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Queiros C, Joly A, Paré A, Listrat A, Travers N, Goga D, Laure B. Use of cutting guides during craniosynostosis sequelae surgery: A comparative study between computer-assisted planning and post-operative results. J Craniomaxillofac Surg 2017; 45:1062-1068. [DOI: 10.1016/j.jcms.2017.03.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 03/15/2017] [Accepted: 03/20/2017] [Indexed: 11/30/2022] Open
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Shim KW, Park EK, Kim JS, Kim YO, Kim DS. Neurodevelopmental Problems in Non-Syndromic Craniosynostosis. J Korean Neurosurg Soc 2016; 59:242-6. [PMID: 27226855 PMCID: PMC4877546 DOI: 10.3340/jkns.2016.59.3.242] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 04/05/2016] [Accepted: 04/06/2016] [Indexed: 11/27/2022] Open
Abstract
Craniosynostosis is the premature fusion of calvarial sutures, resulting in deformed craniofacial appearance. Hence, for a long time, it has been considered an aesthetic disorder. Fused sutures restrict growth adjacent to the suture, but compensatory skull growth occurs to accommodate the growing brain. The primary goal for the management of this craniofacial deformity has been to release the constricted skull and reform the distorted shape of the skull vault. However, the intellectual and behavioral prognosis of affected children has also been taken into consideration since the beginning of the modern era of surgical management of craniosynostosis. A growing body of literature indicates that extensive surgery, such as the whole-vault cranioplasty approach, would result in better outcomes. In addition, the age at treatment is becoming a major concern for optimal outcome in terms of cosmetic results as well as neurodevelopment. This review will discuss major concerns regarding neurodevelopmental issues and related factors.
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Affiliation(s)
- Kyu-Won Shim
- Department of Pediatric Neurosurgery, Craniofacial Reforming and Reconstruction Clinic, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Eun-Kyung Park
- Department of Pediatric Neurosurgery, Craniofacial Reforming and Reconstruction Clinic, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Ju-Seong Kim
- Department of Pediatric Neurosurgery, Craniofacial Reforming and Reconstruction Clinic, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Yong-Oock Kim
- Department of Plastic and Reconstructive Surgery, Craniofacial Reforming and Reconstruction Clinic, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Dong-Seok Kim
- Department of Pediatric Neurosurgery, Craniofacial Reforming and Reconstruction Clinic, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
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Doshier LJ, Muzaffar AR, Deidrick KK, Rice GB. Analysis of individualized education programs to quantify long-term educational needs following surgical intervention for single-suture craniosynostosis. Plast Surg (Oakv) 2015; 23:31-4. [PMID: 25821770 DOI: 10.4172/plastic-surgery.1000901] [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: 11/09/2022] Open
Abstract
BACKGROUND Single-suture craniosynostosis (SSC) is a common craniofacial condition with potential neurocognitive sequelae. OBJECTIVE To quantify any long-term functional academic and behavioural difficulties of children with SSC as indicated by the need for individualized education programs (IEPs), despite having undergone surgical treatment. METHODS Records of all school-age patients from 1992 to 2011 who underwent operative intervention for SSC were identified. Fifty-nine patients' guardians were contacted by telephone to provide informed consent for completion of a mailed standardized questionnaire querying demographic information as well as information regarding the patient's health, family and educational history; specifically whether the patient had ever been provided educational support as delineated in an IEP. The primary outcome measure was the history of the patient being assigned educational support as delineated in an IEP. RESULTS Thirty-seven consenting guardians completed and returned the standardized questionnaire (response rate 62.7%). Twenty-one patients were male and 16 were female, with an age range of five to 14 years (mean age 10.2 years). Eleven (29.7%) patients had a previous history of or currently were receiving educational support delineated in an IEP. CONCLUSIONS A higher proportion of school-age patients with a history of SSC (status postsurgical intervention) in the present study received educational support delineated in an IEP than the proportion of IEPs in the general student population of the United States (11.3%).
