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Craniofacial Dysmorphology in Infants With Non-Syndromic Unilateral Coronal Craniosynostosis. J Craniofac Surg 2022; 33:1903-1908. [PMID: 35013073 DOI: 10.1097/scs.0000000000008464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 12/21/2021] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Unilateral coronal craniosynostosis (UCS) is a congenital disorder resulting from the premature suture fusion, leading to complex primary and compensatory morphologic changes in the shape of not only the calvarium and but also into the skull base. This deformity typically requires surgery to correct the shape of the skull and prevent neurologic sequelae, including increased intracranial pressure, sensory deficits, and cognitive impairment. METHODS The present multicenter study sought to reverse-engineer the bone dysmorphogenesis seen in non-syndromic UCS using a geometric morphometric approach. Computed tomography scans for 26 non-syndromic UCS patients were converted to three-dimensional mesh models. Two hundred thirty-six unique anatomical landmarks and semi-landmarked curves were then plotted on each model, creating wireframe representations of the patients' skulls. RESULTS Generalized Procrustes superimposition, Principal Component Analysis, and heatmaps identified significant superior displacement of the ipsilateral orbit ("harlequin" eye deformity), anterior displacement of the ear ipsilateral to the fused coronal suture, acute deviation of midline skull base structures ipsilateral to the fused coronal suture and flattening of the parietal bone and associated failure to expand superiorly. CONCLUSIONS The described technique illustrates the impact of premature coronal suture fusion on the development of the entire skull and proposes how bone dysmorphology contributes to the patients' neurologic sequelae. By bridging novel basic science methodologies with clinical research, the present study quantitatively describes craniofacial development and bone dysmorphogenesis.
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Kumari S, Verma SK, Singh PK. Crouzon's Syndrome with a Dominant Sinus Pericranii Draining Transverse Sinus: Report of a Rare Association and Review of Literature. Pediatr Neurosurg 2022; 57:196-201. [PMID: 35306498 DOI: 10.1159/000524134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Accepted: 03/11/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Crouzon's syndrome and sinus pericranii (SP) are rare entities. Only few cases having both the features are reported. SP most commonly drains in relation to superior sagittal sinus and their communication to major posterior dural sinuses is rare. CASE REPORT We report a rare case of Crouzon's syndrome with SP at a suboccipital location with termination of left transverse sinus into the SP draining further through the extracranial suboccipital and extravertebral cervical venous plexi into external jugular veins. Distal transverse sinus and sigmoid sinus on the left side were absent. CONCLUSION Crouzon's syndrome with SP is an extremely rare entity. SP with communication to major posterior dural venous sinuses is also rare and mostly associated with multi-suture craniosynostosis. Management depends on the volume of venous blood they are draining. Most of them are dominant type and their occlusion is not feasible. Preoperative diagnosis of a dominant SP is essential for proper surgical planning as it needs to be preserved mandatorily to prevent cerebral venous infarction.
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Affiliation(s)
- Shweta Kumari
- Department of Anatomy, School of Medical Sciences and Research, Sharda University, Greater Noida, India
| | - Satish Kumar Verma
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Pankaj Kumar Singh
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
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Udayakumaran S, Krishnadas A, Subash P. Multisuture and syndromic craniosynostoses: Simplifying the complex. J Pediatr Neurosci 2022; 17:S29-S43. [PMID: 36388010 PMCID: PMC9648657 DOI: 10.4103/jpn.jpn_26_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 03/12/2022] [Indexed: 11/30/2022] Open
Abstract
Most complex craniosynostoses are managed the same way as syndromic craniosynostoses (SCs), as these patients often experience similar problems regarding cognition and increased intracranial pressure (ICP). The evaluation and treatment plan for craniosynostoses is complex, and this, additionally, is complicated by the age at presentation. In this article, the authors review the complexity of SCs in the presentation and management. An algorithm is necessary for such multifaceted and multidimensional pathology as craniosynostoses. In most algorithms, posterior calvarial distraction is a consistent early option for complex craniosynostoses presenting early with raised ICP. Addressing the airway early is critical when significant airway issues are there. All other surgical interventions are tailored on the basis of presentation and age.
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Udayakumaran S, Krishnadas A, Subash P. Robot-assisted frontofacial correction in very young children with craniofacial dysostosis syndromes: a technical note and early functional outcome. Neurosurg Focus 2022; 52:E16. [PMID: 34973669 DOI: 10.3171/2021.10.focus21515] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Accepted: 10/19/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE In this study, the authors aimed to 1) retrospectively analyze the early functional outcomes in a cohort of very young children with craniofacial dysostoses who underwent robot-assisted frontofacial advancement (RAFFA) or robot-assisted midface distraction (RAMD), and 2) analyze the utility of robotic assistance in improving the accuracy and safety of performing transfacial pin insertion for RAFFA or RAMD. METHODS A retrospective analysis of a cohort of 18 children (age range 1-42 months at presentation), who underwent RAFFA or RAMD from February 2015 to February 2021 in the craniofacial unit at Amrita Institute of Medical Sciences and Research Centre in Kochi, India, was performed. Inclusion criteria were patients who had undergone RAFFA in a single stage or RAMD where the cranial vault had been addressed earlier, had been addressed on follow-up, or had not been addressed and had follow-up of at least 6 months. RESULTS Overall, 18 children with syndromic craniosynostosis underwent LeFort level III midface distraction, with or without RAFFA, from February 2015 to February 2021 at a single center in India. The patients' ages ranged from 6 to 47 months at the time of the procedure. All patients had significant obstructive sleep apnea (OSA), significant ocular issues, and disturbed sleep as determined by the authors' preoperative protocol. Clinically significant intracranial pressure issues were present in 17 patients. None of the patients had injury due to the transfacial pin trajectory such as globe injury, damage to the tooth buds, or the loss of purchase during the active distraction phase. The mean distraction achieved was 23 mm (range 18-30 mm) (n = 16/18). Of the 18 patients, 10 (56%) had an excellent outcome and 6 (33%) had a satisfactory outcome. In all cases, the degree of OSA had significantly reduced after surgery. Eye closure improved in all patients, and complete closure was seen in 11 patients. On follow-up, the functional gain remained in 14 of 16 patients at the final follow-up visit. The distraction results were stable during the follow-up period (mean 36 months [range 6-72 months]). CONCLUSIONS The early RAFFA and RAMD protocols investigated in this study gave a significant functional advantage in very young patients with craniofacial dysostoses. The results have demonstrated the accuracy and safety of robotic assistance in performing transfacial pin insertion for RAFFA or RAMD.
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Affiliation(s)
- Suhas Udayakumaran
- 1Division of Paediatric Neurosurgery and Craniofacial Surgery, Department of Neurosurgery, Amrita Institute of Medical Sciences and Research Centre, Amrita Viswa Vidyapeetham, Kochi, Kerala; and
| | - Arjun Krishnadas
- 2Division of Craniomaxillofacial Surgery, Amrita Institute of Medical Sciences and Research Centre, Amrita Viswa Vidyapeetham, Kochi, Kerala, India
| | - Pramod Subash
- 2Division of Craniomaxillofacial Surgery, Amrita Institute of Medical Sciences and Research Centre, Amrita Viswa Vidyapeetham, Kochi, Kerala, India
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The Craniofacial Collaboration UK: Developmental Outcomes in 3-Year-Old Children With Metopic Synostosis. J Craniofac Surg 2021; 33:112-116. [PMID: 34967518 DOI: 10.1097/scs.0000000000008045] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ABSTRACT The Craniofacial Collaboration UK (CC-UK) has been established across the 4 highly specialized craniofacial centers in the UK since 2015. This joint collective aims to address the current limitations within developmental craniofacial research, using robust clinical data from a homogenous sample of children. This paper presents the third wave of findings from the CC-UK, with consideration to developmental and behavioral parent-report measures. Whilst previous data for sagittal synostosis have been presented, this article summarizes the analysis of these outcomes for children with metopic synostosis (MS) at 3 years who have undergone primary corrective surgery. Results highlight similar patterns to that of earlier CC-UK work, with the majority of children falling within 1 standard deviation of the population normative means across all measures. However, statistically significant difficulties were found between group means for children with MS on various developmental and behavioral domains. Prosocial skills and peer difficulties were reported as the greatest areas of behavioral concern for parents, with prosocial skills found to be below the level expected for their chronological age. In order to further understand the developmental trajectory of children with MS, longitudinal examination of individual diagnostic and specific age groups with single-suture craniosynostosis is crucial. The continuation of the CC-UK provides an opportunity to attain this goal.
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Park H, Oh S, Choi JW, Ra YS. Complete posterior cranial vault distraction osteogenesis to correct Chiari malformation type I associated with craniosynostosis. J Neurosurg Pediatr 2021:1-7. [PMID: 34920435 DOI: 10.3171/2021.10.peds21443] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 10/21/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Posterior vault distraction osteogenesis (PVDO) is an effective tool to increase intracranial volume and expand the posterior cranial fossa. During PVDO, the authors extended osteotomy posterior to the foramen magnum to fully expand the posterior cranial fossa. The aim of this study was to investigate the efficacy of complete PVDO in posterior fossa expansion and treatment of Chiari malformation type I (CM-I) in patients with craniosynostosis. METHODS Patients with craniosynostosis who had undergone complete PVDO between January 2012 and May 2020 were reviewed retrospectively. A coronal osteotomy extending to the foramen magnum was performed and the foramen magnum was decompressed by removing its posterior rim with a 1-mm Kerrison rongeur. Four distractor devices were placed and the vector of distraction was controlled from the posterior to the inferior-posterior direction, depending on the deformity. Changes in the intracranial volume, posterior cranial fossa area, and cerebellar tonsillar descent were measured after complete PVDO by using CT and MRI. RESULTS A total of 11 patients with craniosynostosis and concurrent CM-I were included in the study. The mean age was 34.6 ± 24.0 months (continuous variables are expressed as the mean ± SD throughout). One patient had sleep apnea, which was consistent with CM-I, and another patient had a headache, which was nonspecific. The intracranial volume increased from 1179.6 ± 180.2 cm3 to 1440.6 ± 251.5 cm3 (p = 0.003; 24.5% increase compared to the preoperative volume). The posterior skull base area increased from 44.9 ± 19.3 cm2 to 72.7 ± 18.1 cm2 (p = 0.004). Cerebellar tonsillar descent decreased in all 11 patients after complete PVDO (preoperative: 10.8 ± 3.7 mm, postoperative: 2.7 ± 3.0 mm; p = 0.003). Among the 11 patients, 5 showed complete resolution of cerebellar tonsillar herniation. CONCLUSIONS Complete PVDO can more efficiently expand the posterior cranial fossa, unlike conventional methods. Moreover, it helps to relieve cerebellar tonsillar herniation. Complete PVDO is a powerful tool to increase the intracranial and posterior fossa volumes in patients with craniosynostosis and concurrent CM-I.
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Affiliation(s)
- Hojin Park
- 1Department of Plastic and Reconstructive Surgery, and
| | - Somin Oh
- 1Department of Plastic and Reconstructive Surgery, and
| | - Jong Woo Choi
- 1Department of Plastic and Reconstructive Surgery, and
| | - Young Shin Ra
- 2Department of Neurosurgery, Ulsan University, College of Medicine, Asan Medical Center, Seoul, Korea
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Reducing the Burden of Care: Multidisciplinary Management of Late-Manifested Crouzon Syndrome—A Case Report. CHILDREN 2021; 8:children8121122. [PMID: 34943318 PMCID: PMC8700770 DOI: 10.3390/children8121122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 11/29/2021] [Accepted: 11/30/2021] [Indexed: 11/22/2022]
Abstract
The therapy of patients with Crouzon syndrome involves a multidisciplinary team. In most cases, this therapy is extensive, time-consuming, and exhausting for the patient. This case report illustrates a temporally coordinated therapy plan that succeeds in reducing the burden of care. Showing typical extraoral characteristics of Crouzon syndrome, the patient had a frontal and left-sided crossbite, and impaction of the maxillary canines. Multidisciplinary therapy included the extraction of multiple teeth, midface distraction at Le Fort III level, and alignment of the impacted teeth. Before starting, during, and after completion of the treatment, the patient’s oral health-related quality of life was assessed using COHIP-19. The combination of different treatment steps significantly reduced the duration of therapy. The therapy improved not only the patient’s oro- and craniofacial function, but also the patient’s facial appearance in a short treatment period. The patient’s quality of life improved considerably during this time. In the treatment of severe craniofacial anomalies, the highest priority should be given to keeping the burden of care low. All measures should encourage young patients’ appropriate psychosocial development despite extensive therapies, ensuring at the same time medically satisfactory treatment results.
