Morphometric measurements of the cranium in congenital bilateral blind males and females
Rengin Kosif1*, Ocal Sırmatel2, Arzu Canan2
1Department of Anatomy, Faculty of Medicine, University of Abant Izzet Baysal, Gölköy, 14280, Bolu, Turkey. 2Department of Radiology, Faculty of Medicine, University of Abant Izzet Baysal, Gölköy, 14280, Bolu, Turkey.
Abstract
Cranium dimensions diff er according to racial, geopraphic, ethnic and nutritional factors. Th is study will shed light on the question: “Is there a diff erence in the cranial distances measured between congenital bilateral blind people and healthy individuals?” Nine anthropometric measures were performed on the brain MRI midsagittally obtained from male and female congenital bilateral blinds. Th e anthropometric measures taken included the glabella-opisthocranion, nasion-dorsum sellae, dorsum sellae- opisthocranion, nasion-basion, nasion-opisthion, basion-opisthion, prosthion-basion, basion-vertex and the clival angle. In addition, the supratentorial and infratentorial areas were calculated. Glabella-opisthocranion, nasion-dorsum sellae, nasion-basion, prosthion-basion and clival angle were found to be smaller in the congenital bilateral blind females compared to the healthy group, but these results were not statistically signifi cant. Whereas, other measures out of the basion-opisthion were found to be smaller in the congenital bilateral blind males than in the healthy subjects. Of these results, the distance between glabella-opisthocranion, nasion-dorsum sellae and nasion-basion was signifi cantly smaller compared to the measurements taken from the healthy male group. Th e infratentorial area was signifi cantly smaller in congenital blind male subjects and the supratentorial area was signifi cantly larger in congenital blind female subjects. Th is study has revealed that the cranium dimensions of congenital blind people are to diff erent from normal individuals. Th e most signifi cant diff erence was in the distance of the nasion-dorsum sellae. Th e region anterior to the basion and dorsum sellae was prominently smaller. Th e infratentorial area was signifi cantly smaller in congenital blind male subjects and the supratentorial area was signifi cantly larger in congenital blind female subjects. © Association of Basic Medical Sciences of FB&H. All rights reserved
KEY WORDS: congenital bilateral blind, human, craniometry
INTRODUCTION The brain morphology of the blind people has been inves- tigated previously and it was shown that congential blind Measurements of the craniofacial complex are important subjects may have different brain tissue distribution than for studies on human growth, population, variation and do healthy people. Long term living in an environment some medical problems. The development of cranial pro- without visual input can not only induce large changes in portions is the result of genetic, embriogenetic and envi- the visual cortex but also in other areas []. Th ere are dis- ronmental factors []. The shape and size of the cranium tinct diff erences not only in the visual cortex but also the may be aff ected by genetic disorders, congenital disorders, sensory area, auditory area and motor area []. Leporé et primer, seconder or metastatic skull tumors and the amount al. [] found that visual regions of the brain were smaller in of brain tissue and cerebrospinal fluid present [,,,]. volume in blind individuals than in sighted ones. However, Craniofacial traits have substantial amounts of ge- for non-visual areas, the trend was reversed as these areas netic variation, but are significantly affected by oth- grew to be larger in the blind. Th is, the researchers say, sug- er non-genetic factors such as sex and year of birth, gests that the brains of blind individuals are compensating as has been revealed by the genetic analyses []. for the reduced volume in areas normally devoted to vision. The changes that may occur in the cranium in congenital
* Corresponding author: Rengin Kosif, blind people have not been investigated previously. Tradi- Department of Anatomy, Faculty of Medicine, University tional anthropometric expressions of the variability in the of Abant Izzet Baysal, Gölköy, 14280, Bolu, Turkey Tel: +90 (0374) 2534656-3043; Fax: +90 (0374) 2534559 cranium and face have usually emphasized distances and E-mail: [email protected] angles between two or more landmarks []. Are they dif- Submitted: 8 March 2013 / Accepted: 9 September 2013 ferent from any other healthy people? This study aimed