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Affiliation(s)
- Laura J Doshier
- Division of Plastic Surgery, University of Missouri, Columbia, Missouri, USA
| | - Arshad R Muzaffar
- Division of Plastic Surgery, University of Missouri, Columbia, Missouri, USA
| | | | - Gale B Rice
- Division of Plastic Surgery, University of Missouri, Columbia, Missouri, USA
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Abstract
Trigonocephaly is the premature fusion of the metopic suture leading to deformation of anterior calvarium causing keel shaped deformity of forehead. In most cases, surgical correction is for aesthetic and psychosocial reasons. Various techniques have been described. Here we describe a technique, which is simple to perform with good postoperative results. Metopic suture is excised, one side is reconstructed in finger clasping manner to fit in an expanded area, and the other side is transected and simply molded, and all these fixed with nonabsorbable suture. Supraorbital horizontal bar is mobilized on either side anteriorly and fixed with titanium plate and screws.
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Affiliation(s)
- Danish Mohammad
- Department of Neurosurgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sivashanmugam Dhandapani
- Department of Neurosurgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Neurodevelopmental and esthetic results in children after surgical correction of metopic suture synostosis: a single institutional experience. Childs Nerv Syst 2014; 30:1075-82. [PMID: 24337567 DOI: 10.1007/s00381-013-2340-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Accepted: 12/02/2013] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Metopic suture synostosis leading to trigonocephaly is considered the second most frequent type of craniosynostosis. Besides esthetic results, we present 25 consecutive pediatric cases operated upon metopic suture synostosis with a focus on the child's motor, speech, and neurocognitive development. METHODS Twenty-five children (aged 6 to 33 months; median 9.2 months) with trigonocephaly were operated upon between 2002 and 2012 with fronto-orbital advancement including frontal bone cranioplasty and fronto-orbital bandeau remodeling. Neurodevelopmental deficits were evaluated by a standardized questionnaire including gross motor function, manual coordination, speech, and cognitive function performed by independent pediatric/developmental neurologists before surgery and at 6 and 12 months of time interval postoperatively. RESULTS Twenty-one (84 %) boys and four (16 %) girls were included in this study. Mean follow-up period was 33 ± 28 months. Outcome analysis for esthetic results showed a high degree of satisfaction by the parents and treating physicians in 23 cases (92 %). Preoperative evaluation revealed neurodevelopmental deficits in 10 children (40 %; six mild, four moderate degree). Twelve children (48 %) were proven to have a normal preoperative neuropediatric development. Mild or moderate developmental restraints were no longer apparent in 6/13, improved but still apparent in 3/13, and stable in 4/13, 6 months after cranial vault reconstruction. At 12 months of follow-up, deficits were no longer present in 9/13 and improved in 4/13. Apart from this cohort, two children were diagnosed with a syndromic form, and one child had a fetal valproate syndrome. In these three children, neurodevelopmental deficits were more pronounced. Neurocognitive progress was obvious, but was comparably slower, and major deficits were still apparent at last follow-up. All children with proven mild/moderate/severe deficits received intensive physiotherapy, logopedic, or neurobehavioral support. CONCLUSIONS As shown in a single-center observation, surgical correction of metopic suture synostosis not only refines esthetic appearance but also might improve neurodevelopmental outcome if deficits are apparent, even in syndromic forms of the deformity under additional physiotherapy, logopedic, or neurobehavioral support.
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Anterior fronto-orbital remodeling for trigonocephay. Childs Nerv Syst 2012; 28:1369-73. [PMID: 22872250 DOI: 10.1007/s00381-012-1841-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2012] [Accepted: 06/13/2012] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Trigonocephaly secondary to the premature fusion of the metopic synostosis is associated to a risk of cerebral compression and several craniofacial morphological alterations. Numerous surgical techniques have been proposed. They all carry a risk of secondary temporal hollowing PURPOSE The aim of this paper is to describe the surgical technique used for trigonocephaly at the craniofacial unit of Hopital Necker Enfants Malades (French National Referral Center for Faciocraniosynostosis) focusing on its advantages and limitations. Resorbable osteosynthesis should be part of the current techniques.