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Hersh DS, Hughes CD. Syndromic Craniosynostosis: Unique Management Considerations. Neurosurg Clin N Am 2021; 33:105-112. [PMID: 34801135 DOI: 10.1016/j.nec.2021.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Craniosynostosis involves the premature fusion of 1 or more cranial sutures and commonly presents as an isolated, nonsyndromic diagnosis. A subset of patients have syndromic craniosynostosis. Several unique considerations must be taken into account when managing patients with syndromic craniosynostosis. A multidisciplinary craniofacial team with a central coordinator is particularly useful for coordinating care among various specialists, and close monitoring is mandatory owing to the increased risk of intracranial hypertension. Surgical management varies among centers, but core options include fronto-orbital advancement with cranial vault remodeling, posterior vault expansion, endoscopic-assisted suturectomy with postoperative orthotic therapy, and midface advancement.
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Affiliation(s)
- David S Hersh
- Division of Neurosurgery, Connecticut Children's, 282 Washington Street, Hartford, CT 06106, USA; Department of Surgery, UConn School of Medicine, 200 Academic Way, Farmington, CT 06032, USA.
| | - Christopher D Hughes
- Department of Surgery, UConn School of Medicine, 200 Academic Way, Farmington, CT 06032, USA; Divisions of Plastic Surgery and Craniofacial Surgery, Connecticut Children's, 282 Washington Street, Hartford, CT 06106, USA
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Wang MM, Haveles CS, Zukotynski BK, Reid RR, Lee JC. Facial Suture Pathology in Syndromic Craniosynostosis: Human and Animal Studies. Ann Plast Surg 2021; 87:589-599. [PMID: 34699435 PMCID: PMC8667083 DOI: 10.1097/sap.0000000000002822] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Facial deformities in syndromic craniosynostosis are not only functionally, psychosocially, and aesthetically impairing but also notoriously challenging to reconstruct. Whether facial suture synostosis plays a significant role in the pathogenesis of these deformities is inadequately studied in human patients. METHODS The MEDLINE database was queried using a methodologically generated search term inventory. Article inclusion was adjudicated by 2 authors after independent review. Articles provided insight into facial suture involvement in either syndromic craniosynostosis patients or animal models of disease. RESULTS Comprehensive review yielded 19 relevant articles meeting inclusion criteria. Mid-20th century craniofacial biologists characterized how patent facial sutures are essential for normal postnatal facial development. They also posited that premature ossification disrupts growth vectors, causing significant dysmorphologies. Recently, facial suture synostosis was found to cause midfacial deformities independent of cranial base pathology in mouse models of syndromic craniosynostosis. Few recent studies have begun exploring facial suture involvement in patients, and although they have paved the way for future research, they bear significant limitations. CONCLUSIONS The hypothesis that facial suture synostosis acts in conjunction with cranial base pathology to produce the prominent, multifocal facial deformities in syndromic craniosynostosis may fundamentally alter surgical management and warrants further investigation. Methodically evaluating the literature, this review synthesizes all basic science and human clinical research thus far on the role of facial sutures in syndromic craniosynostosis and elucidates important topics for future research. We ultimately identify the need for rigorous imaging studies that longitudinally evaluate facial osteology across patients with various craniosynostosis syndromes.
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Affiliation(s)
- Maxwell M. Wang
- Division of Plastic and Reconstructive Surgery; University of California, Los Angeles, California
| | - Christos S. Haveles
- Division of Plastic and Reconstructive Surgery; University of California, Los Angeles, California
| | - Brian K. Zukotynski
- Division of Plastic and Reconstructive Surgery; University of California, Los Angeles, California
| | - Russell R. Reid
- Section of Plastic and Reconstructive Surgery; University of Chicago, Chicago, Illinois
| | - Justine C. Lee
- Division of Plastic and Reconstructive Surgery; University of California, Los Angeles, California
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Eisová S, Naňka O, Velemínský P, Bruner E. Craniovascular traits and braincase morphology in craniosynostotic human skulls. J Anat 2021; 239:1050-1065. [PMID: 34240418 PMCID: PMC8546506 DOI: 10.1111/joa.13506] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 06/16/2021] [Accepted: 06/18/2021] [Indexed: 11/28/2022] Open
Abstract
Middle meningeal vessels, dural venous sinuses, and emissary veins leave imprints and canals in the endocranium, and thus provide evidence of vascular patterns in osteological samples. This paper investigates whether craniovascular morphology undergoes changes in craniosynostotic human skulls, and if specific alterations may reflect structural and functional relationships in the cranium. The analyzed osteological sample consists of adult individuals with craniosynostoses generally associated with dolichocephalic or brachycephalic proportions, and a control sample of anatomically normal adult skulls. The pattern and dominance of the middle meningeal artery, the morphology of the confluence of the sinuses, and the size and number of the emissary foramina were evaluated. Craniovascular morphology was more diverse in craniosynostotic skulls than in anatomically normal skulls. The craniosynostotic skulls often displayed enlarged occipito-marginal sinuses and more numerous emissary foramina. The craniosynostotic skulls associated with more brachycephalic morphology often presented enlarged emissary foramina, while the craniosynostotic skulls associated with dolichocephalic effects frequently displayed more developed posterior branches of the middle meningeal artery. The course and morphology of the middle meningeal vessels, dural venous sinuses, and emissary veins in craniosynostotic skulls can be related to the redistribution of growth forces, higher intracranial pressure, venous hypertension, or thermal constraints. These functional and structural changes are of interest in both anthropology and medicine, involving epigenetic traits that concern the functional and ontogenetic balance between soft and hard tissues.
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Affiliation(s)
- Stanislava Eisová
- Katedra antropologie a genetiky člověkaPřírodovědecká fakultaUniverzita KarlovaPragueCzech Republic
- Antropologické odděleníPřírodovědecké muzeum, Národní muzeumPragueCzech Republic
| | - Ondřej Naňka
- Anatomický ústav1. lékařská fakultaUniverzita KarlovaPragueCzech Republic
| | - Petr Velemínský
- Antropologické odděleníPřírodovědecké muzeum, Národní muzeumPragueCzech Republic
| | - Emiliano Bruner
- Programa de PaleobiologíaCentro Nacional de Investigación sobre la Evolución HumanaBurgosSpain
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Kronig ODM, Kronig SAJ, Van Adrichem LNA. Intracranial Volume Measured and Correlated to Cephalic Index in Syndromic and Nonsyndromic Anterior Brachycephaly. Ann Plast Surg 2021; 87:575-579. [PMID: 33587462 DOI: 10.1097/sap.0000000000002750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Premature fusion of both coronal sutures (anterior brachycephaly) alters skull shape and potentially affects intracranial volume (ICV). Currently little is known about preoperative ICV in anterior brachycephaly. Aim is to measure preoperative ICV and compare this with normative data. Additionally, ICV will be correlated to most used clinical method of quantification: cephalic index (CI). METHODS Preoperative patients with anterior brachycephaly (age, ≤12 months) were included and categorized by syndrome (when present). Computed tomography scans were used for ICV measurement by manual segmentation (OsiriX (Fondation OsiriX, Geneva, Switzerland)). Intracranial volume of each subgroup was compared with Lichtenberg normative cranial volume growth curves for controls. Cephalic index was calculated and correlated to ICV using Pearson correlation coefficient. RESULTS Thirty-four patients with both syndromic and nonsyndromic anterior brachycephaly were included: 17 with Apert syndrome, 6 with Muenke syndrome, 5 with Saethre Chotzen syndrome, 3 with Crouzon, 1 with craniofrontonasal dysplasia, and 2 nonsyndromal. Mean age at preoperative computed tomography scan was 4 months (1-10 months). Mean ICV was 847.31 cm3 (473.91-1459.22 cm3). Nineteen of 34 patients had skull volumes between ±2 SD curves of Lichtenberg, none of the patients had an ICV smaller than -2 SD and 15 of 34 had an ICV larger than +2 SD. Mean ICV in Apert syndrome was 829.85 cm3 (473.91-1061.53 cm3), in Muenke syndrome 942.06 cm3 (768.02-1136.75 cm3), in Saethre Chotzen syndrome 779.72 cm3 (609.21-1002.95 cm3), in Crouzon syndrome 700.57 cm3 (652.31-784.32 cm3), in craniofrontonasal dysplasia 738.97 cm3, and in the nonsyndromal group 1154.64 cm3 (850.07-1459.22 cm3). Apert had a mean greater than +2SD above the mean, the other subgroups had a mean within normal ranges (±2 SD). Correlation between severity of brachycephaly and overall ICV was low (r = 0.42). CONCLUSIONS Mean preoperative ICV in both syndromic and nonsyndromic anterior brachycephaly was 847.31 cm3. Intracranial volume in anterior brachycephaly is in 55.9% between normal ranges (±2 SD). In 44.1% ICV was greater than +2 SD, especially in Apert syndrome (11/16 Apert patients). None of the included patients had a deviant small ICV of less than -2 SD. Additionally, low correlation between ICV and CI (r = 0.42) was found and therefore CI is not suitable for estimating ICV in anterior brachycephaly.
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Affiliation(s)
- Otto D M Kronig
- From the Department of Plastic and Reconstructive Surgery, University Medical Center Utrecht, The Netherlands
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Saracoglu A, Zengin SU, Ozturk N, Niftaliyev S, Harman F, Aykac Z. The outcomes of using high oxygen concentration in pediatric patients. J Clin Monit Comput 2021; 36:1341-1346. [PMID: 34705168 DOI: 10.1007/s10877-021-00765-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 10/05/2021] [Indexed: 11/24/2022]
Abstract
Oxygen reserve index, available as part of Masimo Rainbow SET pulse oximetry, is a noninvasive and continuous variable intended to provide insight into a patient's oxygen status in the moderate hyperoxic range (PaO2 > 100 and ≤ 200 mm Hg), defined as a patient's oxygen "reserve". When used in conjunction with pulse oximetry, ORi extends the knowledge on a patient's oxygen status providing clinically important information helping to prevent hyperoxemia and hypoxemia. There are limited data on patients undergoing craniosynostosis surgery. Our primary goal was to evaluate the effects of different concentrations of inspiratory oxygen (FiO2) on patient oxygenation status by monitoring ORi. Thirty patients scheduled for craniosynostosis were included in this observational cohort study. Patients were randomized into two equal groups: Group 1 received a fraction of inspired oxygen of 0.8 and group 2 received a FiO2 of 0.6 during induction of anaesthesia. In addition to standard haemodynamic variables with ORi were recorded at baseline 1 min, 5 min, 60 min, and 120 min after intubation. Postoperative complications, length of stay in the intensive care unit and hospital were recorded. In total, 14 patients were evaluated in each group. Gender, age, BMI, ASA scores were similar between groups (p > 0.05). In Group 1, ORi values were significantly higher when compared to group 2 at baseline (0.86 ± 0.21 vs 0.45 ± 0.32, p = 0.001), one minute (0.61 ± 0.24 vs 0.27 ± 0.21, p = 0.001), and 5 min (0.34 ± 0.31 vs 0.10 ± 0.13, p = 0.033). High inspired oxygen concentration during induction of anesthesia in pediatric patients is associated with higher levels of ORi. Therefore, ORi may provide the means to safely reduce the inspired oxygen fraction during inhalational induction in paediatric patients.
