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Chaisrisawadisuk S, Phakdeewisetkul K, Sirichatchai K, Hammam E, Prasad V, Moore MH. Early Bone and Suture Reformations in Different Cranial Regions After Cranial Vault Remodeling for Sagittal Craniosynostosis. J Craniofac Surg 2024:00001665-990000000-01801. [PMID: 39133216 DOI: 10.1097/scs.0000000000010508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 06/26/2024] [Indexed: 08/13/2024] Open
Abstract
Cranial vault remodeling (CVR) is a common procedure for correcting sagittal craniosynostosis. Some approaches leave significant craniectomy defects. The authors investigated the reosteogenesis in different cranial defect areas after CVR. A cross-sectional study was conducted in nonsyndromic sagittal craniosynostosis. Available early postoperative computed tomography (CT) scans were analyzed. The segmentation of three-dimensional reconstructed images was performed. Different cranial defect areas, including coronal, vertex, and occipital regions, were further investigated using an automated three-dimensional analysis software for reosteogenesis percentage. Forty-four CT scans were included. The average age at CVR was 8.8 months. The median time of postoperative CT scans was 6.1 weeks. The median bone reformation percentage of the entire cranial defect was 56.7%. Given the similar postoperative CT timing, the median bone reformation at the coronal, vertex, and occipital areas demonstrated 44.21%, 41.13%, and 77.75%, respectively (P < 0.001). In the simultaneously removed coronal and lambdoid sutures, there were 45% with coronal and lambdoid sutures reformation, followed by lambdoid suture reformation alone, no suture reformation and coronal reformation alone in 35%, 20%, and 0%, respectively (P = 0.013). There was no coronal reformation in the removed coronal suture group. However, 40% demonstrated lambdoid suture reformation after the isolated lambdoid suture removal. The occipital region has the highest reosteogenesis compared with the other cranial defects after CVR in nonsyndromic sagittal craniosynostosis. Within the removed previous patent sutures, the lambdoid suture reformation showed a higher rate than the coronal suture.
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Affiliation(s)
- Sarut Chaisrisawadisuk
- Cleft and Craniofacial SA, Women's and Children's Hospital, North Adelaide, South Australia, Australia
- Division of Plastic Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University
| | - Kantapat Phakdeewisetkul
- Biomechanics Research Center, Meticuly Co. Ltd., Chulalongkorn University
- Advanced Materials Analysis Research Unit, Department of Metallurgical Engineering, Faculty of Engineering,Chulalongkorn University, Bangkok, Thailand
| | - Kanin Sirichatchai
- Biomechanics Research Center, Meticuly Co. Ltd., Chulalongkorn University
| | - Elie Hammam
- Department of Neurosurgery, Women's and Children's Hospital, North Adelaide, South Australia, Australia
| | - Vani Prasad
- Cleft and Craniofacial SA, Women's and Children's Hospital, North Adelaide, South Australia, Australia
| | - Mark H Moore
- Cleft and Craniofacial SA, Women's and Children's Hospital, North Adelaide, South Australia, Australia
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Di Rocco F, Proctor MR. Technical evolution of pediatric neurosurgery: craniosynostosis from 1972 to 2023 and beyond. Childs Nerv Syst 2023; 39:2779-2787. [PMID: 37584742 DOI: 10.1007/s00381-023-06113-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 08/01/2023] [Indexed: 08/17/2023]
Abstract
Very few clinical entities have undergone so many different treatment approaches over such a short period of time as craniosynostosis. Surgical treatments for this condition have ranged from simple linear craniectomies, accounting for the specific role of cranial sutures in assuring the normal growth of the skull, to more complex cranial vault reconstructions, based on the perceived role of the skull base in affecting the growth of the skull. While a great deal of evolution has occurred, there remains controversy regarding the ideal treatment including the best surgical technique, the optimal age for surgery, and the long-term morphological and neurodevelopmental outcomes. The evolution of the surgical management of craniosynostosis in the last 50 years has been affected by several factors. This includes the awareness of needing to operate on affected children during infancy to achieve the best results, the use of multistage operations, the availability of more sophisticated surgical tools, and improved perioperative care. In some forms of craniosynostosis, the operations can be carried out at a very young age with low morbidity, and with the postoperative use of a molding helmet, springs, or distractors, these operations prove to be as effective as traditional larger cranial reconstructions performed in older children. As a consequence, complex surgical operations have become progressively less utilized. A second relevant advance was the more recent advent of a molecular diagnosis, which allowed us to understand the pathogenesis of some associated malformations and neurodevelopmental issues that were observed in some children despite appropriate surgical treatment. Future research should focus on improving the analysis of longer-term outcomes and understanding the natural history of craniofacial conditions, including what issues persist despite optimal surgical correction. Progress in molecular investigations concerning the normal and pathological development of cranial sutures could be a further significant step in the management of craniosynostosis, possibly favoring a "medical" treatment in the near future. Artificial intelligence will likely have a role in establishing the diagnosis with less reliance on radiographic studies and in assisting with surgical planning. Overall, much progress has been made, but there remains much to do.
