe cases between
4 and 6 months old who wish to proceed with this fully self-funded treatment. Japanese people
tend to be brachycephalic with an average CI of 86.5 and severe PB with a CI above 100 is often
encountered. Helmet therapy is also performed for PB cases with a CI above 100, in our team.
Flattening of the occipital region improves, while the temporal protrusion does not.
It is important to assess an infant’s cranial morphology accurately to ensure not to overlook
craniosynostosis and to provide appropriate treatment based on age and severity.
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4th Congress of Asian-Australasian Society for Pediatric Neurosurgery (AASPN2023)

Education1990-1996
1998-2002

M.D., Niigata University School of Medicine
Ph.D. Niigata University Graduate School of Medicine

Medical Training
1996-2002
Resident
Department of Neurosurgery, Niigata University Hospital
2002-2012
Stuff Physician, Niigata University Hospital
2012-present
Medical License
Full Medical License (Japan) #377679
Board Certification
Board Certified Neurosurgeon, Japanese Neurosurgical Society #5943
Board Certified Pediatric neurosurgeon, Japanese pediatric neurosurgical society #17075
Qualified neurosurgeon, Japanese Society for Neuroendoscopy #10-NE-007
Japanese Board of Medical Genetics #1418
Educational Commission for Foreign Medical Graduates #0-679-750-0MembershipJapanese Society for Pediatric Neurosurgery
International Society for pediatric neurosurgery
Japanese Society for Neuroendoscopy
Japanese Society of Child Neurology
Japanese Neurosurgical Society
Japan Society of Human Genetics
Japanese Congress of Neurological Surgeons21

4th Congress of Asian-Australasian Society for Pediatric Neurosurgery (AASPN2023)

Dec. 13, Room A
Symposium 3: Plagiocephaly: positional or synostotic? diagnosis &management

Cranial shape induction: management of deformational
plagiocephaly/brachycephaly by helmets
Makoto Hikosaka, Tsuyoshi Kaneko, Ako Takamatsu, Masafumi Kamata,
Makoto Akahori
Division of Plastic Surgery, Department of Surgical Specialties, National Center for Child Health andDevelopment

Deformational plagiocephaly and brachycephaly (DP/B) is a head deformity caused by an external
force on the intrinsically normal skull. Its incidence in the US increased from 0.3% to as high as 48%
after “Safe to Sleep” campaign in 1992 to reduce the incidence of sudden infant death syndrome by
the American Academy of Pediatrics. The deformity has the tendency to self-correct. Physical therapy
is recommended for mild to moderate cases, whereas molding helmets are applied for more severecases.
At National Center for Child Health and Development, Clinic for Baby’s Head Shape was establishedin 2011. It is a specialized clinic for head deformity, mainly DP/B. The Clinic’s missions areprevention and treatment of DP/B, dissemination of knowledge about DP/B, and early diagnosis ofcraniosynostosis. Our experience with the first 159 patients showed efficacy and safety of molding
helmet therapy. We showed that more severe the initial deformity, longer it takes for improvement
and more severe the residual deformity. We also showed that there are no clear adverse effects tothe patients’ development through helmet therapy. The results with our recent 100 patients showedsimilar efficacy and safety.
Clinics specializing in DP/B are increasing in Japan. Clinicians should be aware of craniosynostosis
as an important differential diagnosis of DP/B. The early diagnosis enables endoscope-assisted
suturectomy to be performed, which is a low-invasive treatment only applicable to patients withage of 3-6 months or younger. The late diagnosis may lead to adverse effects to development andhead deformity which can be repaired only through surgery. Clinicians should also be aware of theindications of molding helmet therapy, as milder DP/B may self-correct with growth.

2002
2004
2006
2007
2008
2009
2012
2021

Resident (Department of Plastic and Reconstructive Surgery), School of Medicine, Keio University
Senior Resident (Department of Plastic and Reconstructive Surgery), School of Medicine, Keio University
Associate Professor, School of Medicine, Keio University
Doctor, Department of Plastic and Reconstructive Surgery, National Hospital Organization Tokyo Medical CenterDoctor, Department of Plastic and Reconstructive Surgery, Yokohama Municipal Citizen's Hospital
Chief, Department of Plastic and Reconstructive Surgery, Hiratsuka City Hospital
Doctor, Division of Plastic Surgery, National Center for Child Health and Development
Chief, Division of Plastic Surgery, National Center for Child Health and Development

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4th Congress of Asian-Australasian Society for Pediatric Neurosurgery (AASPN2023)

Dec. 14, Room A
Symposium 4: Neurosurgical management of intracranial cystic lesions

What is the best practice? Endoscopic or microsurgery or shunt?
Jun Kurihara
Department of Neurosurgery, Saitama Children’s Medical Center23