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Affiliation(s)
- Ayten Saracoglu
- Department of Anesthesiology and Intensive Care, Marmara University Pendik Training and Research Hospital, Fevzi Cakmak Mh. Muhsin Yazicioglu Cd., Pendik/Istanbul, Turkey.
| | - Seniyye Ulgen Zengin
- Department of Anesthesiology and Intensive Care, Marmara University Pendik Training and Research Hospital, Fevzi Cakmak Mh. Muhsin Yazicioglu Cd., Pendik/Istanbul, Turkey
| | - Nilufer Ozturk
- Department of Pediatry, Marmara University Pendik Training and Research Hospital, Istanbul, Turkey
| | - Seymur Niftaliyev
- Department of Neurosurgery, Marmara University Pendik Training and Research Hospital, Istanbul, Turkey
| | - Ferhat Harman
- Department of Neurosurgery, Marmara University Pendik Training and Research Hospital, Istanbul, Turkey
| | - Zuhal Aykac
- Department of Anesthesiology and Intensive Care, Marmara University Pendik Training and Research Hospital, Fevzi Cakmak Mh. Muhsin Yazicioglu Cd., Pendik/Istanbul, Turkey
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Cross C, Khonsari RH, Larysz D, Johnson D, Kölby L, Moazen M. Predicting and comparing three corrective techniques for sagittal craniosynostosis. Sci Rep 2021; 11:21216. [PMID: 34707183 PMCID: PMC8551239 DOI: 10.1038/s41598-021-00642-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 10/08/2021] [Indexed: 11/26/2022] Open
Abstract
Sagittal synostosis is the most occurring form of craniosynostosis, resulting in calvarial deformation and possible long-term neurocognitive deficits. Several surgical techniques have been developed to correct these issues. Debates as to the most optimal approach are still ongoing. Finite element method is a computational tool that's shown to assist with the management of craniosynostosis. The aim of this study was to compare and predict the outcomes of three reconstruction methods for sagittal craniosynostosis. Here, a generic finite element model was developed based on a patient at 4 months of age and was virtually reconstructed under all three different techniques. Calvarial growth was simulated to predict the skull morphology and the impact of different reconstruction techniques on the brain growth up to 60 months of age. Predicted morphology was then compared with in vivo and literature data. Our results show a promising resemblance to morphological outcomes at follow up. Morphological characteristics between considered techniques were also captured in our predictions. Pressure outcomes across the brain highlight the potential impact that different techniques have on growth. This study lays the foundation for further investigation into additional reconstructive techniques for sagittal synostosis with the long-term vision of optimizing the management of craniosynostosis.
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Affiliation(s)
- Connor Cross
- Department of Mechanical Engineering, University College London, London, UK
| | - Roman H Khonsari
- Department of Maxillofacial Surgery and Plastic Surgery, School of Medicine, Necker - Enfants Malades University Hospital, Assistance Publique - Hôpitaux de Paris, University of Paris, Paris, France
| | - Dawid Larysz
- Department of Head and Neck Surgery for Children and Adolescents, University of Warmia and Mazury in Olsztyn. Ul, Zolnierska 18a, 10-561, Olsztyn, Poland
| | - David Johnson
- Oxford Craniofacial Unit, Oxford University Hospital, NHS Foundation Trust, Oxford, UK
| | - Lars Kölby
- Department of Plastic Surgery, Sahlgrenska University Hospital, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Mehran Moazen
- Department of Mechanical Engineering, University College London, London, UK.
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Galiay L, Hennocq Q, Cross C, Arnaud E, Larysz D, Kölby L, Paternoster G, Khonsari RH, Moazen M. Management of sagittal craniosynostosis: Morphological comparison of 8 surgical techniques. Br J Oral Maxillofac Surg 2021; 60:499-506. [DOI: 10.1016/j.bjoms.2021.09.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 09/14/2021] [Indexed: 12/18/2022]
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Kalmar CL, Zapatero ZD, Kosyk MS, Carlson AR, Bartlett SP, Heuer GG, Tucker AM, Taylor JA, Lang SS, Swanson JW. Elevated intracranial pressure with craniosynostosis: a multivariate model of age, syndromic status, and number of involved cranial sutures. J Neurosurg Pediatr 2021:1-8. [PMID: 34560658 DOI: 10.3171/2021.6.peds21162] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 06/10/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Children with multiple prematurely fused cranial sutures and those undergoing surgical correction later in life appear to experience worse neurocognitive outcomes, but it is unclear whether higher intracranial pressure (ICP) is implicated in this process. The purpose of this study was to elucidate the effect of age at intervention and number of involved cranial sutures on ICP, as well as to assess which cranial suture closure may be more associated with elevated ICP. METHODS The prospective craniofacial database at the authors' institution was queried for patients undergoing initial corrective surgery for craniosynostosis in whom intraoperative measurement of ICP was obtained prior to craniectomy. Age, involved sutures, and syndromic status were analyzed in the context of measured ICP by using multiple linear regression. RESULTS Fifty patients met the inclusion criteria. Age at procedure (p = 0.028, β = +0.060 mm Hg/month) and multiple-suture involvement (p = 0.010, β = +4.175 mm Hg if multisuture) were both significantly implicated in elevated ICP. The actual number of major sutures involved was significantly correlated to ICP (p = 0.001; β = +1.687 mm Hg/suture). Among patients with single-suture involvement, there was an overall significant difference of median ICP across the suture types (p = 0.008), with metopic having the lowest (12.5 mm Hg) and sagittal having the highest (16.0 mm Hg). Patients with multiple-suture involvement had significantly higher ICP (p = 0.003; 18.5 mm Hg). Patients with craniofacial syndromes were 79.3 times more likely to have multiple-suture involvement (p < 0.001). Corrective surgery for craniosynostosis demonstrated significant intraoperative reduction of elevated ICP (all p < 0.050). CONCLUSIONS Syndromic status, older age at intervention for craniosynostosis, and multiple premature fusion of cranial sutures were associated with significantly higher ICP.
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Affiliation(s)
- Christopher L Kalmar
- 1Division of Plastic and Reconstructive Surgery, Children's Hospital of Philadelphia; and
| | - Zachary D Zapatero
- 1Division of Plastic and Reconstructive Surgery, Children's Hospital of Philadelphia; and
| | - Mychajlo S Kosyk
- 1Division of Plastic and Reconstructive Surgery, Children's Hospital of Philadelphia; and
| | - Anna R Carlson
- 1Division of Plastic and Reconstructive Surgery, Children's Hospital of Philadelphia; and
| | - Scott P Bartlett
- 1Division of Plastic and Reconstructive Surgery, Children's Hospital of Philadelphia; and
| | - Gregory G Heuer
- 2Division of Neurosurgery, Children's Hospital of Philadelphia, Pennsylvania
| | - Alexander M Tucker
- 2Division of Neurosurgery, Children's Hospital of Philadelphia, Pennsylvania
| | - Jesse A Taylor
- 1Division of Plastic and Reconstructive Surgery, Children's Hospital of Philadelphia; and
| | - Shih-Shan Lang
- 2Division of Neurosurgery, Children's Hospital of Philadelphia, Pennsylvania
| | - Jordan W Swanson
- 1Division of Plastic and Reconstructive Surgery, Children's Hospital of Philadelphia; and
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Van Adrichem LNA, Kronig SAJ, Kronig ODM. Validation of Skully Care as a Fast Method for Quantifying Positional Cranial Deformities. Cleft Palate Craniofac J 2021; 59:1107-1113. [PMID: 34559019 PMCID: PMC9411692 DOI: 10.1177/10556656211035022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective Craniofacial measuring is valuable for diagnosis and evaluation of growth and treatment of positional skull deformities. Plagiocephalometry (PCM) quantifies skull deformities and is proven to be reliable and valid. However, PCM needs direct skin contact with thermoplastic material, is laborious and time-consuming. Therefore, Skully Care (SC) was developed to measure positional skull deformities with a smartphone application. Design SC is retrospectively compared to PCM. Setting Pediatric physiotherapy centers. Patients Age ≤1 year, analyzed or treated for positional skull deformities. Interventions A total of 60 skull shape analyses were performed. Main Outcome Measures The main outcome measures employed are Pearson correlation coefficient between cranial vault asymmetry index (CVAI; in SC) and oblique diameter difference index (ODDI; in PCM) and between cranial index (CI; in SC) and cranial proportional index (CPI; in PCM). Mann–Whitney U test determined difference of time consumption between PCM and SC. Results High correlation was found between CVAI and ODDI (r = 0.849; P < .01) in positional plagiocephaly and very high correlation between CI and CPI (r = 0.938; P < .01) in positional brachycephaly. SC is significantly faster than PCM (P < .001). Conclusions SC is valid in analyzing positional skull deformities and strongly correlates to PCM, the gold standard in daily physiotherapy practice. The combination of simplicity, validity, speed, and user and child convenience makes SC a promising craniofacial measuring method in daily practice. SC has potential to be the modern successor for analyzing positional skull deformities.
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Affiliation(s)
- Léon N A Van Adrichem
- Department of Plastic and Reconstructive Surgery and Hand Surgery, 8124University Medical Center Utrecht, the Netherlands
| | - Sophia A J Kronig
- Department of Plastic and Reconstructive Surgery and Hand Surgery, 8124University Medical Center Utrecht, the Netherlands
| | - Otto D M Kronig
- Department of Plastic and Reconstructive Surgery and Hand Surgery, 8124University Medical Center Utrecht, the Netherlands
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Craniofacial Surgery-Related Hashtag Utilisation on Instagram. J Craniofac Surg 2021; 32:2035-2040. [PMID: 33770046 DOI: 10.1097/scs.0000000000007593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Patients, parents, and carers are increasingly using social media to access and contribute to health information. There are currently 3.484 billion active social media users. Instagram is a primarily visual social media platform for sharing photographs and videos with currently over one billion monthly active users. Limited research has investigated the use of Instagram in healthcare contexts including plastic surgery, and in the treatment of specific conditions, such as fibromyalgia and scoliosis. This study aimed to investigate the use of Instagram in relation to craniofacial surgery. METHODS The authors investigated the use of 12 Instagram craniofacial surgery-related hashtags. Quantitative and qualitative data were collected for each of the "top" nine posts associated with each hashtag. Duplicate posts, posts not in English and those not relevant to craniofacial surgery were excluded.Thematic analysis was then used to qualitatively evaluate the captions and comments of each of the nine "top" posts associated with each hashtag. RESULTS A total number of 151,738 posts were identified using the 12 hashtags queried in the present study, with #craniofacial being the most popular hashtag (87% of posts). Parents (n = 25, 33%) and surgeons (n = 25, 33%) were responsible for the majority of posts. A heterogenous group were responsible for the remaining 34% of posts.Results indicated that parents and surgeons posted significantly different images (chi-squared with Yates correlation is 25.0519, P < 0.00001). Parents' posts were predominantly images of their child/patients (n = 24) compared to posts about patients by surgeons (n = 6). Posts by surgeons were predominantly images of professionals (n = 14) compared to images of professionals posted by parents (n = 1).Results of qualitative analysis of captions of posts indicated a significant difference in themes that emerged between parents and surgeons; with surgeons largely using Instagram for information giving, and parents for sharing of experiences (chi-square (n = 108) = 40.83, P < 0.00001).There was a significant difference (two-tailed t test, P = 0.002) in engagement (measured by the number of likes on posts) on posts by parents (mean = 3778) compared to posts by surgeons (mean = 135.4). CONCLUSIONS Results indicate that craniofacial-surgery related posts on Instagram provide a medium to allow individuals and families with rare disorders to connect and share their experiences. The use of Instagram to share information about craniofacial abnormalities via Instagram has the potential to be used by healthcare professionals to educate and support patients and families.
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Osborn AJ, Roberts RM, Dorstyn DS, Grave BG, David DJ. Sagittal Synostosis and Its Association With Cognitive, Behavioral, and Psychological Functioning: A Meta-analysis. JAMA Netw Open 2021; 4:e2121937. [PMID: 34515785 PMCID: PMC8438597 DOI: 10.1001/jamanetworkopen.2021.21937] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
IMPORTANCE Findings on the cognitive, behavioral, and psychological functioning of individuals with sagittal synostosis (SS) are highly disparate, limiting their clinical utility. OBJECTIVE To identify and review research on individuals with SS and to determine whether, and to what extent, they experience cognitive, behavioral, and psychological difficulties compared with their healthy peers or normative data for each measure. DATA SOURCES PubMed, Scopus, Embase, and PsycINFO were searched through January 2021 with no date restrictions. Scopus citation searches and manual checks of the reference lists of included studies were conducted. STUDY SELECTION Studies included participants of any age who had received a diagnosis of single-suture (isolated or nonsyndromic) SS or scaphocephaly and who had been assessed on cognitive, behavioral, and psychological outcomes. DATA EXTRACTION AND SYNTHESIS Data were independently extracted by 2 reviewers. Case-control outcomes (individuals with SS vs healthy peers or normative data) were compared using random-effects models with 3 effect sizes calculated: weighted Hedges g (gw), odds ratios (ORs), and mean prevalence rates. This study follows the Meta-analysis of Observational Studies in Epidemiology (MOOSE) reporting guidelines. MAIN OUTCOMES AND MEASURES Findings were categorized by surgical status (conservatively managed, presurgery, postsurgery, or combined); domain (eg, general cognition); type of cognitive, behavioral, or psychological measure (objective or subjective); and source of comparison data (peers or normative data). RESULTS Data from 32 studies, involving a pooled sample of 1422 children and adults with SS (mean [SD] age at assessment, 5.7 [6.6] years; median [interquartile range] age, 3.3 [0.5-10.3] years), were analyzed. Data on sex were available for 824 participants, and 642 (78%) were male. Individual study results varied substantially. Objective tests identified significant moderate group differences on 3 of 16 examined domains: presurgical motor functioning (3 studies; gw = -0.42; 95% CI, -0.67 to -0.18; P < .001), postsurgical short-term memory (2 studies; gw = -0.45; 95% CI, -0.72 to -0.17; P < .001), and postsurgical visuospatial ability (6 studies; gw = 0.31; 95% CI, 0.18 to 0.44; P < .001). Prevalence estimates and ORs varied widely, with 15 studies showing prevalence estimates ranging from 3% to 37%, and 3 studies showing ORs ranging from 0.31 (95% CI, 0.01 to 6.12) for processing speed in the conservatively managed sample to 4.55 (95% CI, 0.21 to 98.63) for postsurgical visuospatial abilities. CONCLUSIONS AND RELEVANCE In this meta-analysis, findings for the functioning of participants with SS were highly disparate and often of low quality, with small samples sizes and control groups rarely recruited. Nonetheless, the findings suggest that some individuals with SS experience negative outcomes, necessitating routine assessment.