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Affiliation(s)
- Federico Di Rocco
- Department of Pediatric Neurosurgery, Hôpital Femme Mère Enfant, INSERM 1033, Université de Lyon, Centre de Reference Malformations Craniofaciales, Lyon, France
| | - Mark R Proctor
- Department of Neurosurgery, Boston Children's Hospital/Harvard Medical School, 300 Longwood Ave, Boston, MA, 02459, USA.
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Beuriat PA, Szathmari A, Chauvel-Picard J, Gleizal A, Paulus C, Mottolese C, Di Rocco F. Coronal and lambdoid suture evolution following total vault remodeling for scaphocephaly. Neurosurg Focus 2021; 50:E4. [PMID: 33794500 DOI: 10.3171/2021.1.focus201004] [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: 11/24/2020] [Accepted: 01/05/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Different types of surgical procedures are utilized to treat craniosynostosis. In most procedures, the fused suture is removed. There are only a few reports on the evolution of sutures after surgical correction of craniosynostosis. To date, no published study describes neosuture formation after total cranial vault remodeling. The objective of this study was to understand the evolution of the cranial bones in the area of coronal and lambdoid sutures that were removed for complete vault remodeling in patients with sagittal craniosynostosis. In particular, the investigation aimed to confirm the possibility of neosuture formation. METHODS CT images of the skulls of children who underwent operations for scaphocephaly at the Hôpital Femme Mère Enfant, Lyon University Hospital, Lyon, France, from 2004 to 2014 were retrospectively reviewed. Inclusion criteria were diagnosis of isolated sagittal synostosis, age between 4 and 18 months at surgery, and availability of reliable postoperative CT images obtained at a minimum of 1 year after surgical correction. Twenty-six boys and 11 girls were included, with a mean age at surgery of 231.6 days (range 126-449 days). The mean interval between total vault reconstruction and CT scanning was 5.3 years (range 1.1-12.2 years). RESULTS Despite the removal of both the coronal and lambdoid sutures, neosutures were detected on the 3D reconstructions. All combinations of neosuture formation were seen: visible lambdoid and coronal neosutures (n = 20); visible lambdoid neosutures with frontoparietal bony fusion (n = 12); frontoparietal and parietooccipital bony fusion (n = 3); and visible coronal neosutures with parietooccipital bony fusion (n = 2). CONCLUSIONS This is the first study to report the postoperative skull response after the removal of normal patent sutures following total vault remodeling in patients with isolated sagittal synostosis. The reappearance of a neosuture is rather common, but its incidence depends on the type of suture. The outcome of the suture differs with the incidence of neosuture formation between these transverse sutures. This might imply genetic and functional differences among cranial sutures, which still have to be elucidated.