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Ozlen F, Kafadar AM, Abuzayed B, Ulu MO, Isler C, Dashti R, Erdincler P. Surgical treatment of trigonocephaly: technique and long-term results in 48 cases. J Neurosurg Pediatr 2011; 7:300-10. [PMID: 21361772 DOI: 10.3171/2010.12.peds10359] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT The authors present their experience in the surgical treatment of metopic synostosis by orbital bandeau remodeling and frontal bone rotation. The pitfalls and advantages of the surgical technique are discussed, along with the long-term clinical results in 48 consecutive cases. METHODS Forty-eight consecutive patients in whom trigonocephaly was diagnosed between 1990 and 2009 were treated with frontal bone rotation and frontoorbital bandeau remodeling. Of these patients, 38 (79%) were boys and 10 (21%) were girls. The age at the time of surgical treatment ranged between 4 and 42 months (mean ± SD 11.4 ± 8.7 months). The average follow-up period was 5.5 ± 4.2 years (range 5 months-19 years). The preoperative and latest postoperative photographs of the patients were evaluated for the following features: 1) shape of the forehead; 2) hypotelorism; and 3) temporal depression. Scores of 0, 1, or 2 were assigned for each item: 0 was normal, 1 meant moderate deformity, and 2 denoted severe deformity. RESULTS In the early postoperative period, no complications were documented. The average hospitalization period was 4 days. Follow-up radiographs or 3D CT scans were obtained at regular intervals. The mean preoperative scores for the evaluated items were 1.38 ± 0.49 for the shape of the forehead, 1.33 ± 0.48 for hypotelorism, and 1.7 ± 0.46 for the temporal depression. The mean postoperative scores were 0.06 ± 0.24 for the shape of the forehead, 0.21 ± 0.4 for hypotelorism, and 0.67 ± 0.48 for the temporal depression. Overall, the total preoperative score dropped from 4.4 to 0.93 postoperatively (p < 0.05). All the patients were contented with the cosmetic results. CONCLUSIONS Early detection and treatment of metopic suture synostosis has a significant, favorable influence on the outcomes. Good understanding of the structural abnormality and the pathophysiological mechanisms of the possible complications is very important for performing proper surgical reconstruction.
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Affiliation(s)
- Fatma Ozlen
- Department of Neurosurgery, Cerrahpasa Medical Faculty,Istanbul University, Istanbul, Turkey
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Hankinson TC, Fontana EJ, Anderson RCE, Feldstein NA. Surgical treatment of single-suture craniosynostosis: an argument for quantitative methods to evaluate cosmetic outcomes. J Neurosurg Pediatr 2010; 6:193-7. [PMID: 20672943 DOI: 10.3171/2010.5.peds09313] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The traditional reasons for surgical intervention in children with single-suture craniosynostosis (SSC) are cosmetic improvement and the avoidance/treatment of intracranial hypertension, which has been thought to contribute to neurocognitive deficits. Despite considerable work on the topic, the exact prevalence of intracranial hypertension in the population of patients with SSC is unknown, although it appears to be present in only a minority. Additionally, recent neuropsychological and anatomical literature suggests that the subtle neurocognitive deficits identified in children with a history of SSC may not result from external compression. They may instead reflect an underlying developmental condition that includes disordered primary CNS development and early suture fusion. This implies that current surgical techniques are unlikely to prevent neurocognitive deficits in patients with SSC. As such, the most common indication for surgical treatment in SSC is cosmetic, and most patients benefit from considerable subjective cosmetic normalization following surgery. Pediatric craniofacial surgeons have not, however, agreed upon objective means to assess postoperative cranial morphological improvement. We should therefore endeavor to agree upon objective craniometric tools for the assessment of operative outcomes, allowing us to accurately compare the various surgical techniques that are currently available.
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Affiliation(s)
- Todd C Hankinson
- Division of Pediatric Neurosurgery, Children's Hospital of Alabama, University of Alabama, Birmingham, Alabama, USA.
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Toth K, Collett B, Kapp-Simon KA, Cloonan YK, Gaither R, Cradock MM, Buono L, Cunningham ML, Dawson G, Starr J, Speltz ML. Memory and response inhibition in young children with single-suture craniosynostosis. Child Neuropsychol 2008; 14:339-52. [PMID: 17899471 PMCID: PMC3470829 DOI: 10.1080/09297040701594888] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Using two versions of the A-not-B task, memory and response inhibition were assessed in 17- to 24-month-old children with surgically corrected single-suture craniosynostosis (cases) and unaffected children (controls). Children's development and language were initially assessed on average at 6-7 months of age and again at this second visit. Cases and controls performed at equivalent levels on average, with cases performing slightly better than controls on several of the variables measured. However, fewer cases than controls were able to complete the more challenging of the two tasks, which may have predictive significance for later functioning. Children's age and cognitive ability were related to successful performance on the A-not-B task. Among cases, age of cranioplastic surgery was unrelated to performance. Our findings suggest that children with single-suture craniosynostosis show normal development of visual memory and response inhibition in the age range studied here.