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Affiliation(s)
- Amanda J. Osborn
- School of Psychology, The University of Adelaide, Adelaide, South Australia, Australia
| | - Rachel M. Roberts
- School of Psychology, The University of Adelaide, Adelaide, South Australia, Australia
| | - Diana S. Dorstyn
- School of Psychology, The University of Adelaide, Adelaide, South Australia, Australia
| | - Ben G. Grave
- Craniofacial Australia, North Adelaide, South Australia, Australia
| | - David J. David
- Craniofacial Australia, North Adelaide, South Australia, Australia
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Can DDT, Lepard JR, Anh NM, Tuan PA, Tuan TD, Son VT, Grant JH, Johnston JM. Nonsyndromic craniosynostosis in Vietnam: initial surgical outcomes of subspecialty mentorship. J Neurosurg Pediatr 2021; 28:508-515. [PMID: 34450594 DOI: 10.3171/2021.5.peds20932] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 05/10/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE There is a global deficit of pediatric neurosurgical care, and the epidemiology and overall surgical care for craniosynostosis is not well characterized at the global level. This study serves to highlight the details and early surgical results of a neurosurgical educational partnership and subsequent local scale-up in craniosynostosis correction. METHODS A prospective case series was performed with inclusion of all patients undergoing correction of craniosynostosis by extensive cranial vault remodeling at Children's Hospital 2, Ho Chi Minh City, Vietnam, between January 1, 2015, and December 31, 2019. RESULTS A total of 76 patients were included in the study. The group was predominantly male, with a male-to-female ratio of 3.3:1. Sagittal synostosis was the most common diagnosis (50%, 38/76), followed by unilateral coronal (11.8%, 9/76), bicoronal (11.8%, 9/76), and metopic (7.9%, 6/76). The most common corrective technique was anterior cranial vault remodeling (30/76, 39.4%) followed by frontoorbital advancement (34.2%, 26/76). The overall mean operative time was 205.8 ± 38.6 minutes, and the estimated blood loss was 176 ± 89.4 mL. Eleven procedures were complicated by intraoperative durotomy (14.5%, 11/76) without any damage of dural venous sinuses or brain tissue. Postoperatively, 4 procedures were complicated by wound infection (5.3%, 4/76), all of which required operative wound debridement. There were no neurological complications or postoperative deaths. One patient required repeat reconstruction due to delayed intracranial hypertension. There was no loss to follow-up. All patients were followed at outpatient clinic, and the mean follow-up period was 32.3 ± 18.8 months postoperatively. CONCLUSIONS Surgical care for pediatric craniosynostosis can be taught and sustained in the setting of collegial educational partnerships with early capability for high surgical volume and safe outcomes. In the setting of the significant deficit in worldwide pediatric neurosurgical care, this study provides an example of the feasibility of such relationships in addressing this unmet need.
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Affiliation(s)
- Dang Do Thanh Can
- 1University of Medicine and Pharmacy at Ho Chi Minh City, Vietnam.,2Neurosurgical Department, Children's Hospital 2, Ho Chi Minh City, Vietnam
| | - Jacob R Lepard
- 3Department of Neurological Surgery, University of Alabama at Birmingham, Birmingham, Alabama.,4Section of Pediatric Neurosurgery, Children's of Alabama, Birmingham, Alabama; and
| | - Nguyen Minh Anh
- 1University of Medicine and Pharmacy at Ho Chi Minh City, Vietnam
| | - Pham Anh Tuan
- 1University of Medicine and Pharmacy at Ho Chi Minh City, Vietnam
| | - Tran Diep Tuan
- 1University of Medicine and Pharmacy at Ho Chi Minh City, Vietnam
| | - Vo Tan Son
- 1University of Medicine and Pharmacy at Ho Chi Minh City, Vietnam
| | - John H Grant
- 5Department of Plastic Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - James M Johnston
- 3Department of Neurological Surgery, University of Alabama at Birmingham, Birmingham, Alabama.,4Section of Pediatric Neurosurgery, Children's of Alabama, Birmingham, Alabama; and
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Rufai SR, Hisaund M, Jeelani NUO, McLean RJ. Detection of intracranial hypertension in children using optical coherence tomography: a systematic review. BMJ Open 2021; 11:e046935. [PMID: 34380720 PMCID: PMC8359522 DOI: 10.1136/bmjopen-2020-046935] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES To evaluate the diagnostic capability of optical coherence tomography (OCT) in children aged under 18 years old with intracranial hypertension (IH). DESIGN Systematic review. METHODS We conducted a systematic review using the following platforms to search the keywords 'optical coherence tomography' and 'intracranial hypertension' from inception to 2 April 2020: Cochrane Central Register of Controlled Trials, EMBASE, MEDLINE, PubMed and Web of Science, without language restrictions. Our search returned 2729 records, screened by two independent screeners. Studies were graded according to the Oxford Centre for Evidence-Based Medicine and National Institutes of Health Quality Assessment Tool for observational studies. RESULTS Twenty-one studies were included. Conditions included craniosynostosis (n=354 patients), idiopathic IH (IIH; n=102), space-occupying lesion (SOL; n=42) and other pathology (n=29). OCT measures included optic nerve parameters, rim parameters (notably retinal nerve fibre layer thickness) and retinal parameters. Levels of evidence included 2b (n=13 studies), 3b (n=4) and 4 (n=4). Quality of 10 studies was fair and 11 poor. There was inconsistency in OCT parameters and reference measures studied, although OCT did demonstrate good diagnostic capability for IH in craniosynostosis, IIH and SOL. CONCLUSIONS This systematic review identified various studies involving OCT to assist diagnosis and management of IH in children with craniosynostosis, IIH, SOL and other pathology, in conjunction with established clinical measures of intracranial pressure. However, no level 1 evidence was identified. Validating prospective studies are, therefore, required to determine optimal OCT parameters in this role and to develop formal clinical guidelines. PROSPERO REGISTRATION NUMBER CRD42019154254.
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Affiliation(s)
- Sohaib R Rufai
- University of Leicester Ulverscroft Eye Unit, Leicester Royal Infirmary, Leicester, UK
- UCL Great Ormond Street Institute of Child Health and Craniofacial Unit, Great Ormond Street Hospital for Children, London, UK
- Clinical and Academic Department of Ophthalmology, Great Ormond Street Hospital for Children, London, UK
| | - Michael Hisaund
- University of Leicester Ulverscroft Eye Unit, Leicester Royal Infirmary, Leicester, UK
| | - Noor Ul Owase Jeelani
- UCL Great Ormond Street Institute of Child Health and Craniofacial Unit, Great Ormond Street Hospital for Children, London, UK
| | - Rebecca J McLean
- University of Leicester Ulverscroft Eye Unit, Leicester Royal Infirmary, Leicester, UK
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Influence of Monobloc/Le Fort III Surgery on the Developing Posterior Maxillary Dentition and Its Resultant Effect on Orthognathic Surgery. Plast Reconstr Surg 2021; 147:253e-259e. [PMID: 33235043 DOI: 10.1097/prs.0000000000007539] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Timing of frontofacial surgery for the syndromic craniosynostosis as it relates to various surgical risks has not been adequately studied. The purpose of this study was to investigate posterior dental complications of midface advancement in patients with syndromic craniosynostosis undergoing surgery at different ages and the effects on subsequent orthognathic surgery. METHODS A retrospective chart review of patients with syndromic craniosynostosis treated with midface advancement (monobloc or Le Fort III) from 1999 to 2018 was carried out. Patient demographics, records, and imaging studies were reviewed. A subanalysis of those patients who were also treated with orthognathic surgery from 2014 to 2018 with imaging studies available for analysis was also performed. RESULTS Thirty-seven patients met the inclusion criteria. Sixty-four percent of the patients had radiographic evidence of maxillary molar dental abnormality. Older age at the time of surgery was significantly associated with a lower odds of sustaining dental injury (OR, 0.55; p = 0.034). The odds of damaging second or third maxillary molars was significantly higher with a younger age at the time of surgery (p = 0.021 and p = 0.034). The odds of sustaining dental injury increased moving posteriorly, showing the risk of abnormal pattern of M3 greater than M2 greater than M1. Advanced age at the time of surgery was significantly associated with decreased odds of dental injury (OR, 0.55; p = 0.034). CONCLUSIONS Damage to the developing permanent maxillary molars may affect orthodontic management, mastication, and potentially maxillary development. Delaying frontofacial surgery until development of the permanent maxillary dentition should be considered if other indications do not mandate earlier intervention.
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Ciliary Signalling and Mechanotransduction in the Pathophysiology of Craniosynostosis. Genes (Basel) 2021; 12:genes12071073. [PMID: 34356089 PMCID: PMC8306115 DOI: 10.3390/genes12071073] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 07/10/2021] [Accepted: 07/13/2021] [Indexed: 12/25/2022] Open
Abstract
Craniosynostosis (CS) is the second most prevalent inborn craniofacial malformation; it results from the premature fusion of cranial sutures and leads to dimorphisms of variable severity. CS is clinically heterogeneous, as it can be either a sporadic isolated defect, more frequently, or part of a syndromic phenotype with mendelian inheritance. The genetic basis of CS is also extremely heterogeneous, with nearly a hundred genes associated so far, mostly mutated in syndromic forms. Several genes can be categorised within partially overlapping pathways, including those causing defects of the primary cilium. The primary cilium is a cellular antenna serving as a signalling hub implicated in mechanotransduction, housing key molecular signals expressed on the ciliary membrane and in the cilioplasm. This mechanical property mediated by the primary cilium may also represent a cue to understand the pathophysiology of non-syndromic CS. In this review, we aimed to highlight the implication of the primary cilium components and active signalling in CS pathophysiology, dissecting their biological functions in craniofacial development and in suture biomechanics. Through an in-depth revision of the literature and computational annotation of disease-associated genes we categorised 18 ciliary genes involved in CS aetiology. Interestingly, a prevalent implication of midline sutures is observed in CS ciliopathies, possibly explained by the specific neural crest origin of the frontal bone.
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Dunaway DJ, Budden C, Ong J, James G, Jeelani NUO. Monobloc Distraction and Facial Bipartition Distraction with External Devices. Clin Plast Surg 2021; 48:507-519. [PMID: 34051902 DOI: 10.1016/j.cps.2021.03.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Monobloc and bipartition advancement by external distraction plays a major role in the treatment of syndromic craniosynostosis. They can reverse the associated facial deformity and play a role in the management of ocular exposure, intracranial hypertension, and upper airway obstruction. Facial bipartition distraction corrects the intrinsic facial deformities of Apert syndrome. Both procedures are associated with relatively high complication rates principally related to ascending infection and persistent cerebrospinal fluid leaks. Modern perioperative management has resulted in a significant decline in complications. External distractors allow fine tuning of distraction vectors and improve outcome but are less well tolerated than internal distractors.
