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Management of Sagittal and Lambdoid Craniosynostosis: Open Cranial Vault Expansion and Remodeling. Oral Maxillofac Surg Clin North Am 2022; 34:395-419. [PMID: 35752548 DOI: 10.1016/j.coms.2022.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The prevalence of sagittal and lambdoid suture craniosynostosis differs considerably, as they are notably the most and least prevalent sutures involved in isolated suture craniosynostosis, respectively. The goals of reconstructing the cranial vault in both entities is the same: to release the fused suture, expand cranial volume, restore normal head shape and morphology, and allow for normal growth of the cranial vault. With regards to sagittal suture synostosis, opinions vary on whether reconstruction should focus on either the anterior or poster cranial vault. In contrast, the poster cranial vault is always targeted in lambdoid suture craniosynostosis.
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Ghizoni E, Denadai R, Raposo-Amaral CA, Joaquim AF, Tedeschi H, Raposo-Amaral CE. Diagnosis of infant synostotic and nonsynostotic cranial deformities: a review for pediatricians. REVISTA PAULISTA DE PEDIATRIA (ENGLISH EDITION) 2016. [PMID: 27256993 PMCID: PMC5176072 DOI: 10.1016/j.rppede.2016.02.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Objective: To review the current comprehensive care for nonsyndromic craniosynostosis and nonsynostotic cranial deformity and to offer an overall view of these craniofacial conditions. Data source: The review was conducted in the PubMed, SciELO, and LILACS databases without time or language restrictions. Relevant articles were selected for the review. Data synthesis: We included the anatomy and physiology of normal skull development of children, discussing nuances related to nomenclature, epidemiology, etiology, and treatment of the most common forms of nonsyndromic craniosynostosis. The clinical criteria for the differential diagnosis between positional deformities and nonsyndromic craniosynostosis were also discussed, giving to the pediatrician subsidies for a quick and safe clinical diagnosis. If positional deformity is accurately diagnosed, it can be treated successfully with behavior modification. Diagnostic doubts and craniosynostosis patients should be referred straightaway to a multidisciplinary craniofacial center. Conclusions: Pediatricians are in the forefront of the diagnosis of patients with cranial deformities. Thus, it is of paramount importance that they recognize subtle cranial deformities as it may be related to premature fusion of cranial sutures.
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Affiliation(s)
- Enrico Ghizoni
- Universidade Estadual de Campinas (Unicamp), Campinas, SP, Brasil.
| | - Rafael Denadai
- Instituto de Cirurgia e Plástica Crânio Facial, Hospital Sobrapar, Campinas, SP, Brasil
| | | | | | - Helder Tedeschi
- Universidade Estadual de Campinas (Unicamp), Campinas, SP, Brasil
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Ghizoni E, Denadai R, Raposo-Amaral CA, Joaquim AF, Tedeschi H, Raposo-Amaral CE. Diagnosis of infant synostotic and nonsynostotic cranial deformities: a review for pediatricians. REVISTA PAULISTA DE PEDIATRIA 2016; 34:495-502. [PMID: 27256993 DOI: 10.1016/j.rpped.2016.01.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 01/10/2016] [Accepted: 01/11/2016] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To review the current comprehensive care for nonsyndromic craniosynostosis and nonsynostotic cranial deformity and to offer an overall view of these craniofacial conditions. DATA SOURCE The review was conducted in the PubMed, SciELO, and LILACS databases without time or language restrictions. Relevant articles were selected for the review. DATA SYNTHESIS We included the anatomy and physiology of normal skull development of children, discussing nuances related to nomenclature, epidemiology, etiology, and treatment of the most common forms of nonsyndromic craniosynostosis. The clinical criteria for the differential diagnosis between positional deformities and nonsyndromic craniosynostosis were also discussed, giving to the pediatrician subsidies for a quick and safe clinical diagnosis. If positional deformity is accurately diagnosed, it can be treated successfully with behavior modification. Diagnostic doubts and craniosynostosis patients should be referred straightaway to a multidisciplinary craniofacial center. CONCLUSIONS Pediatricians are in the forefront of the diagnosis of patients with cranial deformities. Thus, it is of paramount importance that they recognize subtle cranial deformities as it may be related to premature fusion of cranial sutures.