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Affiliation(s)
- Karen Toth
- Outpatient Child Psychiatry Department, Children’s Hospital & Regional Medical Center, Seattle, WA
| | - Brent Collett
- Outpatient Child Psychiatry Department, Children’s Hospital & Regional Medical Center, Seattle, WA
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA
| | - Kathleen A. Kapp-Simon
- Department of Surgery, Northwestern University, Chicago, IL; Craniomaxillofacial Service of Shriners Hospital for Children, Chicago, IL
| | | | - Rebecca Gaither
- Department of Surgery, Northwestern University, Chicago, IL; Craniomaxillofacial Service of Shriners Hospital for Children, Chicago, IL
| | - Mary M. Cradock
- Department of Psychology, St. Louis Children’s Hospital, St. Louis, MO
| | - Lauren Buono
- Department of Neuropsychology, Children’s Health Care of Atlanta, Atlanta, GA
| | - Michael L. Cunningham
- Department of Pediatrics, University of Washington, Seattle, WA; Children’s Craniofacial Center, Children’s Hospital & Regional Medical Center, Seattle, WA
| | - Geraldine Dawson
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA
- Department of Psychology, University of Washington, Seattle, WA, USA
| | - Jacqueline Starr
- Department of Epidemiology, University of Washington, Seattle, WA
- Department of Pediatrics, University of Washington, Seattle, WA; Children’s Craniofacial Center, Children’s Hospital & Regional Medical Center, Seattle, WA
| | - Matthew L. Speltz
- Outpatient Child Psychiatry Department, Children’s Hospital & Regional Medical Center, Seattle, WA
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA
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Kelleher MO, Murray DJ, McGillivary A, Kamel MH, Allcutt D, Earley MJ. Non-syndromic trigonocephaly: surgical decision making and long-term cosmetic results. Childs Nerv Syst 2007; 23:1285-9. [PMID: 17569057 DOI: 10.1007/s00381-007-0386-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2006] [Revised: 02/07/2007] [Indexed: 12/01/2022]
Abstract
BACKGROUND Surgical correction is often required for cosmetic correction of trigonocephaly. The purpose of this paper was to report the long-term aesthetic outcome as appreciated by the parents/patients themselves. The self-evaluation of cosmetic outcome after trigonocephaly correction has not previously been reported. The management and different surgical techniques utilized over a 16-year period are discussed. MATERIALS AND METHODS An observational study was undertaken of the clinical outcome, operative data, complications and cosmetic satisfaction of these trigonocephaly patients. The parents/child were asked to rate their satisfaction with the cosmetic outcome both in terms of head shape and scar appearance, on a five-point scale (excellent-5, very good-4, good-3, fair-2 and poor-1). RESULTS Sixty-three patients presented with non-syndromic trigonocephaly over the 16 years. Nineteen of 63 had a mild form of trigonocephaly and were managed conservatively. The remainder underwent surgical correction. Forty-two of 44 (95%) underwent fronto-orbital advancement with either barrel staving (26/44) or frontal bone rotation/re-modelling (16/44), with 2 of 44 having burring of the metopic ridge. Head shape rating was regarded as excellent in 25 of 63 (40%), very good in 18 of 63 (28%), good in 18 of 63 (28%) and fair in 2 of 63 (4%). Of those that underwent surgery, the scar was zigzag in 32 of 44 and straight in 12 of 44. Scar was rated as being excellent in 21 of 44 (48%), very good in 12 of 44 (28%) good in 11 of 44 (24%). CONCLUSIONS Metopic synostosis can result in varying degrees of severity. Milder forms can be treated conservatively, with more severe forms requiring both frontal bone re-modelling and fronto-orbital advancement. Surgical correction results in a high level of patient/parent satisfaction.
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Affiliation(s)
- Michael O Kelleher
- Department of Neurosurgery, Beaumont Hospital, Dublin 9, Republic of Ireland.
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