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Affiliation(s)
- David J Dunaway
- Great Ormond Street Hospital for Children, Great Ormond Street, London WC1N 7JH, UK.
| | - Curtis Budden
- Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, 8440 112 Street, Edmonton, AB T6G 2B7, Canada
| | - Juling Ong
- Great Ormond Street Hospital for Children, Great Ormond Street, London WC1N 7JH, UK
| | - Greg James
- Great Ormond Street Hospital for Children, Great Ormond Street, London WC1N 7JH, UK
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Frič R, Langvatn EA, Due-Tønnessen BJ, Eide PK. The role of pulsatile and static intracranial pressure measurements in the management of children with craniosynostosis-an institutional experience from 49 patients. Acta Neurochir (Wien) 2021; 163:2015-2023. [PMID: 33389123 DOI: 10.1007/s00701-020-04680-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 12/14/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Although measurement of intracranial pressure (ICP) has occasionally been utilized in children with craniosynostosis (CSS), data on parameters of pulsatile ICP in CSS are still lacking, and the role of pulsatile ICP measurements in the management of CSS is not well established. METHODS From our department's database, we retrieved the data from children in whom the measurement of static and pulsatile ICP was a part of the diagnostic work-up in different clinical situations related to CSS. Both clinical and ICP data were retrospectively reviewed and analyzed. RESULTS We identified 49 children with CSS, median age 4.4 years (range 0.2-18.9), in whom a total of 67 diagnostic ICP measurements were undertaken between 2002 and 2014. The CSS was syndromal in 23 cases. The rationale for ICP measurement was a question of indication for cranial vault expansion surgery (CVES) in 12 patients (Group 1), of its timing in 10 patients (Group 2), of suspected abnormally elevated ICP or hydrocephalus in 11 patients (Group 3), of indication for repeated CVES in 13 patients (Group 4), or shunt dysfunction in three patients (Group 5). The average mean ICP for the whole cohort was 15.1 ± 5.5 mmHg and mean wave amplitude (MWA) 5.3 ± 2.2 mmHg. There was no significant difference in ICP parameters when compared between Groups 1-5. Fundoscopy revealed papilledema in five out of 32 children (15.6%). There were significantly higher parameters of pulsatile ICP (MWA) in patients with papilledema, but no statistically significant difference in parameters of static ICP. CONCLUSIONS In this cohort of pediatric patients with CSS presenting with various diagnostic challenges, we found the diagnostic measurement of static and pulsatile ICP useful in selecting the optimal treatment modality and timing of surgery. Papilledema was associated with elevated pulsatile ICP, a parameter that in previous studies has been shown to correlate with impaired intracranial compliance.
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Cross C, Khonsari RH, Galiay L, Patermoster G, Johnson D, Ventikos Y, Moazen M. Using Sensitivity Analysis to Develop a Validated Computational Model of Post-operative Calvarial Growth in Sagittal Craniosynostosis. Front Cell Dev Biol 2021; 9:621249. [PMID: 34124030 PMCID: PMC8187911 DOI: 10.3389/fcell.2021.621249] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 04/21/2021] [Indexed: 11/13/2022] Open
Abstract
Craniosynostosis is the premature fusion of one or more sutures across the calvaria, resulting in morphological and health complications that require invasive corrective surgery. Finite element (FE) method is a powerful tool that can aid with preoperative planning and post-operative predictions of craniosynostosis outcomes. However, input factors can influence the prediction of skull growth and the pressure on the growing brain using this approach. Therefore, the aim of this study was to carry out a series of sensitivity studies to understand the effect of various input parameters on predicting the skull morphology of a sagittal synostosis patient post-operatively. Preoperative CT images of a 4-month old patient were used to develop a 3D model of the skull, in which calvarial bones, sutures, cerebrospinal fluid (CSF), and brain were segmented. Calvarial reconstructive surgery was virtually modeled and two intracranial content scenarios labeled “CSF present” and “CSF absent,” were then developed. FE method was used to predict the calvarial morphology up to 76 months of age with intracranial volume-bone contact parameters being established across the models. Sensitivity tests with regards to the choice of material properties, methods of simulating bone formation and the rate of bone formation across the sutures were undertaken. Results were compared to the in vivo data from the same patient. Sensitivity tests to the choice of various material properties highlighted that the defined elastic modulus for the craniotomies appears to have the greatest influence on the predicted overall skull morphology. The bone formation modeling approach across the sutures/craniotomies had a considerable impact on the level of contact pressure across the brain with minimum impact on the overall predicated morphology of the skull. Including the effect of CSF (based on the approach adopted here) displayed only a slight reduction in brain pressure outcomes. The sensitivity tests performed in this study set the foundation for future comparative studies using FE method to compare outcomes of different reconstruction techniques for the management of craniosynostosis.
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Affiliation(s)
- Connor Cross
- Department of Mechanical Engineering, University College London, London, United Kingdom
| | - Roman H Khonsari
- Service de Chirurgie Maxillo-Faciale et Plastique, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Leila Galiay
- Service de Chirurgie Maxillo-Faciale et Plastique, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Giovanna Patermoster
- Department of Neurosurgery, Craniofacial 16 Surgery Unit, Necker-Enfants Malades University Hospital, Assistance Publique-Hôpitaux de 17 Paris, Université de Paris, Paris, France
| | - David Johnson
- Oxford Craniofacial Unit, Oxford University Hospital, NHS Foundation Trust, Oxford, United Kingdom
| | - Yiannis Ventikos
- Department of Mechanical Engineering, University College London, London, United Kingdom
| | - Mehran Moazen
- Department of Mechanical Engineering, University College London, London, United Kingdom
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Grewal JS, Cohn JE, Burdett J, Tampio A, Licata J, Davis WJ, Tatum SA, Nicholas BD. Otitis Media and Hearing Loss in Patients With Nonsyndromic Craniosynostosis: A Multicenter Study. Cleft Palate Craniofac J 2021; 59:652-658. [PMID: 34000844 DOI: 10.1177/10556656211017795] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES The objectives of this study were to: (1) determine the prevalence of otitis media with effusion in patients with nonsyndromic craniosynostosis; (2) determine the prevalence of hearing loss in patients with nonsyndromic craniosynostosis; and (3) identify potential patterns and outcomes in patients with nonsyndromic craniosynostosis. METHODS A retrospective chart review was conducted at 2 academic institutions, St Christopher's Hospital for Children and SUNY Upstate Medical University, from January 2015 through August 2018, to identify patients having nonsyndromic craniosynostosis with a concurrent diagnosis of otitis media and/or hearing loss. The demographic data and categorical variables were analyzed using descriptive statistics and chi-square testing, respectively. RESULTS In the entire cohort of patients (N = 113, age range 0-123 months), 36% had otitis media with effusion on either history, physical examination, tympanometry, and/or imaging. Half (50%) of patients with coronal synostosis had otitis media with effusion compared to sagittal (40.7%), metopic (26.3%), multiple (25%), and lambdoid (0%). However, these differences were not statistically significant (P = .190). Most patients had normal hearing (91%), while a minority had either conductive (7%) or sensorineural (2%) hearing loss. CONCLUSION The presence of otitis media in our cohort of patients with nonsyndromic craniosynostosis appears to be at the upper limit of normal when compared to historical rates in normocephalic children. Synostosis subtype did not appear to predict the presence of otitis media. Only 9% of patients with nonsyndromic craniosynostosis were found to have a hearing loss.
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Affiliation(s)
- Jeewanjot S Grewal
- Department of Otolaryngology-Head and Neck Surgery, 2971Henry Ford Hospital, Detroit, MI, USA
| | - Jason E Cohn
- Department of Otolaryngology-Head and Neck Surgery, 6556Philadelphia College of Osteopathic Medicine, Philadelphia, PA, USA
| | - Jacob Burdett
- Department of Otolaryngology-Head and Neck Surgery, 6556Philadelphia College of Osteopathic Medicine, Philadelphia, PA, USA
| | - Alex Tampio
- Department of Otolaryngology and Communication Sciences, 12302SUNY Upstate Medical University, Syracuse, NY, USA
| | - Jordan Licata
- Department of Otolaryngology-Head and Neck Surgery, 6556Philadelphia College of Osteopathic Medicine, Philadelphia, PA, USA
| | - Wellington J Davis
- Department of Pediatric Plastic and Reconstructive Surgery, Lehigh Valley Health Network, Allentown, PA, USA
| | - Sherard A Tatum
- Department of Otolaryngology and Communication Sciences, 12302SUNY Upstate Medical University, Syracuse, NY, USA
| | - Brian D Nicholas
- Department of Otolaryngology and Communication Sciences, 12302SUNY Upstate Medical University, Syracuse, NY, USA
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77
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Humphries LS, Swanson JW, Bartlett SP, Taylor JA. Craniosynostosis: Posterior Cranial Vault Remodeling. Clin Plast Surg 2021; 48:455-471. [PMID: 34051898 DOI: 10.1016/j.cps.2021.03.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Posterior cranial vault distraction osteogenesis is a powerful, reliable, low-morbidity method to achieve intracranial expansion. It is particularly useful in treating turribrachycephaly seen in syndromic craniosynostosis, allowing for gradual expansion of the bone while stretching the soft tissues over several weeks allowing greater volumetric expansion than conventional techniques. Posterior cranial vault distraction osteogenesis constitutes a more gradual remodeling modality, with infrequent complications. As a first step in intracranial expansion, it preserves the frontal cranium for future frontofacial procedures. A drawback is the need for a second surgery to remove the device, and this must be taken into account during counseling.
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Affiliation(s)
- Laura S Humphries
- Division of Plastic and Reconstructive Surgery, University of Mississippi Medical Center, Children's of Mississippi Hospital, 2500 N. State Street, Jackson, MS 39216, USA. https://twitter.com/ls_humphries
| | - Jordan W Swanson
- Division of Plastic and Reconstructive Surgery, The Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA 19104, USA
| | - Scott P Bartlett
- Division of Plastic and Reconstructive Surgery, The Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA 19104, USA
| | - Jesse A Taylor
- Division of Plastic and Reconstructive Surgery, The Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA 19104, USA.
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Kulker D, Louisy A, Listrat A, Travers N, Pare A, Laure B. Is reverse frontal cranioplasty eligible for the correction of both the forehead deformities and the intracranial hypertension in craniosynostosis? Comparison of the preoperative and postoperative intracranial volumes. J Craniomaxillofac Surg 2021; 49:815-822. [PMID: 34217566 DOI: 10.1016/j.jcms.2021.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 02/21/2021] [Accepted: 03/20/2021] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND This study aimed to describe the surgical technique of reverse frontal cranioplasty (RFC), the aesthetical modification as well as the modification of intracranial volume (ICV) to assess its potential eligibility for the treatment of the intracranial hypertension (IH). MATERIALS AND METHODS A retrospective monocentric study included the patients with a history of craniosynostosis with a forehead deformity who underwent RFC. A subjective outcome questionnaire (SOQ) was conducted with each patient or their parent to determine their level of satisfaction after RFC. Pre- and postoperative computed tomography (CT) scans were analyzed and compared to investigate the ICV change and fronto-nasal angle. RESULTS Eleven patients were included in the study (6 female and 5 male) with a mean age of 10.9 years old (range 3-23 years) and an average follow-up of 4.5 years (1-11 years). All patients responded to the questionnaire with a high level of overall satisfaction (mean 9.1/10). The mean preoperative FNA was 134° ± 5° while the mean postoperative angle was 126.4° ± 6, corresponding to an average decrease of 7.6° (95% CI, 4.0-11.2°; p < 0.001). One patient with preoperative IH had a clinical recurrence during the follow-up. The ICV was significantly higher after the surgery (p < 0.0001), with an average increase of 3.2% (95% CI, 2.3-4.1%). CONCLUSION Reverse (RFC) is a useful technique for the correction of the frontal malformations related to craniosynostosis, such as a sloping forehead and/or a lack of the supraorbital projection. Regarding the limited gain of intracranial volume (ICV), it should not be used alone as primary cranial expansion surgery for craniosynostosis with intracranial hypertension (IH).