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Affiliation(s)
- Pierre-Aurélien Beuriat
- 1French Referral Center for Craniosynostosis.,Departments of2Pediatric Neurosurgery and.,4Université de Lyon, France
| | - Alexandru Szathmari
- 1French Referral Center for Craniosynostosis.,Departments of2Pediatric Neurosurgery and
| | - Julie Chauvel-Picard
- 1French Referral Center for Craniosynostosis.,3Pediatric Maxillo-Facial Surgery, Hôpital Femme Mère Enfant; and.,4Université de Lyon, France
| | - Arnaud Gleizal
- 1French Referral Center for Craniosynostosis.,3Pediatric Maxillo-Facial Surgery, Hôpital Femme Mère Enfant; and.,4Université de Lyon, France
| | - Christian Paulus
- 1French Referral Center for Craniosynostosis.,3Pediatric Maxillo-Facial Surgery, Hôpital Femme Mère Enfant; and
| | - Carmine Mottolese
- 1French Referral Center for Craniosynostosis.,Departments of2Pediatric Neurosurgery and
| | - Federico Di Rocco
- 1French Referral Center for Craniosynostosis.,Departments of2Pediatric Neurosurgery and.,4Université de Lyon, France
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Neosagittal Suture Formation after Endoscopic Sagittal Strip Craniectomy: A Case Report and Literature Review. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3368. [PMID: 33564591 PMCID: PMC7862037 DOI: 10.1097/gox.0000000000003368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 11/23/2020] [Indexed: 11/26/2022]
Abstract
The fate of the excised synostotic suture in craniosynostosis remains relatively understudied. The purpose of this report is to describe a case of neosagittal suture formation following endoscopic excision of a pathology-proven synostotic suture, with CT demonstration of complete reossification in the areas adjacent to the neosagittal suture. We additionally review the existing literature on neosuture formation that has been published over the past 50 years. We conclude that continued investigation is warranted, both through histological comparison of normal and neosutures and through studies to determine clinical risk factors, as this may improve our understanding of the underlying mechanism of pathologic premature suture fusion in craniosynostosis.
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Neo-Sagittal Suture Formation After Cranial Vault Remodeling in Sagittal Craniosynostosis. J Craniofac Surg 2020; 32:282-284. [PMID: 32947338 DOI: 10.1097/scs.0000000000007072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
ABSTRACT Craniosynostosis is a condition where the cranial sutures are early fused. Sagittal suture synostosis is found to be the most prevalent. Many techniques ranging from simple suture excision to wide suturectomy have been developed for treating this condition. While repeated fusion of previously excised involved sutures is common, neosuture formation has been identified in many recent reports after craniosynostosis surgery. In this case report, the authors present a finding of the neosuture formation in a patient presented with sagittal craniosynostosis after wide suturectomy with total cranial vault remodeling so that the pathologically fused suture can be reversed.
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Zubovic E, Skolnick GB, Naidoo SD, Bellanger M, Smyth MD, Patel KB. Endoscopic treatment of combined metopic-sagittal craniosynostosis. J Neurosurg Pediatr 2020; 26:113-121. [PMID: 32302979 DOI: 10.3171/2020.2.peds2029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 02/18/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Combined metopic-sagittal craniosynostosis is traditionally treated with open cranial vault remodeling and fronto-orbital advancement, sometimes in multiple operations. Endoscopic treatment of this multisuture synostosis presents a complex challenge for the surgeon and orthotist. METHODS The authors retrospectively analyzed the preoperative and 1-year postoperative CT scans of 3 patients with combined metopic-sagittal synostosis, all of whom were treated with simultaneous endoscope-assisted craniectomy of the metopic and sagittal sutures followed by helmet therapy. Established anthropometric measurements were applied to assess pre- and postoperative morphology, including cranial index and interfrontal divergence angle (IFDA). Patients' measurements were compared to those obtained in 18 normal controls. RESULTS Two boys and one girl underwent endoscope-assisted craniectomy at a mean age of 81 days. The mean preoperative cranial index was 0.70 (vs control mean of 0.82, p = 0.009), corrected postoperatively to a mean of 0.82 (vs control mean of 0.80, p = 0.606). The mean preoperative IFDA was 110.4° (vs control mean of 152.6°, p = 0.017), corrected postoperatively to a mean of 139.1° (vs control mean of 140.3°, p = 0.348). The mean blood loss was 100 mL and the mean length of stay was 1.7 days. No patient underwent reoperation. The mean clinical follow-up was 3.4 years. CONCLUSIONS Endoscope-assisted craniectomy with helmet therapy is a viable single-stage treatment option for combined metopic-sagittal synostosis, providing correction of the stigmata of trigonoscaphocephaly, with normalization of the cranial index and IFDA.
