Osteoclastic craniectomy for scaphocephaly in infants results in physiological head shapes

The validation of morphometric outcomes and stratification system for nonsyndromic sagittal craniosynostosis following total calvarial remodeling

This study aimed to provide an external validation of morphometric outcomes, including recently developed parameters - vertico-longitudinal index (VLI) and vertex-nasion-opisthocranion (VNO) angle - along with a proposed stratification system for nonsyndromic sagittal craniosynostosis (NSC). Thin-cut CT scans performed before and after total calvarial remodeling in 70 NSC children (mean preoperative age, 7.0 months; mean postoperative age 23.8 months) were evaluated. The parameters, including linear dimensions, morphometry-based indices, and cranial angles, were measured at the cranial vault and base. Each patient was also assigned a scaphocephaly severity score (SSS). The obtained data were compared with an age-matched control group of 80 normocephalic children. After surgery, all dimensions of the cranial vault increased, but did not normalize (p < 0.0001). Contrarily, some normalization was noted in the skull base, within the anterior and posterior cranial fossae. Postoperative results confirmed the diagnostic cut-off level for VNO at 50°; however, the proposed VLI cut-offs skewed the accuracy of SSS in the control group. To the best of our knowledge, this study was the first to discuss the value of an NSC stratification system in relation to underlying components. The SSS has a relevant background, but its accuracy would increase with a redefinition of normative VLI ranges.

Is computer-assisted design and manufacturing technology useful in the surgical management of trigonocephaly?

The aim of this study is to assess the usefulness of CAD/CAM technology in the surgical treatment of trigonocephaly compared to conventional surgical treatment. Children operated from trigonocephaly between 2017 and 2019 at the French Referral Center for craniosynostosis of Femme-Mère-Enfant Hospital of Lyon, France, were included and separated in two groups. Group 1 included children operated on trigonocephaly using CAD-CAM technology; Group 2 included children operated on trigonocephaly without CAD-CAM technology. Age, gender, duration of surgery, complications, blood transfusion and esthetic results were analyzed. The experience of the craniofacial surgeon was also evaluated and quantified in order to weigh the results. Twenty children were included in the study: 10 in the Group 1 and 10 in the Group 2. No statistical difference was observed between these 2 groups concerning the duration of the surgery (137 min ± 39,17 versus 137,2 min ± 64,50; p = 0,85), complications (20% in group 1 versus 10% in group 2; p = 1), the realization of blood transfusion (80% in group 1 versus 70% in group 2) and the esthetic results (5/5 in group 1 versus 4,6/5 in group 2; p = 0,21). However, the use of CAD-CAM technology significantly accelerates the duration of surgery by 25.8 min on average for the surgeon starting in craniofacial surgery (from 197,8 ± 10,21 min without CAD-CAM to 172 ± 18,76 min with CAD-CAM; p = 0.05) but significantly slows the experienced surgeon by 25.4 min on average (from 76,6 ± 8,65 min without CAD-CAM to 102 ± 6,2 min with CAD-CAM; p = 0.01). In the management of trigonocephaly, CAD/CAM technology seems to present a modest interest for the experienced surgeon but presents a real interest for the young surgeon. Within the limitations of the study, it seems that CAD/CAM technology is a relevant addition to the armamentarium of doctors who are in training because surgical time is reduced.