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Affiliation(s)
- D Kulker
- Department of Maxillofacial and Plastic Surgery, Burns Unit, Trousseau Hospital, 37000, Tours, France; University of François Rabelais, School of Medicine, 37000, Tours, France.
| | - A Louisy
- Department of Maxillofacial and Plastic Surgery, Burns Unit, Trousseau Hospital, 37000, Tours, France; University of François Rabelais, School of Medicine, 37000, Tours, France
| | - A Listrat
- Department of Pediatric Neurosurgery, Clocheville Hospital, Reference Center for Rare Craniofacial Malformations, Tours University Hospital, 37000, France
| | - N Travers
- Department of Pediatric Neurosurgery, Clocheville Hospital, Reference Center for Rare Craniofacial Malformations, Tours University Hospital, 37000, France
| | - A Pare
- Department of Maxillofacial and Plastic Surgery, Burns Unit, Trousseau Hospital, 37000, Tours, France; University of François Rabelais, School of Medicine, 37000, Tours, France
| | - B Laure
- Department of Maxillofacial and Plastic Surgery, Burns Unit, Trousseau Hospital, 37000, Tours, France; University of François Rabelais, School of Medicine, 37000, Tours, France; Department of Pediatric Maxillofacial Surgery and Craniofacial Surgery, Clocheville Hospital, Reference Center for Rare Craniofacial Malformations, Tours University Hospital, 37000, France
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79
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Kim BS, Shin HR, Kim HJ, Yoon H, Cho YD, Choi KY, Choi JY, Kim WJ, Ryoo HM. Septal chondrocyte hypertrophy contributes to midface deformity in a mouse model of Apert syndrome. Sci Rep 2021; 11:7979. [PMID: 33846505 PMCID: PMC8041873 DOI: 10.1038/s41598-021-87260-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 03/24/2021] [Indexed: 11/25/2022] Open
Abstract
Midface hypoplasia is a major manifestation of Apert syndrome. However, the tissue component responsible for midface hypoplasia has not been elucidated. We studied mice with a chondrocyte-specific Fgfr2S252W mutation (Col2a1-cre; Fgfr2S252W/+) to investigate the effect of cartilaginous components in midface hypoplasia of Apert syndrome. In Col2a1-cre; Fgfr2S252W/+ mice, skull shape was normal at birth, but hypoplastic phenotypes became evident with age. General dimensional changes of mutant mice were comparable with those of mice with mutations in EIIa-cre; Fgfr2S252W/+, a classic model of Apert syndrome in mice. Col2a1-cre; Fgfr2S252W/+ mice showed some unique facial phenotypes, such as elevated nasion, abnormal fusion of the suture between the premaxilla and the vomer, and decreased perpendicular plate of the ethmoid bone volume, which are related to the development of the nasal septal cartilage. Morphological and histological examination revealed that the presence of increased septal chondrocyte hypertrophy and abnormal thickening of nasal septum is causally related to midface deformities in nasal septum-associated structures. Our results suggest that careful examination and surgical correction of the nasal septal cartilage may improve the prognosis in the surgical treatment of midface hypoplasia and respiratory problems in patients with Apert syndrome.
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Affiliation(s)
- Bong-Soo Kim
- Department of Molecular Genetics and Dental Pharmacology, School of Dentistry and Dental Research Institute, Seoul National University, Seoul, South Korea
| | - Hye-Rim Shin
- Department of Molecular Genetics and Dental Pharmacology, School of Dentistry and Dental Research Institute, Seoul National University, Seoul, South Korea
| | - Hyun-Jung Kim
- Department of Molecular Genetics and Dental Pharmacology, School of Dentistry and Dental Research Institute, Seoul National University, Seoul, South Korea
| | - Heein Yoon
- Department of Molecular Genetics and Dental Pharmacology, School of Dentistry and Dental Research Institute, Seoul National University, Seoul, South Korea
| | - Young-Dan Cho
- Department of Periodontology, School of Dentistry and Dental Research Institute, Seoul National University, Seoul, South Korea
| | - Kang-Young Choi
- Department of Plastic and Reconstructive Surgery, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Je-Yong Choi
- Department of Biochemistry and Cell Biology, Cell and Matrix Research Institute, Skeletal Disease Analysis Center, Korea Mouse Phenotyping Center (KMPC), School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Woo-Jin Kim
- Department of Molecular Genetics and Dental Pharmacology, School of Dentistry and Dental Research Institute, Seoul National University, Seoul, South Korea.
| | - Hyun-Mo Ryoo
- Department of Molecular Genetics and Dental Pharmacology, School of Dentistry and Dental Research Institute, Seoul National University, Seoul, South Korea.
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O’Sullivan H, Bracken S, Doyle J, Twomey E, Murray DJ, Kyne L. X-rays had little value in diagnosing children's abnormal skull shapes, and primary care clinicians should refer concerns to specialist teams. Acta Paediatr 2021; 110:1330-1334. [PMID: 33226692 PMCID: PMC8246982 DOI: 10.1111/apa.15686] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 10/10/2020] [Accepted: 11/20/2020] [Indexed: 11/29/2022]
Abstract
Aim This study examined the consensus between the primary care radiological diagnosis and specialist clinical diagnosis of abnormal skull shapes in children. Methods We performed a retrospective review of children treated at the National Paediatric Craniofacial Centre at Children's Health Ireland, Dublin, Ireland. Group 1 were referred by primary care colleagues concerned about suspected abnormal skull shapes from 1 January 2015 to 30 May 2017. These included cases where they sought specialist confirmation that the skull shape was normal. Group 2 underwent surgery for craniosynostosis from 1 January 2011 to 25 October 2017. The primary care skull X‐ray reports were examined for both groups to see whether they matched the specialist diagnosis. Results Group 1 comprised 300 children, and 59 (20%) had pre‐referral skull X‐rays. The primary care X‐ray reports and specialist diagnoses agreed in 44 (75%) cases, including 19 (43%) who had a normal skull shape. Group 2 comprised 274 children, and 63 (23%) had pre‐referral skull X‐rays. In this group, there was agreement in 41 (65%) diagnoses; however, the primary care X‐ray reports did not diagnose craniosynostosis for the remaining 22 (35%) children. Conclusion X‐rays were of little value in diagnosing abnormal skull shapes, especially craniosynostosis, and primary care clinicians should refer concerns to specialist teams.
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Affiliation(s)
- Hugh O’Sullivan
- Department of Paediatrics Children’s Health Ireland at Temple Street Dublin Ireland
| | - Shirley Bracken
- National Paediatric Craniofacial Centre Children’s Health Ireland at Temple Street Dublin Ireland
| | - Jodie Doyle
- Department of Paediatrics Children’s Health Ireland at Temple Street Dublin Ireland
| | - Eilish Twomey
- Radiology Department Children’s Health Ireland at Temple Street Dublin Ireland
| | - Dylan J. Murray
- National Paediatric Craniofacial Centre Children’s Health Ireland at Temple Street Dublin Ireland
| | - Louise Kyne
- Department of Paediatrics Children’s Health Ireland at Temple Street Dublin Ireland
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81
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Meier N. Anesthetic Considerations for Pediatric Craniofacial Surgery. Anesthesiol Clin 2021; 39:53-70. [PMID: 33563386 DOI: 10.1016/j.anclin.2020.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Anesthetic management of craniosynostosis remains a challenging experience. It requires input and collaboration from multiple specialties to improve patient outcomes. Understanding the surgical corrective techniques and the underlying risks of each is essential to providing the best care to this patient population. The propensity for significant blood loss necessitates fundamental knowledge of pediatric resuscitation and the development of perioperative transfusion protocols that have been shown to reduce transfusion requirements in the peri-operative period.
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Affiliation(s)
- Nicholas Meier
- Department of Anesthesiology, Medical College of Wisconsin, Children's Hospital of Wisconsin, 9200 West Wisconsin Avenue, Milwaukee, WI 53226, USA.
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82
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The Future of Clinical Craniofacial Research: A Collaborative International Craniofacial Registry. J Craniofac Surg 2020; 32:8-9. [PMID: 33235160 DOI: 10.1097/scs.0000000000007078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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83
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Birgfeld CB, Heike C. Distinguishing Between Lambdoid Craniosynostosis and Deformational Plagiocephaly: A Review of This Paradigm Shift in Clinical Decision-Making and Lesson for the Future. Craniomaxillofac Trauma Reconstr 2020; 13:248-252. [PMID: 33456695 DOI: 10.1177/1943387520965801] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The cause of occipital asymmtery can be either extrinsic or intrinsic. Intrinsic causes include lambdoid craniosynsotosis. This condition is generally treated with cranial vault expansion surgery. Extrinsic causes include deformational plagiocephaly, which became commonplace after the "Back to Sleep Campaign" instituted in the 1980s by the American Academy of Pediatrics. The treatment of this condition is non surgical. Dr. Joseph Gruss was instumental in differentiating between these conditions and reducing the number of unnecessary surgeries that were previously being performed.
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Affiliation(s)
- Craig B Birgfeld
- Seattle Children's Hospital, University of Washington, Seattle, WA, USA
| | - Carrie Heike
- Seattle Children's Hospital, University of Washington, Seattle, WA, USA
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Kuta V, Curry L, McNeely D, Walling S, Chorney J, Bezuhly M. Understanding families' experiences following a diagnosis of non-syndromic craniosynostosis: a qualitative study. BMJ Open 2020; 10:e033403. [PMID: 32973048 PMCID: PMC7517552 DOI: 10.1136/bmjopen-2019-033403] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 07/08/2020] [Accepted: 08/04/2020] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES Craniosynostosis is typically diagnosed and surgically corrected within the first year of life. The diagnosis and surgical correction of the condition can be a very stressful experience for families. Despite this, there is little research exploring the impact that craniosynostosis has on families, especially in the period immediately following diagnosis and correction. In this study, the authors aimed to qualitatively examine the psychosocial experience of families with a child diagnosed with craniosynostosis. DESIGN Qualitative study. SETTING Tertiary care paediatric health centre. PARTICIPANTS Mothers of children newly diagnosed with single-suture, non-syndromic craniosynostosis. INTERVENTION Semistructured interviews regarding parental experience with the initial diagnosis, their decision on corrective surgery for their child, the operative experience, the impact of craniosynostosis on the family and the challenges they encountered throughout their journey. PRIMARY AND SECONDARY OUTCOME MEASURES Thematic analysis, a type of qualitative analysis that provides an in-depth account of participant's experiences, was used to analyse the interview data. RESULTS Over a 4-year period, 12 families meeting eligibility criteria completed the study. Three main themes (six subthemes) emerged from the preoperative interviews: frustration with diagnostic delays (parental intuition and advocacy, hope for improved awareness), understanding what to expect (healthcare supports, interest in connecting with other families) and justifying the need for corrective surgery (influence of the surgeon, struggle with cosmetic indications). Two main themes (four subthemes) were drawn from the postoperative interviews: overcoming fear (the role of healthcare professionals, transition home) and relief (reduction in parental anxiety, cosmetic improvements). CONCLUSIONS Overall, the diagnosis of craniosynostosis has a profound impact on families, leading them to face many struggles throughout their journey. A better understanding of these experiences will help to inform future practice, with a hope to improve this experience for other families moving forward.
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Affiliation(s)
- Victoria Kuta
- Division of Otolaryngology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Lauren Curry
- Division of General Internal Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Daniel McNeely
- Division of Neurosurgery, IWK Health Centre, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Simon Walling
- Division of Neurosurgery, IWK Health Centre, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jill Chorney
- Department of Anaesthesia, Pain Management and Perioperative Medicine, IWK Health Centre, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Michael Bezuhly
- Division of Plastic Surgery, IWK Health Centre, Dalhousie University, Halifax, Nova Scotia, Canada
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85
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de Jong G, Bijlsma E, Meulstee J, Wennen M, van Lindert E, Maal T, Aquarius R, Delye H. Combining deep learning with 3D stereophotogrammetry for craniosynostosis diagnosis. Sci Rep 2020; 10:15346. [PMID: 32948813 PMCID: PMC7501225 DOI: 10.1038/s41598-020-72143-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 08/11/2020] [Indexed: 11/09/2022] Open
Abstract
Craniosynostosis is a condition in which cranial sutures fuse prematurely, causing problems in normal brain and skull growth in infants. To limit the extent of cosmetic and functional problems, swift diagnosis is needed. The goal of this study is to investigate if a deep learning algorithm is capable of correctly classifying the head shape of infants as either healthy controls, or as one of the following three craniosynostosis subtypes; scaphocephaly, trigonocephaly or anterior plagiocephaly. In order to acquire cranial shape data, 3D stereophotographs were made during routine pre-operative appointments of scaphocephaly (n = 76), trigonocephaly (n = 40) and anterior plagiocephaly (n = 27) patients. 3D Stereophotographs of healthy infants (n = 53) were made between the age of 3-6 months. The cranial shape data was sampled and a deep learning network was used to classify the cranial shape data as either: healthy control, scaphocephaly patient, trigonocephaly patient or anterior plagiocephaly patient. For the training and testing of the deep learning network, a stratified tenfold cross validation was used. During testing 195 out of 196 3D stereophotographs (99.5%) were correctly classified. This study shows that trained deep learning algorithms, based on 3D stereophotographs, can discriminate between craniosynostosis subtypes and healthy controls with high accuracy.