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Affiliation(s)
- Ema Zubovic
- 1Division of Plastic & Reconstructive Surgery, Department of Surgery, and
| | - Gary B Skolnick
- 1Division of Plastic & Reconstructive Surgery, Department of Surgery, and
| | - Sybill D Naidoo
- 1Division of Plastic & Reconstructive Surgery, Department of Surgery, and
| | | | - Matthew D Smyth
- 2Department of Neurosurgery, Washington University School of Medicine in St. Louis; and
| | - Kamlesh B Patel
- 1Division of Plastic & Reconstructive Surgery, Department of Surgery, and
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Surgical Approach and Periprocedural Outcomes by Race and Ethnicity of Children Undergoing Craniosynostosis Surgery. Plast Reconstr Surg 2019; 144:1384-1391. [DOI: 10.1097/prs.0000000000006254] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
The formation of the cranial sutures, in utero, occurs when the ossification of the skull bones reaches predestined positions around gestational week 15 to 20. Craniosynostosis, and the consequent skull shape deformities, is treated with surgery including osteotomies of the fused sutures. The occasional appearance of a new suture in the osteotomy lines has previously been described as sporadic events. In this retrospective study, a 4-year consecutive series of osteotomies combined with springs for craniosynostosis were systematically analysed regarding the appearance of neosutures. In total, 84 patients were included and in 16 patients (19%) a new radiologically normal suture appeared in a part of the suture that was completely closed preoperatively. Additionally, in 7 patients (8%) a new suture appeared in a part of the suture that had a discernible suture prior to surgery.In conclusion, in this consecutive and well-defined patient cohort operated for craniosynostosis, the formation of a neosuture is not a rare, and speculatively not a random, event. The appearance of a new suture long after the normal time period for suture formation in utero indicates that the craniosynostosis may just as well be caused by disturbed formation of the suture as actual premature closure.
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Affiliation(s)
- Karin Säljö
- Department of Plastic Surgery, Sahlgrenska University Hospital, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Magge SN, Bartolozzi AR, Almeida ND, Tsering D, Myseros JS, Oluigbo CO, Rogers GF, Keating RF. A comparison of endoscopic strip craniectomy and pi craniectomy for treatment of sagittal craniosynostosis. J Neurosurg Pediatr 2019; 23:708-714. [PMID: 30925476 DOI: 10.3171/2019.1.peds18203] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 01/14/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Sagittal craniosynostosis is managed with a wide variety of operative strategies. The current investigation compares the clinical outcomes of two widely performed techniques: pi craniectomy and minimally invasive endoscopic strip craniectomy (ESC) followed by helmet therapy. METHODS This IRB-approved retrospective study examined patients diagnosed with nonsyndromic, single-suture sagittal craniosynostosis treated with either pi craniectomy or ESC. Included patients had a minimum postoperative follow-up of 5 months. RESULTS Fifty-one patients met the inclusion criteria (pi 21 patients, ESC 30 patients). Compared to patients who underwent ESC, the pi patients were older at the time of surgery (mean age 5.06 vs 3.11 months). The mean follow-up time was 23.2 months for ESC patients and 31.4 months for pi patients. Initial cranial index (CI) was similar between the groups, but postoperatively the ESC patients experienced a 12.3% mean increase in CI (from 0.685 to 0.767) compared to a 5.34% increase for the pi patients (from 0.684 to 0.719), and this difference was statistically significant (p < 0.001). Median hospital length of stay (1 vs 2 days) and operative duration (69.5 vs 93.3 minutes) were significantly less for ESC (p < 0.001 for both). The ESC patients showed a trend toward better results when surgery was done at younger ages. Craniectomy width in ESC cases was positively associated with CI improvement (slope of linear regression = 0.69, p = 0.026). CONCLUSIONS While both techniques effectively treated sagittal craniosynostosis, ESC showed superior results compared to pi craniectomy. ESC showed a trend for better outcomes when done at younger ages, although the trend did not reach statistical significance. A wider craniectomy width (up to 2 cm) was associated with better outcomes than smaller craniectomy widths among the ESC patients.