Bosn J Basic Med Sci 2013; 13 (4): 237-241 RENGIN KOSIF ET AL.: MORPHOMETRIC MEASUREMENTS OF THE CRANIUM IN CONGENITAL BILATERAL BLIND MALES AND FEMALES
FIGURE 1. Measurements of 7 anthropometric distances. 1: pros- FIGURE 2. Measurements of the (ba-ver) and (cli-ang). 8: clival thion-basion 2: basion-opisthion (McRae line), 3:nasion-opisthion, angle, 9: basion-vertex 4: nasion-basion, 5: nasion-dorsum sellae, 6: dorsum sellae-opis- thocranion, 7: glabella-opisthocranion to show whether that kind of difference also affect cra- ly protruding point on the back of the braincase. niometric proportions and to compare standard anthro- Nasion (Na ): The middle point of the frontonasal suture. pometric cranial measurements taken from congenital Basion (Ba): Th e midpoint of the anterior margin of the fora- bilateral blind people with those taken from healthy ones. men magnum. Opisthion (Op): The mid-point on the posterior mar- MATERIALS AND METHODS gin of the foramen magnum is termed the opisthion. Prosthion (Pr): The point of the upper alveolar process Samples and Procedures that projects most anteriorly, a point on the alveolar For this study, ethic permission was granted to researchers in arch midway between the median upper incisor teeth. the Abant Izzet Baysal University. Th is study was supported Vertex (Ver): Th e highest point of the skull, the top of the head. by the Abant Izzet Baysal University Scientific Research Clival angle (Cli-ang): The clival angle, between Committee. Nine anthropometric measures on supratento- the ethmoidal plane (the plane of the cribriform rial area and two diff erent infratentorial area were performed plate of the ethmoid bone) and the clival plane on the brain via MRI midsagittally obtained from males (the plane of the intracranial surface of the clivus). and females congenital bilateral blind people. Images Dorsum sellae (DS): A square portion of bone on the body of were obtained with a . Tesla, Magnetom Symphony (Sie- the sphenoid posterior to the sella turcica or hypophysial fossa. mens, Germany) MR device. Th e subjects’ ages range from - (.±.). The results obtained were compared Surface Area Measurements with those of the males and females healthy individu- . Infratentorial area (ITA) and supratentorial area (STA): als. Th e healthy subjects’ ages range from - (.±.). (Figure ) Th e method has been proposed by Krogness to Th e cranial distances measured are shown in Figures , , , . evaluate the size of the bony posterior fossa with regard to The anthropometric measures included the glabella- the overall cranial cavity in a more realistic fashion []. opisthocranion [], nasion-dorsum sellae [], dor- Th is method, which omits compensatory tentorial enlarge- sum sellae- opisthocranion [], nasion-basion [], ment, better demonstrates retardation of mesodermal os- nasion-opisthion [], basion-opisthion [], prosthion- seous growth [,]. According to this method, the ITA basion [], basion-vertex [] and the clival angle []. was outlined by dorsum sellae cranially, internal table of Glabella (Gl): The most forwardly projecting point in the the occipital bone dorsally, the clivus ventrally and the mid-sagittal plane at the lower margin of the frontal bone. McRae line caudally, whereas, STA was the area between Opisthocranion (Oc): The most posterior- dorsum sellae and the internal tables of the bones in the
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FIGURE 3. Measurement method of supratentorial area and in- FIGURE 4. Measurement method of infratentorial area 2 fratentorial area 1
supratentorial compartment, excluding the sella turcica. cantly larger in congenital blind females (p=.) (Table ). . Infratentorial area (ITA): (Figure ): In the meth- Surface area measurements were correlated with some an- od of measurement proposed by Nishikawa which thropometric measurements. permits combine devaluation of the bony andtento- There was no correlation between supraratentorial and rial parts of the posterior fossa [, ]. The ITA was infratentorial surface areas and anthropometric measure- marked as the area outlined by tentorial apex-dorsum ments in congenital blind females. But with infratento- sellae line, the McRae line occipital bone and clivus. real surface area , a moderate positive correlation with Th e average values and standard deviations of all measure- prosthion-basion distance was recorded (r=., p=.). ments were calculated. A two tailed paired t-test was used to There was no correlation between infratentorial sur- compare the measurements. Th e Pearson correlation test was face areas and