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Affiliation(s)
- Guido de Jong
- Department of Neurosurgery, Radboudumc, Nijmegen, The Netherlands.
| | - Elmar Bijlsma
- Department of Neurosurgery, Radboudumc, Nijmegen, The Netherlands
| | - Jene Meulstee
- Radboudumc 3D Lab, Radboudumc, Nijmegen, The Netherlands
- Department of Oral and Maxillofacial Surgery, Radboudumc, Nijmegen, The Netherlands
| | - Myrte Wennen
- Department of Neurosurgery, Radboudumc, Nijmegen, The Netherlands
- Technical Medicine, University of Twente, Enschede, The Netherlands
| | - Erik van Lindert
- Department of Neurosurgery, Radboudumc, Nijmegen, The Netherlands
| | - Thomas Maal
- Radboudumc 3D Lab, Radboudumc, Nijmegen, The Netherlands
- Department of Oral and Maxillofacial Surgery, Radboudumc, Nijmegen, The Netherlands
| | - René Aquarius
- Department of Neurosurgery, Radboudumc, Nijmegen, The Netherlands
| | - Hans Delye
- Department of Neurosurgery, Radboudumc, Nijmegen, The Netherlands
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86
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Craniosynostosis in a Painting by Hans Suess Kulmbach. J Craniofac Surg 2020; 31:1510. [DOI: 10.1097/scs.0000000000006583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Outcome Measures Reported in Published Clinical Research Studies in Craniosynostosis: A Systematic Review. J Craniofac Surg 2020; 31:1672-1677. [PMID: 32740313 DOI: 10.1097/scs.0000000000006680] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
CONTEXT The fair comparison of treatment interventions for craniosynostosis across different studies is expected to be impaired by incomplete reporting and the use of inconsistent outcomes. OBJECTIVE This review assessed the outcomes currently reported in studies of craniosynostosis, and whether these outcomes are formally defined and prespecified in the study methods. DATA SOURCES, SEARCH TERMS, AND STUDY SELECTION Studies were sourced via an electronic, multi-database literature search for "craniosynostosis." All primary, interventional research studies published from 2011 to 2015 were reviewed. DATA EXTRACTION Two independent researchers assessed each study for inclusion and performed the data extraction. For each study, data were extracted on the individual outcomes reported, and whether these outcomes were defined and prespecified in the methods. DATA SYNTHESIS AND RESULTS Of 1027 studies screened, 240 were included and proceeded to data extraction. These studies included 18,365 patients.2192 separate outcomes were reported. Of these, 851 outcomes (38.8%) were clearly defined, 1394 (63.6%) were prespecified in the study methods."Clinical and functional" was the most commonly reported outcome theme (900 outcomes, 41.1%), and "patient-reported" outcomes the least (7 outcomes, 0.3%)."Duration of surgery" was the most commonly reported single outcome (reported 80 times). "Cranial index" was the most variably defined outcome (18 different definitions used). CONCLUSION The outcomes reported following treatment interventions for craniosynostosis are incompletely and variably defined. Improving definitions for these outcomes may aid comparison of different management strategies and improve craniosynostosis care. Suboptimal prespecification of these outcomes in the study methods implied that outcome reporting bias cannot be excluded.
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88
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Lo WB, Thant KZ, Kaderbhai J, White N, Nishikawa H, Dover MS, Evans M, Rodrigues D. Posterior calvarial distraction for complex craniosynostosis and cerebellar tonsillar herniation. J Neurosurg Pediatr 2020; 26:421-430. [PMID: 32650306 DOI: 10.3171/2020.4.peds19742] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 04/21/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Children with syndromic, multisuture, and lambdoid craniosynostosis undergoing calvarial surgery often have Chiari malformation type I (CM-I) (or cerebellar tonsillar herniation). The optimal management of this patient group, including the surgical techniques and timing of surgery, remains uncertain. Posterior calvarial distraction (PCD) is an effective method to increase the supratentorial cranial volume and improve raised intracranial pressure in children with complex craniosynostosis. This study investigated the efficacy of PCD in posterior fossa (PF) volume expansion and treatment of CM-I and associated syringomyelia (syrinx) in this group of children. METHODS This retrospective study included patients who were surgically treated between 2006 and 2015. Over 10 years, 16 patients with multisuture synostosis, lambdoid synostosis, or craniosynostosis associated with a confirmed genetic syndrome, and a concurrent CM-I, were included. The mean age at the time of surgery was 5.1 years (range 8 months-18 years). Fourteen patients had pansynostosis and 2 had lambdoid synostosis. Eight had a confirmed syndromic diagnosis (Crouzon in 8, Apert in 4, Pfeiffer in 1, and Saethre-Chotzen in 1). Ten patients had raised intracranial pressure; 4 had syringomyelia. RESULTS The average clinical follow-up was 50 months (range 9-116 months). Clinically, 9 patients improved, 7 remained stable, and none deteriorated. The average distraction distance was 23 mm (range 16-28 mm). The PF anterior-posterior (AP) distance/width ratio increased from 0.73 to 0.80 mm (p = 0.0004). Although an osteotomy extending inferior to the torcula (compared with superior) was associated with a larger absolute PF AP distance increase (13 vs 6 mm, p = 0.028), such a difference was not demonstrable when the PF AP distance/width ratio was calculated. Overall, the mean tonsillar herniation improved from 9.3 to 6.0 mm (p = 0.011). Syrinx dimensions also improved in the AP (from 7.9 to 3.1 mm) and superior-inferior (from 203 to 136 mm) dimensions. No patients required further foramen magnum decompression for CM. Of the 16 patients, 2 had subsequent frontoorbital advancement and remodeling, of which 1 was for volume expansion and 1 was for cosmetic purposes. Two patients required CSF shunt insertion after PCD. CONCLUSIONS Following PCD, PF volume increased as well as supratentorial volume. This morphometric change was observed in osteotomies both inferior and superior to the torcula. The PF volume increase resulted in improvement of cerebellar tonsillar herniation and syrinx. PCD is an efficacious first-line, single-stage treatment for concurrent pansynostosis and lambdoid craniosynostosis, CM-I, and syrinx.
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Affiliation(s)
- William B Lo
- Departments of1Neurosurgery and.,2Craniofacial Surgery, Birmingham Children's Hospital, Birmingham, United Kingdom
| | | | - Jameel Kaderbhai
- 2Craniofacial Surgery, Birmingham Children's Hospital, Birmingham, United Kingdom
| | - Nicholas White
- 2Craniofacial Surgery, Birmingham Children's Hospital, Birmingham, United Kingdom
| | - Hiroshi Nishikawa
- 2Craniofacial Surgery, Birmingham Children's Hospital, Birmingham, United Kingdom
| | | | - Martin Evans
- 2Craniofacial Surgery, Birmingham Children's Hospital, Birmingham, United Kingdom
| | - Desiderio Rodrigues
- Departments of1Neurosurgery and.,2Craniofacial Surgery, Birmingham Children's Hospital, Birmingham, United Kingdom
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Update on evidence in craniomaxillofacial surgery. Curr Opin Otolaryngol Head Neck Surg 2020; 28:241-245. [PMID: 32628418 DOI: 10.1097/moo.0000000000000642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW Evidence-based medicine underpins clinical practice. Ideally, our clinical decision-making stems from systematic reviews of randomized controlled trials. However, in practice, this is not often the case, and we must instead rely on the best available evidence. RECENT FINDINGS We review the history of evidence-based research, the development of the levels of evidence, and the relationship of evidence and bias present in craniomaxillofacial surgery. We also discuss the recent trends in CMF publications and identify areas for improvement. SUMMARY Because of inherent challenges, the quality of evidence in craniomaxillofacial surgery lags behind other surgical and medical specialties. However, over recent years this has improved significantly, with better reporting of data and a higher rate of randomized controlled trials.
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Kim JS, Block LM, Zhu X, Davit AJ. Management of Paronychia in Patients With Apert Syndrome. Tech Hand Up Extrem Surg 2020; 25:30-34. [PMID: 32398550 DOI: 10.1097/bth.0000000000000295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Apert syndrome is a complex congenital syndrome that includes bicoronal craniosynostosis, craniofacial dysmorphologies, cleft palate, hearing loss, spina bifida occulta, cardiac anomalies, and affects the upper and lower extremities-producing complex syndactyly in these patients. Management of the hands yields several challenges and mandates close follow-up to balance repair of complex polysyndactyly with other pressing interventions, such as posterior cranial vault distraction and surgical management of the airway. Our goals of therapy for the hands are to preserve 10 digits, provide sufficient soft tissue coverage, optimize hand function, and minimize the number of surgical interventions. Ideally, surgical management of the hand differences occurs between the ages of 9 months and 2 years, to optimize neurocognitive development. In complex syndactyly observed in patients with Apert syndrome, there are broad, conjoined nail plates that overlie the fused digits, and paronychia occurs frequently. Suppurative infections can delay definitive surgical intervention for the patient's complex syndactyly, and resolution of paronychia is critical. This study aims to propose an effective and safe technique to manage paronychia when it occurs in patients with Apert complex syndactyly and to mitigate the length of delay to definitive polysyndactyly reconstruction. In the context of these patients' need for multiple surgical interventions within the first few years of life, this strategy for preventing or mitigating paronychia can play an important role in streamlining their complex surgical management while avoiding multiple cancellations.
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Affiliation(s)
| | - Lisa M Block
- Children's Hospital of Pittsburgh, Pittsburgh, PA
| | - Xiao Zhu
- University of Pittsburgh Medical Center
| | - Alexander J Davit
- University of Pittsburgh Medical Center
- Children's Hospital of Pittsburgh, Pittsburgh, PA
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Cortical Thickness in Crouzon-Pfeiffer Syndrome: Findings in Relation to Primary Cranial Vault Expansion. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e3204. [PMID: 33173703 PMCID: PMC7647527 DOI: 10.1097/gox.0000000000003204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 09/01/2020] [Indexed: 01/02/2023]
Abstract
Background Episodes of intracranial hypertension are associated with reductions in cerebral cortical thickness (CT) in syndromic craniosynostosis. Here we focus on Crouzon-Pfeiffer syndrome patients to measure CT and evaluate associations with type of primary cranial vault expansion and synostosis pattern. Methods Records from 34 Crouzon-Pfeiffer patients were reviewed along with MRI data on CT and intracranial volume to examine associations. Patients were grouped according to initial cranial vault expansion (frontal/occipital). Data were analyzed by multiple linear regression controlled for age and brain volume to determine an association between global/lobar CT and vault expansion type. Synostosis pattern effect sizes on global/lobar CT were calculated as secondary outcomes. Results Occipital expansion patients demonstrated 0.02 mm thicker cortex globally (P = 0.81) with regional findings, including: thicker cortex in frontal (0.02 mm, P = 0.77), parietal (0.06 mm, P = 0.44) and occipital (0.04 mm, P = 0.54) regions; and thinner cortex in temporal (-0.03 mm, P = 0.69), cingulate (-0.04 mm, P = 0.785), and, insula (-0.09 mm, P = 0.51) regions. Greatest effect sizes were observed between left lambdoid synostosis and the right cingulate (d = -1.00) and right lambdoid synostosis and the left cingulate (d = -1.23). Left and right coronal synostosis yielded effect sizes of d = -0.56 and d = -0.42 on respective frontal lobes. Conclusions Both frontal and occipital primary cranial vault expansions correlate to similar regional CT in Crouzon-Pfeiffer patients. Lambdoid synostosis appears to be associated with cortical thinning, particularly in the cingulate gyri.
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92
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Excessive ossification of the bandeau in Crouzon and Apert syndromes. J Craniomaxillofac Surg 2020; 48:376-382. [DOI: 10.1016/j.jcms.2020.02.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Revised: 01/30/2020] [Accepted: 02/24/2020] [Indexed: 01/11/2023] Open
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Lehner M, Wendling-Keim D, Kunz M, Deininger S, Zundel S, Peraud A, Mast G. On-site CAD templates reduce surgery time for complex craniostenosis repair in infants: a new method. Childs Nerv Syst 2020; 36:793-801. [PMID: 31900627 DOI: 10.1007/s00381-019-04474-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Accepted: 12/10/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION The surgical correction of craniostenosis in children is a time-consuming and taxing procedure. To facilitate this procedure, especially in infants with complex craniostenosis, we refined the computer-aided design and manufacturing technique (CAD/CAM) based on computed tomography (CT)-generated DICOM data. We used cutting guides and molding templates, which allowed the surgeon to reshape and fixate the supraorbital bar extracorporeally on a side table and to control the intracorporal fit without removing the template. METHOD AND PATIENTS To compare our traditional concept with the possibility of preoperative virtual planning (PVP) technique, the surgical treatment and courses of 16 infants with complex craniostenosis following fronto-orbital advancement (FOA) (age range 8-15 months) were analyzed in two groups (group 1: traditional, control group n = 8, group 2: CAD/CAM planned, n = 8). RESULTS While in both groups, the head accurately reshaped postoperatively during the follow-up; the CAD group 2 showed a significantly shorter operating time with a mean of 4 h 25 min compared with group 1 with a mean of 5 h 37 min (p = 0.038). Additionally, the CAD group 2 had a significantly lower volume of blood loss (380 ml vs. 575 ml mean, p = 0.047), lower blood transfusion volume (285 ml vs. 400 ml mean, p = 0.108), lower fresh frozen plasma (FFP) volume (140 ml vs. 275 ml mean, p = 0.019), shorter stay in the pediatric intensive care unit (PICU) (3 vs. 5 days mean (p = 0.002), and shorter total length of hospital stay (6 days vs. 8 days mean, p = 0.002). CONCLUSION CAD/CAM cutting guides and templates offer optimizing operative efficiency, precision, and accuracy in craniostenosis surgery in infants. As shown in this single-center observational study, the use of on-site templates significantly accelerates the reconstruction of the bandeau. The virtual 3D planning technique increases surgical precision without discernible detrimental effects.