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Affiliation(s)
- Enrico Ghizoni
- Universidade Estadual de Campinas (Unicamp), Campinas, SP, Brasil.
| | - Rafael Denadai
- Instituto de Cirurgia e Plástica Crânio Facial, Hospital Sobrapar, Campinas, SP, Brasil
| | | | | | - Helder Tedeschi
- Universidade Estadual de Campinas (Unicamp), Campinas, SP, Brasil
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Progressive frontal morphology changes during the first year of a modified Pi procedure for scaphocephaly. Childs Nerv Syst 2016; 32:337-44. [PMID: 26409882 DOI: 10.1007/s00381-015-2914-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2015] [Accepted: 09/16/2015] [Indexed: 02/05/2023]
Abstract
PURPOSE The purpose of this study was to quantify the changes in frontal morphology in patients with scaphocephaly treated with a modified Pi procedure. METHODS Consecutive scaphocephalic patients (n = 13) who underwent surgery before 12 months of age that had more than 1 year of follow-up and standard preoperative, 3-month, and 1-year photographs were included. Anthropometric measurements were used to document the craniofacial index. Computerized photogrammetric analyses of five craniofacial angles (bossing angle, nasofrontal angle, angle of facial convexity, and angle of total facial convexity) were also performed. RESULTS Comparisons of the preoperative and postoperative direct anthropometric measurements of the cephalic index showed a significant (all p < 0.05) increase in the postoperative period, with no significant differences in early versus late postoperative period comparisons. Comparisons of the preoperative and postoperative computerized photogrammetric measurements of the craniofacial angles showed a significant (all p < 0.05) reduction (bossing angle, angle of facial convexity, and angle of total facial convexity) and increase (nasofrontal angle) in the early and late postoperative periods. CONCLUSIONS Frontal morphology significantly changed over the first year of the modified Pi procedure.
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Craniectomy Gap Patency and Neosuture Formation following Endoscopic Suturectomy for Unilateral Coronal Craniosynostosis. Plast Reconstr Surg 2014; 134:81e-91e. [DOI: 10.1097/prs.0000000000000285] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Cranial Vault Growth in Multiple-Suture Nonsyndromic and Syndromic Craniosynostosis. J Craniofac Surg 2013; 24:753-7. [DOI: 10.1097/scs.0b013e3182868b4f] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Ridgway EB, Berry-Candelario J, Grondin RT, Rogers GF, Proctor MR. The management of sagittal synostosis using endoscopic suturectomy and postoperative helmet therapy. J Neurosurg Pediatr 2011; 7:620-6. [PMID: 21631199 DOI: 10.3171/2011.3.peds10418] [Citation(s) in RCA: 89] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Suturectomy as a treatment for craniosynostosis was largely replaced in the late twentieth century by more extensive, but predictable, cranial remodeling procedures. Recent technical innovations, such as using the endoscope combined with postoperative orthotic reshaping, have led to a resurgence of interest in suturectomy as a safer, less invasive method. METHODS A retrospective chart review was performed for all cases of sagittal synostosis treated with endoscopic sagittal suture strip craniectomy and helmet therapy between 2004 and 2008. Data collected included gestational age, genetic evaluations and syndromic status, age at operation, duration of procedure, need for blood transfusions, length of hospital stay, preoperative and postoperative head circumference percentile and cranial index, duration of helmet use, length of follow-up, complications, and revisions. RESULTS Fifty-six patients with isolated sagittal synostosis were treated using endoscopic suturectomy and completed helmet therapy. Mean age at time of procedure was 3.24 months. Mean operative duration was 45.32 minutes. Mean hospital stay was 1.39 days. There were 2 transfusions and no deaths. The mean length of follow-up was 2.34 years. Helmet therapy was instituted for a mean of 7.47 months. Head circumference percentile increased from 61.42% to 89.27% over 2 years of follow-up. Cranial index increased from a preoperative mean of 0.69 to 0.76 over 2 years of follow-up. Reoperations for synostosis included 1 sagittal suture refusion and 2 cases in which other sutures fused. CONCLUSIONS Sagittal synostosis can be safely treated with endoscopic suturectomy and helmet therapy. Improvements in cranial volume and shape are comparable to open procedures and are enduring.