anthropometric measurements in used for the evaluation of relationships of the measured values with each other and correlation coeffi cient values were given. TABLE 1. Means and standard deviations of cranial distances A p value less than . was considered statistically signifi cant. CBM HM CBF HF RESULTS GL-OPC (mm) 173.29±7.04* 177.59±5.08* 168.29±7.48 169.20±5.70 NA-DS (mm) 72.41±3.68* 75.84±2.21* 69.78±3.44 70.51±3.20 DS-OPC (mm) 95.83±5.42 97.53±4.20 96.21±4.82 94.72±4.21 The means and standard deviations of cranial distances NA-BA (mm) 99.72±4.74* 102.97±4.36* 95.79±5.37 96.09±4.16 and surface area measurements are shown in Table and . NA-OP (mm) 135.10±5.43 137.51±4.47 129.66±5.58 128.67±5.09 BA-OP (mm) 37.57±3.19 36.55±2.10 36.11±3.38 34.55±3.19 The glabella-opisthocranion, nasion-dorsum sellae, nasion- PR-BA (mm) 92.87±5.20 96.50±4.98 87.78±4.71 91.14±4.36 basion, prosthion-basion and clival angle were found to be BA-VER (mm) 140.11±6.32 140.82±5.23 135.31±3.87 135.14±3.66 smaller in the congenital bilateral blind female group com- CLI. ANG (º) 115.27±5.04 117.10±6.14 119.07±3.97 119.17±8.58 pared to the healthy group, but these results were not statisti- CBM: Congenital blind male, HM: Healty male, CBF: Congenital blind cally signifi cant whereas, other measures out of the basion- female, HF: Healty female. opisthion were found to be smaller in the congenital bilateral *: p<0.05 blind males than in the healthy male subjects. Of these re- sults, the distance between the glabella-opisthocranion TABLE 2. Means and standard deviations of surface area mea- surements (.±. mm, p=.), nasion-dorsum sellae (.±. mm, p=.) and nasion-basion (.±. mm, p=.) CBM HM CBF HF 2 was significantly smaller compared to the healthy male STA (cm ) 129.47±6.76 128.07±8.76 128.31±8.06* 122.44±7.58* ITA1 (cm2) 22.49±3.98 22.92±2.12 20.14±1.99 20.49±1.64 group (p< .). Th e most signifi cant diff erence was in the ITA2 (cm2) 33.84±2.72* 35.33±2.60* 31.89±2.33 33.05±2.34 distance of nasion-dorsum sellae (p=.) (Table ). Infratentorial area was signifi cantly smaller in congenital CBM: Congenital blind male, HM: Healty male, CBF: Congenital blind female, HF: Healty female. blind males (p=.) and supratentorial area was signifi- *: p<0.05
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congenital blind males. But moderate positive cor- nificantly larger in males in sexual dimorphism. In our relation was found between supratentorial area and nasion- study this measurement is larger, but not significantly so. basion distance in congenital blind males (r=., p=.). Cistulli found nasion-dorsum sellae .± . mm in nor- mal males and that distances were significantly increased DISCUSSION this distance in the Marfan sendrom male []. In our study, the distance of nasion-dorsum sellae was found to In blind individuals, the brain undergoes structural changes be significantly smaller in congenital bilateral blind male. and is reorganized by adapting to the absence of sensory Guyot found to be clival angle .± .° in his inputs. The volume of the regions of the brain that deal study []. In our study, the clival angle was found to with vision has been found to be smaller in blind indivi- be smaller in both blind and sighted people (Table ). dals compared to those in sighted subjects. The volume Th e STA was larger in the congenital blind males and females of the regions of the brain that are not involved in vision but signifi cantly larger in the congenital blind female in this has been found to be bigger to compensate for this condi- study. Erdoğan et al reported that a large supratentorial area tion. It was found that frontal lobes were significantly en- means that there is no atrophy in white matter []. It was larged in blind subjects compared to sighted subjects []. indicated that small STA signals brain atrophy []. It has Compared with the normal controls, the regions ex- been reported that supratentorial and infratentorial volume panded in the blind men’s brain located at Brodmann were lesser in multiple sklerosis subjects and supratentorial , where one finds the occipital lobe, cuneus, supe- volume was smaller in autism [,]. Th is study has shown rior occipital gyrus, limbic lobe, cingulate gyrus. The con- that brain atrophy did not occur in congenital bilateral tracted regions are located at Brodmann , where blind people. Infratentorial area was signifi cantly smaller one finds the occipital lobe and lingual gyrus []. There in congenital blind males when compared to sigted males are distinct differences not only in the visual cortex but (p=.). In the same patient group, we found the volume also the sensory area, auditory area and motor area []. of cerebellum to be smaller, but not significantly so []. According to our knowledge, this is the first craniomet- Th e fi ndings are consistent with in congenital blind males. ric study of congenital bilateral blind people. This study Th e supratentorial area and nasion-basion distance was cor- has revealed that the cranium dimensions of congeni- related in congenital blind males. Th is fi nding shows expan- tal blind people are different. The most significant dif- sion the front side of basion is correlated with an expanding ference was in the distance of nasion-dorsum sellae supratentorial area. Small infratentorial area that would be (p=.). The region anterior to the basion and dor- able to early findings at infratentorial tumors as medullo- sum sellae was prominently smaller. No meaningfull blastoma in this people. Supratentorial area was signifi cantly change occurred at the region behind the dorsum sellae. larger in congenital blind females when compared to sigted Unilateral clinical anophthalmia (absence or extreme hy- females (p=.). The diagnosis of supratentorial tumors poplasia of the eyeball) always results in hypoplasia of may be delayed for this reason in congenital blind females. the ipsilateral bony orbit, as there is no stimulus induc- Widespread hypertrophy was observed in non-occipital ing growth of the orbital socket []. Our findings sup- white matter, particularly in the prefrontal and frontal ar- ported this study. The reason for why the front part of eas in early and late-onset blind adults []. In this study, the the dorsum sellae is shorter in sighted people, can be supratentorial area was significantly larger in congenital explained by undevelopment of structures of orbita. blind females (p=.) but infratentorial area was not sig- Cotton found vertex-basion height .±. mm; nificantly different in congenital blind females. The study glabella-opisthocranion length .±. mm and ba- is that we have done in the same patient group, we found sion-opisthion distance .±. mm in his study []. the volume of cerebellum to be significantly smaller []. Cameron was found, female nasion-basion length .± . mm, glabella-occipital length ±. mm, male CONCLUSION nasion-basion length ± . mm, glabella-occipital length ±. mm in his study []. For congenital bi- As a result cranial measurements of congential bilateral lateral blind people and healthy ones, the glabella-opistho- blind people are different from sighted people, this differ- cranion distance was found smaller in this study (Table ). ence is clear in the front of basion and dorsum sellae. Brain Naderi was found distance between the basion and atrophy did not occur in congenital bilateral blind people opisthion .±. mm []. In our study this mea- in supratentorial area because of larger than sigthed people. surement was found to be larger but not significantly. When the infratentorial area was evaluated, significant Ursi et al. [] reported that sella-nasion distances are sig- atrophy had occurred in congenital bilateral blind males.
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[] Cakirer B, Hans MG, Graham G, Aylor J, Tishler PV, Redline S. The normative data described here form a basis for quan- Th e relationship between craniofacial morphology and obstructive titative analysis of MRI from congenital bilateral blind in- sleep apnea in whites and in African-Americans. Am J Respir Crit dividuals. We hope this study will provide additional new Care Med ; ():-. [] Nagashima M, Inoue K, Sasaki T, Miyasaka K, Matsumura G, Ko- knowledge the studies in craniometric, morphologic, clinic dama G. Th ree-dimensional imaging and osteometry of adult hu- and antropometric areas of research. To our knowledge, man skulls using helical computed tomography. Surg Radiol Anat ; ():-. this is the first study showing whether congential blind- [] Karagöz F, Izgi N, Kapicioglu Sencer S. Morphometric measure- ness affects cranial dimensions. Although found to be sta- ments of the cranium in patients with Chiari type I malformation tistically signifi cant, the diff erences are small. Th us, further and comparison with the normal population. Acta Neurochir (Wien) ; ():-. studies with more subjects and using more precise mea- [] Hatipoglu HG, Ozcan HN, Hatipoglu US, Yuksel E. Age, sex and surement methods are necessary to confirm our findings. body mass index in relation to calvarial diploe thickness and cra- niometric data on MRI. Forensic Sci Int ; (-):-. ACKNOWLEGMENT [] Clement JG, Marks MK. Editors. Computer-graphic facial recon- struction Elsevier Academic Press ;p . [] Guyot L, Richard O, Adalian P, Bartoli C, Dutour O, Leonetti G. Th is study was supported by the Abant Izzet Baysal Univer- An anthropometric study of relationships between the clival angle and craniofacial measurements in adult human skulls. Surg Radiol sity Scientifi c Research Committee. Anat ; ():-. [] Nyland H, Krogness KG. Size of posterior fossa in Chiari type I DECLARATION OF INTEREST malformation in adults. Acta Neurochir (Wien) ; :–. [] Nishikawa M, Sakamoto H, Hakuba A, Nakanishi N, Inoue Y. Pathogenesis of Chiari malformation a morphometric study of the Th e authors declare no confl ict of interest. posterior cranial fossa. J Neurosurg ; :–. [] Gundlach KK, Guthoff RF, Hingst VH, Schittkowski MP, Bier UC. Expansion of the socket and orbit for congenital clinical anophthal- REFERENCES mia. Plast Reconst Surg ; ():-. [] Cotton F, Rozzi FR, Vallee B, Pachai C, Hermier M, Guihard- Costa AM. et al. Cranial sutures and craniometric points detected [] Finizio M, Quaremba G, Mazzacca G, Ciacci C. Large forehead: on MRI. Surg Radiol Anat ; ():-. A novel sign of undiagnosed coeliac disease. Dig Liver Dis ; [] Cameron J. Craniometric studies. American Journal of Physical :–. Anthropology ; ():-. [] Ridgway EB, Weiner HL. Skull deformities. Pediatr Clin North Am [] Naderi S, Korman E, Cıtak G, Guvencer M, Arman C, Senoglu M ; ():-. et al. Morphometric analysis of human occipital condyle. Clin Neu- [] Sutherland JE, Dahdaleh NS, Greenlee JDW, Kirby, Sargent MD. rol Neurosurg ; ():–. Large osteolytic skull tumor presenting as a small subcutaneous [] Ursi WJ, Trotman CA, McNamara JA Jr, Behrents RG. Sexual scalp lesion. J Am Board Fam Med ; ():-. dimorphism in normal craniofacial growth. Angle Orthod ; [] Lieberman DE, Pearson OM, Mowbray KM. Basicranial infl uence ():-. on overall cranial shape. J Hum Evol ; :–. [] Cistulli PA, Gotsopoulos H, Sullivan CE. Relationship between [] Huggare J, Rönning. Growth of the cranial vault: infl uence of in- craniofacial abnormalities and sleep-disordered breathing in Mar- tracranial and extracranial pressures. Acta Odontol Scand ; fan’s syndrome. Chest ; ():-. ():-. [] Guyot L, Richard O, Adalian P, Bartoli C, Dutour O, Leonetti G. [] Martínez-Abadías N, Esparza M, Sjøvold T, González-José R, San- An anthropometric study of relationships between the clival angle tos M, Hernández M. Heritability of human cranial dimensions: and craniofacial measurements in adult human skulls. Surg Radiol comparing the evolvability of diff erent cranial regions. J Anat ; Anat ; ():-. :–. [] Erdoğan N, Ulger H, Tuna I, Okur A. A novel index to estimate the [] Yang C, Wu S, Bai Y, Gao H. Deformation-based morphometric corpus callosum morphometry in adults: callosal/supratentorial- study on blind men’s brain structures. th Asian-Pacifi c Confer- supracallosal area ratio. Diagn Interv Radiol ; ():-. ence on Medical and Biological Engineering IFMBE Proceedings [] Lin X, Blumhardt LD, Constantinescu CS. Th e relationship of brain ; :–. DOI ./----. and cervical cord volume to disability in clinical subtypes of mul- [] Yang C, Pan W, Zheng L. Voxel-based morphometric study on tiple sclerosis: a three-dimensional MRI study. Acta Neurol Scand chinese blind men's brain structure. Journal of Beijing Institute of ; ():-. Technology ; ():-. [] Liu C, Edwards S, Gong Q, Roberts N, Blumhardt LD. Th ree di- [] Leporé N, Voss P, Lepore F, Chou YY, Fortin M, Gougoux F et al. mensional MRI estimates of brain and spinal cord atrophy in mul- Brain structure changes visualized in early- and late-onset blind tiple sclerosis. J Neurol Neurosurg Psychiatry ; ():-. subjects. Neuroimage ; ():-. [] Jou RJ, Mateljevic N, Minshew NJ, Keshavan MS, Hardan AY. [] Benfer RA. Morphometric analysis of cartesian coordinates of the Reduced Central White Matter Volume in Autism: Implications human skull. Am J Phys Antropol ; ():-. for Long-Range Connectivity. Psychiatry Clin Neurosci ; [] Cotton F, Rozzi FR, Vallee B, Pachai C, Hermier M, Guihard-Costa ():–. AM. et al. Cranial sutures and craniometric points detected on [] KOSİF R, Sahin B, Gürel S. Comparison of cerebellar volume be- MRI. Surg Radiol Anat ; ():-. tween the people who are bilateral congenital blind with healthy [] Jho HD, Ko Y. Glabellar approach: simplifi ed midline anterior skull ones. International Journal Of Morphology ; ():-. base approach. Minim Invasive Neurosurg ; ():-.
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