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Affiliation(s)
- Markus Lehner
- Department of Pediatric Surgery, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University of Munich, Munich, Germany. .,Department of Pediatric Surgery, Children's Hospital of Lucerne, Kantonsspital Lucerne, Lucerne, Switzerland.
| | - D Wendling-Keim
- Department of Pediatric Surgery, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - M Kunz
- Department of Neurosurgery, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - S Deininger
- Department of Pediatric Surgery, Children's Hospital of Lucerne, Kantonsspital Lucerne, Lucerne, Switzerland.,Department of Neurosurgery, Section Pediatric Neurosurgery, University of Ulm, Ulm, Germany
| | - S Zundel
- Department of Pediatric Surgery, Children's Hospital of Lucerne, Kantonsspital Lucerne, Lucerne, Switzerland
| | - A Peraud
- Department of Neurosurgery, Ludwig-Maximilians-University of Munich, Munich, Germany.,Department of Neurosurgery, Section Pediatric Neurosurgery, University of Ulm, Ulm, Germany
| | - G Mast
- Department of Orofacial Surgery, Ludwig-Maximilians-University of Munich, Munich, Germany
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94
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Azoulay-Avinoam S, Bruun R, MacLaine J, Allareddy V, Resnick CM, Padwa BL. An Overview of Craniosynostosis Craniofacial Syndromes for Combined Orthodontic and Surgical Management. Oral Maxillofac Surg Clin North Am 2020; 32:233-247. [PMID: 32081578 DOI: 10.1016/j.coms.2020.01.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This article provides an overview of epidemiology, genetics, and common orofacial features of those with craniosynostosis. Patients with craniosynostosis require several surgical procedures along with continuum of care. The earliest surgical interventions are done during the first few years of life to relieve the fused sutures. Midface advancement, limited phase of orthodontic treatment, and combined orthodontics/orthognathic surgery treatment are usually required during later years. This article presents several examples of cases with outcomes associated with these procedures.
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Affiliation(s)
- Shayna Azoulay-Avinoam
- Department of Orthodontics, College of Dentistry, University of Illinois at Chicago, 801 South Paulina Street, 138AD (MC841), Chicago, IL 60612-7211, USA
| | - Richard Bruun
- Boston Children's Hospital Cleft Lip/Palate and Craniofacial Teams, Department of Dentistry, Boston Children's Hospital, Harvard School of Dental Medicine, 300 Longwood Avenue, Boston, MA 02115, USA
| | - James MacLaine
- Department of Developmental Biology, Boston Children's Hospital, Harvard School of Dental Medicine, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Veerasathpurush Allareddy
- Department of Orthodontics, College of Dentistry, University of Illinois at Chicago, 801 South Paulina Street, 138AD (MC841), Chicago, IL 60612-7211, USA.
| | - Cory M Resnick
- Oral & Maxillofacial Surgery Program, Department of Plastic & Oral Surgery, Harvard Medical School, 300 Longwood Avenue, Hunnewell, 1st Floor, Boston, MA 02115, USA
| | - Bonnie L Padwa
- Section of Oral and Maxillofacial Surgery, Department of Plastic & Oral Surgery, Harvard Medical School, 300 Longwood Avenue, Hunnewell, 1st Floor, Boston, MA 02115, USA
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Abstract
Early fusion of the sagittal suture is a clinical condition called, sagittal craniosynostosis. Calvarial reconstruction is the most common treatment option for this condition with a range of techniques being developed by different groups. Computer simulations have a huge potential to predict the calvarial growth and optimise the management of this condition. However, these models need to be validated. The aim of this study was to develop a validated patient-specific finite element model of a sagittal craniosynostosis. Here, the finite element method was used to predict the calvarial morphology of a patient based on its preoperative morphology and the planned surgical techniques. A series of sensitivity tests and hypothetical models were carried out and developed to understand the effect of various input parameters on the result. Sensitivity tests highlighted that the models are sensitive to the choice of input parameter. The hypothetical models highlighted the potential of the approach in testing different reconstruction techniques. The patient-specific model highlighted that a comparable pattern of calvarial morphology to the follow up CT data could be obtained. This study forms the foundation for further studies to use the approach described here to optimise the management of sagittal craniosynostosis.
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97
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Parents' Experiences of Their Child's Craniosynostosis and the Initial Care Process. J Craniofac Surg 2019; 31:251-256. [PMID: 31764563 DOI: 10.1097/scs.0000000000006033] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Craniosynostosis is usually diagnosed in early infancy. Treatment almost always involves surgery and care is optimally organized around an interdisciplinary team of specialists at a craniofacial center. This study aimed to investigate Swedish parents' experiences of having a child with craniosynostosis and their perceptions of the initial care process. Semistructured telephone interviews were conducted with 20 parents (10 fathers and 10 mothers) of children with nonsyndromic craniosynostosis who were undergoing surgery at the Uppsala Craniofacial Center. A thematic data analysis revealed 6 themes presented in a timeline following the parents' journey from detection of their child's abnormal skull shape to waiting for surgery: Detection of the abnormal skull shape, thoughts, and feelings before the appointment with the craniofacial team, an appointment with the craniofacial team, searching the Internet and social media, waiting for surgery, and suggestions for improvement. Although meeting with the craniofacial team was considered informative, parents expressed concerns about surgery and their infant's long-term prognosis were evident. Most parents had no previous knowledge about craniosynostosis and craniofacial syndromes and wished for more information already at the time of its detection. The Internet was used both at the time of suspicion that something was wrong with the child and later to learn about risks and consequences, alternative treatments and prognosis.
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98
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de Goederen R, Joosten KFM, den Ottelander BK, van der Oest MJW, Bröker-Schenk EMM, van Veelen MLC, Wolvius EB, Versnel SL, Tasker RC, Mathijssen IMJ. Improvement in Sleep Architecture is associated with the Indication of Surgery in Syndromic Craniosynostosis. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2019; 7:e2419. [PMID: 31741814 PMCID: PMC6799402 DOI: 10.1097/gox.0000000000002419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 07/01/2019] [Indexed: 11/25/2022]
Abstract
Supplemental Digital Content is available in the text. Children with syndromic craniosynostosis (sCS) often suffer from obstructive sleep apnea (OSA) and intracranial hypertension (ICH). Both OSA and ICH might disrupt sleep architecture. However, it is unclear how surgically treating OSA or ICH affects sleep architecture. The aim of this study was twofold: to explore the usefulness of sleep architecture analysis in detecting disturbed sleep and to determine whether surgical treatment can improve it.
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Affiliation(s)
- Robbin de Goederen
- Department of Plastic and Reconstructive Surgery, and Hand Surgery, Erasmus MC, Rotterdam, the Netherlands
| | - Koen F M Joosten
- Department of Pediatrics, Intensive Care Unit, Erasmus MC, Rotterdam, the Netherlands
| | - Bianca K den Ottelander
- Department of Plastic and Reconstructive Surgery, and Hand Surgery, Erasmus MC, Rotterdam, the Netherlands
| | - Mark J W van der Oest
- Department of Plastic and Reconstructive Surgery, and Hand Surgery, Erasmus MC, Rotterdam, the Netherlands
| | | | | | - Eppo B Wolvius
- Department of Oral- and Maxillofacial Surgery, Erasmus MC, Rotterdam, the Netherlands
| | - Sarah L Versnel
- Department of Plastic and Reconstructive Surgery, and Hand Surgery, Erasmus MC, Rotterdam, the Netherlands
| | - Robert C Tasker
- Departments of Neurology and Anesthesia (Pediatrics), Harvard Medical School and Boston Children's Hospital, Boston, MA, USA
| | - Irene M J Mathijssen
- Department of Plastic and Reconstructive Surgery, and Hand Surgery, Erasmus MC, Rotterdam, the Netherlands
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99
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Massimi L, Bianchi F, Frassanito P, Calandrelli R, Tamburrini G, Caldarelli M. Imaging in craniosynostosis: when and what? Childs Nerv Syst 2019; 35:2055-2069. [PMID: 31289853 DOI: 10.1007/s00381-019-04278-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 06/25/2019] [Indexed: 12/14/2022]
Abstract
PURPOSE Currently, the interest on craniosynostosis in the clinical practice is raised by their increased frequency and their genetic implications other than by the still existing search of less invasive surgical techniques. These reasons, together with the problem of legal issues, make the need of a definite diagnosis for a crucial problem, even in single-suture craniosynostosis (SSC). Although the diagnosis of craniosynostosis is primarily the result of physical examination, craniometrics measuring, and observation of the skull deformity, the radiological assessment currently plays an important role in the confirmation of the diagnosis, the surgical planning, and even the postoperative follow-up. On the other hand, in infants, the use of radiation or the need of sedation/anesthesia raises the problem to reduce them to minimum to preserve such a delicate category of patient from their adverse effects. METHODS, RESULTS AND CONCLUSIONS This review aims at summarizing the state of the art of the role of radiology in craniosynostosis, mainly focusing on indications and techniques, to provide an update not only to pediatric neurosurgeons or maxillofacial surgeons but also to all the other specialists involved in their management, like neonatologists, pediatricians, clinical geneticists, and pediatric neurologists.
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Affiliation(s)
- L Massimi
- Fondazione Policlinico Gemelli IRCCS, Neurochirurgia Infantile, Rome, Italy.
- Università Cattolica del Sacro Cuore, Istituto Neurochirurgia, Rome, Italy.
| | - F Bianchi
- Fondazione Policlinico Gemelli IRCCS, Neurochirurgia Infantile, Rome, Italy
| | - P Frassanito
- Fondazione Policlinico Gemelli IRCCS, Neurochirurgia Infantile, Rome, Italy
| | - R Calandrelli
- Polo scienze delle immagini, di laboratorio ed infettivologiche, Area diagnostica per immagini, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - G Tamburrini
- Fondazione Policlinico Gemelli IRCCS, Neurochirurgia Infantile, Rome, Italy
- Università Cattolica del Sacro Cuore, Istituto Neurochirurgia, Rome, Italy
| | - M Caldarelli
- Fondazione Policlinico Gemelli IRCCS, Neurochirurgia Infantile, Rome, Italy
- Università Cattolica del Sacro Cuore, Istituto Neurochirurgia, Rome, Italy
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100
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Kljajić M, Maltese G, Tarnow P, Sand P, Kölby L. Sustained attention and vigilance of children treated for sagittal and metopic craniosynostosis. Child Neuropsychol 2019; 26:475-488. [DOI: 10.1080/09297049.2019.1682130] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Marizela Kljajić
- Department of Plastic Surgery, Institute of Clinical Sciences, Sahlgrenska, Academy, Göteborg University, Sahlgrenska University Hospital, Göteborg, Sweden
| | - Giovanni Maltese
- Department of Plastic Surgery, Institute of Clinical Sciences, Sahlgrenska, Academy, Göteborg University, Sahlgrenska University Hospital, Göteborg, Sweden
| | - Peter Tarnow
- Department of Plastic Surgery, Institute of Clinical Sciences, Sahlgrenska, Academy, Göteborg University, Sahlgrenska University Hospital, Göteborg, Sweden
| | - Peter Sand
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Gothenburg University, Sahlgrenska University Hospital, Göteborg, Sweden
| | - Lars Kölby
- Department of Plastic Surgery, Institute of Clinical Sciences, Sahlgrenska, Academy, Göteborg University, Sahlgrenska University Hospital, Göteborg, Sweden
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