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Affiliation(s)
- Emily B Ridgway
- Department of Plastic Surgery, Children’s Hospital Boston, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA
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Moon SH, Paik HW, Byeon JH. Treatment of sagittal synostosis: Subtotal cranial vault remodelling with right-angled Z-osteotomies. J Plast Reconstr Aesthet Surg 2010; 63:1787-93. [DOI: 10.1016/j.bjps.2009.11.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2009] [Revised: 11/05/2009] [Accepted: 11/06/2009] [Indexed: 11/25/2022]
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Correction of hydrocephalic macrocephaly with total cranial vault remodeling and molding helmet therapy. Plast Reconstr Surg 2009; 125:1763-1770. [PMID: 19952872 DOI: 10.1097/prs.0b013e3181cc5a1b] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Hydrocephalic macrocephaly is a rare problem that may result in cranial vault instability, difficulties with posture and movement, and hindrance in neurological development. The authors studied the outcomes of hydrocephalic macrocephalic cases in which patients underwent single-stage total cranial vault remodeling and postoperative helmet therapy. METHODS Consecutive patients with hydrocephalic macrocephaly treated at University of California, Los Angeles from 2000 to 2007 were studied (n = 8). Perioperative examinations (head circumference), lateral cranial radiographs (anteroposterior, lateral, and cranial height measurements) and three-dimensional computed tomography scans (cranial volume) were used to access cranial reduction. Developmental testing, physician evaluations (Whitaker score), and parental surveys were used. RESULTS Improvements in mean head circumference (from 58.8 cm to 48.9 cm, or 17 percent reduction), and cranial volume measurements (from 1924 cc to 1212 cc, or 35 percent reduction) were seen in patients after the procedure. In addition, developmental testing scores improved in half, or four of eight patients. Whitaker score was 1.9 with only one case requiring revision but five needing subsequent shunts. Surveys showed a high satisfaction rate with final appearance and ease of childcare. CONCLUSION For the rare patient with hydrocephalic macrocephaly, treatment with total cranial vault remodeling with postoperative helmet therapy may be successful, but follow-up monitoring and subsequent ventriculoperitoneal shunting may be necessary.
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Three Tenets for Staged Correction of Kleeblattschädel or Cloverleaf Skull Deformity. Plast Reconstr Surg 2009; 123:310-318. [DOI: 10.1097/prs.0b013e3181934773] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Complete Correction of Severe Scaphocephaly: The Melbourne Method of Total Vault Remodeling. Plast Reconstr Surg 2008; 121:1300-1310. [DOI: 10.1097/01.prs.0000304592.56498.d6] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Burstein F, Eppley B, Hudgins R, Williams J, Boydston W, Reisner A, Stevenson K. Application of the Spanning Plate Concept to Frontal Orbital Advancement. J Craniofac Surg 2006; 17:241-5. [PMID: 16633169 DOI: 10.1097/00001665-200603000-00007] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Frontal orbital advancement (FOA), is the procedure of choice in treatment of coronal and metopic synostosis. Resorbable plates and screws have been widely accepted for use in pediatric craniofacial surgery, including FOA. We have applied the concept of extended resorbable spanning plates to FOA for metopic, unilateral, and bilateral coronal synostosis in infants and children during a 5-year period. We report on 60 patients, ages 4 to 15 months (mean, 7 months); 28 girls, 32 boys. Follow-up ranged from 12 to 36 months (mean, 24 months). There were no structural failures, no infections, and no complications related to the use of extended spanning plates. Extended spanning plates decrease mobility between bone segments, confer greater stability to the construct, and reduce both the number of plates and of screws that are necessary and reduce the operative time. Application of these plates simplifies FOA surgery and represents a step in the evolution of plating technology.
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Affiliation(s)
- Fernando Burstein
- Division of Plastic and Reconstructive Surgery University of Indiana, Indianapolis, USA.
