{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,6]],"date-time":"2026-03-06T20:13:39Z","timestamp":1772828019120,"version":"3.50.1"},"reference-count":54,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"1","license":[{"start":{"date-parts":[[2025,10,24]],"date-time":"2025-10-24T00:00:00Z","timestamp":1761264000000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,10,24]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>The objective of this study was to investigate the relationship between unilateral premature fusion of the posterior intraoccipital synchondrosis (UPF-PIOS) and head tilt in pediatric patients, as well as to analyze the clinical features of children diagnosed with UPF-PIOS exhibiting torticollis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>A retrospective observational study was conducted at the Center for Torticollis in the Department of Physical Medicine and Rehabilitation of a tertiary hospital. Among 14,869 pediatric patients who visited the clinic between January 1, 2005, and July 15, 2024, 1680 children with persistent torticollis underwent 3D CT for further evaluation. UPF-PIOS was diagnosed based on three criteria: 1) asymmetrical posterior skull base on 3D volume-rendered images, 2) confirmation of UPF-PIOS on 3D or axial craniofacial CT, and 3) a \u2265 2-mm vertical skull length difference between the right and left sides on coronal CT images. Clinical characteristics such as sex, age at diagnosis, skull asymmetry, head tilt direction, and craniovertebral junction abnormalities were analyzed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>Fifteen cases of UPF-PIOS were identified (0.89% of those who underwent imaging). The median age at diagnosis was 19 months, with most diagnosed before age 3 years. The median vertical length difference was 8.0 mm, with the affected side being shorter. All patients exhibited head tilt toward the UPF-PIOS side, and 53% had craniovertebral junction abnormalities.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>UPF-PIOS is an underrecognized cause of torticollis in young children. Its characteristic clinical features include an asymmetrical posterior skull base, shortening of the skull on the affected side, and a head tilt toward the side of the prematurely fused synchondrosis. Recognizing this pattern\u2014a tetrad of unilateral synchondrosis fusion and the three resultant findings\u2014is clinically important for differential diagnosis. Considering UPF-PIOS in children with torticollis (especially when physical therapy fails) can prevent misdiagnosis (e.g., distinguishing it from lambdoid craniosynostosis) and guide appropriate management. Further research with larger cohorts and long-term follow-up is warranted to confirm these findings.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2025.8.peds25253","type":"journal-article","created":{"date-parts":[[2025,10,25]],"date-time":"2025-10-25T02:15:06Z","timestamp":1761358506000},"page":"60-68","source":"Crossref","is-referenced-by-count":0,"title":["New insights into the relationship between skull base fusion and torticollis in children"],"prefix":"10.3171","volume":"37","author":[{"given":"Jisun","family":"Hwang","sequence":"first","affiliation":[{"name":"Department of Radiology, Seoul National University Bundang Hospital, Seongnam;"},{"name":"Radiology, Ajou University School of Medicine, Suwon, South Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yoonju","family":"Na","sequence":"additional","affiliation":[{"name":"Departments of Physical Medicine and Rehabilitation and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jin Wook","family":"Choi","sequence":"additional","affiliation":[{"name":"Radiology, Ajou University School of Medicine, Suwon, South Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shin-Young","family":"Yim","sequence":"additional","affiliation":[{"name":"Departments of Physical Medicine and Rehabilitation and"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"6","key":"b1","series-title":"Plast Reconstr Surg","first-page":"973e","article-title":"Physiologic timeline of cranial-base suture and synchondrosis closure","volume":"148","author":"Vu GH","year":"2021","unstructured":"Vu GH, Xu W, Go BC,  Physiologic timeline of cranial-base suture and synchondrosis closure. 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Postures of the head, upper, and lower neck in forward head posture: static and quasi-static analyses. Middle East J Rehabil Health Stud. 2023;10(4):e136377."},{"issue":"5","key":"b13","series-title":"J Craniofac Surg","first-page":"1266","article-title":"Torticollis caused by nontraumatic craniovertebral junction abnormalities","volume":"29","author":"Park S","year":"2018","unstructured":"Park S, Woo JE, Kim S, Yim SY. Torticollis caused by nontraumatic craniovertebral junction abnormalities. J Craniofac Surg. 2018;29(5):1266\u20131270."},{"issue":"4","key":"b14","series-title":"Neurospine","first-page":"859","article-title":"From anatomic to genetic understanding of developmental craniovertebral junction abnormalities","volume":"17","author":"Ropper AE","year":"2020","unstructured":"Ropper AE. From anatomic to genetic understanding of developmental craniovertebral junction abnormalities. 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