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O'Hara CM, Izadi K, Albright AL, Bradley JP. Case report of optic atrophy in pansynostosis: an unusual presentation of scalp edema from hair braiding. Pediatr Neurosurg 2006; 42:100-4. [PMID: 16465079 DOI: 10.1159/000090463] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2004] [Accepted: 12/10/2004] [Indexed: 11/19/2022]
Abstract
Pansynostosis (fusion of all cranial sutures) and optic atrophy were found as incidental CT scan and ophthalmological findings in an 8-year-old who presented to the emergency room with scalp edema from tight 'cornrow' hair braiding. Cranial vault expansion was successfully performed. Ophthalmological problems have stabilized but have not reversed. Late presentation of craniosynostosis and the pathophysiology of secondary optic atrophy are discussed.
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Affiliation(s)
- Catherine M O'Hara
- Division of Plastic and Reconstructive Surgery, University of California, Los Angeles, CA 90095, and Division of Plastic and Reconstructive Surgery, University of Pittsburgh School of Medicine, Children's Hospital of Pittsburgh, PA, USA
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Amm CA, Denny AD. Correction of Sagittal Synostosis Using Foreshortening and Lateral Expansion of the Cranium Activated by Gravity: Surgical Technique and Postoperative Evolution. Plast Reconstr Surg 2005; 116:723-35. [PMID: 16141807 DOI: 10.1097/01.prs.0000176897.76579.7c] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The authors present a technique for correction of sagittal synostosis addressing the transverse constriction and providing foreshortening of the skull without the use of hardware. The design of the osteotomies combined with strict postoperative supine positioning allows foreshortening of the skull, with concomitant expansion. METHODS Twenty-two patients were operated on using the foreshortening and lateral expansion activated by gravity technique. Postoperative follow-up included clinical evaluation and three-dimensional computed tomographic scanning at 4 to 6 weeks, 1 year, and yearly afterward. These scans were analyzed using three-dimensional surface analysis software, according to a protocol the authors describe in this article. RESULTS The cephalic index improved from 66.4 preoperatively to 74.5 at 1 year postoperatively (normal, 72 to 87). Transverse growth continued to be the dominant vector of growth up to 1 year (until ossification-bridging of the vertex craniectomy). Beyond 1 year, the main area of transverse growth was overlying the temporal suture, producing a distinctive temporal bossing in patients. The parietal areas showed mini-mal growth afterward. Growth was mainly occipital between 1 and 3 years of age, and frontal afterward, up to 5 years of age. A low frontal bossing also occurred in some of our patients and resolved spontaneously. CONCLUSIONS The authors have described a technique for correction of scaphocephaly that avoids the use of hardware, with acceptable operative times and transfusion needs. Postoperative improvement in shape is satisfactory. Analysis of the three-dimensional scans of these patients shows abnormal skull growth patterns up to 5 years of age.
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Abstract
One of the main risks of craniosynostosis surgery is the possible need for an allogenic blood transfusion (ABT). Most patients are operated on in the first months of life, when physiological conditions are particularly sensitive to even limited blood losses. Furthermore, most surgical techniques proposed in the past were based on extensive craniectomies and cranial remodeling. Because of the known infective and immunologic risks of ABT, in recent years more attention has been dedicated to factors that might help reduce the risk of ABT. We review recent preoperative (ie, erythropoietin administration), intraoperative (ie, acute normovolemic hemodilution, intraoperative blood salvage), and postoperative (ie, clinical monitoring, postoperative blood salvage) anesthesiologic procedures developed with this aim in mind. We also consider operative techniques and technical apparatus that reduce surgical invasiveness, particularly preoperative planning, age selection, and the role of endoscopic assistance and gradual distraction devices.
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Affiliation(s)
- C Di Rocco
- Pediatric Neurosurgical Unit, Institute of Anesthesiology, Catholic University Medical School, Largo "A. Gemelli," 8, 00,168 Rome, Italy
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Affiliation(s)
- Barry L Eppley
- Division of Plastic Surgery, Indiana University School of Medicine, Indianapolis 46202, USA.
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