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Affiliation(s)
- Suresh N Magge
- Divisions of1Neurosurgery and
- 3George Washington UniversitySchool of Medicine and Health Sciences, Washington, DC; and
| | - Arthur R Bartolozzi
- 4Department of Orthopedic Surgery, Stanford University,Palo Alto, California
| | - Neil D Almeida
- 3George Washington UniversitySchool of Medicine and Health Sciences, Washington, DC; and
| | | | - John S Myseros
- Divisions of1Neurosurgery and
- 3George Washington UniversitySchool of Medicine and Health Sciences, Washington, DC; and
| | - Chima O Oluigbo
- Divisions of1Neurosurgery and
- 3George Washington UniversitySchool of Medicine and Health Sciences, Washington, DC; and
| | - Gary F Rogers
- 2Plastic Surgery, Children's National Health System
- 3George Washington UniversitySchool of Medicine and Health Sciences, Washington, DC; and
| | - Robert F Keating
- Divisions of1Neurosurgery and
- 3George Washington UniversitySchool of Medicine and Health Sciences, Washington, DC; and
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Pendharkar AV, Shahin MN, Cavallo C, Zhao X, Ho AL, Sussman ES, Grant GA. Minimally invasive approaches to craniosynostosis. J Neurosurg Sci 2018; 62:745-764. [PMID: 29790726 DOI: 10.23736/s0390-5616.18.04483-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Craniosynostosis (CS) is defined as the premature fusion of one or more calvarial sutures. This carries several consequences, including abnormal/asymmetric cranial vault development, increased intracranial pressure, compromised neurocognitive development, and craniofacial deformity. Definitive management is surgical with the goal of protecting cerebral development by re-establishing normal cranial vault expansion and correcting cosmetic deformity. In today's practice, CS surgery has advanced radically from simple craniectomies to major cranial vault reconstructive (CVR) procedures. More recently there has been considerable interest in endoscopic assisted surgery (EAS). Theoretical benefits include decreased operative time, morbidity, blood loss, postoperative pain, cost and faster recovery times. In this focused review, we summarize the current body of literature reporting clinical outcomes in EAS and review the data comparing EAS and CVR.
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Affiliation(s)
- Arjun V Pendharkar
- Division of Pediatric Neurosurgery, Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA -
| | - Maryam N Shahin
- Division of Pediatric Neurosurgery, Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Claudio Cavallo
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Xiaochun Zhao
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Allen L Ho
- Division of Pediatric Neurosurgery, Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Eric S Sussman
- Division of Pediatric Neurosurgery, Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Gerald A Grant
- Division of Pediatric Neurosurgery, Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA
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Arts S, Delye H, van Lindert EJ. Intraoperative and postoperative complications in the surgical treatment of craniosynostosis: minimally invasive versus open surgical procedures. J Neurosurg Pediatr 2018; 21:112-118. [PMID: 29171801 DOI: 10.3171/2017.7.peds17155] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To compare minimally invasive endoscopic and open surgical procedures, to improve informed consent of parents, and to establish a baseline for further targeted improvement of surgical care, this study evaluated the complication rate and blood transfusion rate of craniosynostosis surgery in our department. METHODS A prospective complication registration database that contains a consecutive cohort of all pediatric neurosurgical procedures in the authors' neurosurgical department was used. All pediatric patients who underwent neurosurgical treatment for craniosynostosis between February 2004 and December 2014 were included. In total, 187 procedures were performed, of which 121 were endoscopically assisted minimally invasive procedures (65%). Ninety-three patients were diagnosed with scaphocephaly, 50 with trigonocephaly, 26 with plagiocephaly, 3 with brachycephaly, 9 with a craniosynostosis syndrome, and 6 patients were suffering from nonsyndromic multisutural craniosynostosis. RESULTS A total of 18 complications occurred in 187 procedures (9.6%, 95% CI 6.2-15), of which 5.3% (n = 10, 95% CI 2.9-10) occurred intraoperatively and 4.2% (n = 8, 95% CI 2.2-8.2) occurred postoperatively. In the open surgical procedure group, 9 complications occurred: 6 intraoperatively and 3 postoperatively. In the endoscopically assisted procedure group, 9 complications occurred: 4 intraoperatively and 5 postoperatively. Blood transfusion was needed in 100% (n = 66) of the open surgical procedures but in only 21% (n = 26, 95% CI 15-30) of the endoscopic procedures. One patient suffered a transfusion reaction, and 6 patients suffered infections, only one of which was a surgical site infection. A dural tear was the most common intraoperative complication that occurred (n = 8), but it never led to postoperative sequelae. Intraoperative bleeding from a sagittal sinus occurred in one patient with only minimal blood loss. There were no deaths, permanent morbidity, or neurological sequelae. CONCLUSIONS Complications during craniosynostosis surgery were relatively few and minor and were without permanent sequelae in open and in minimally invasive procedures. The blood transfusion rate was significantly reduced in endoscopic procedures compared with open procedures.
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Masserano B, Woo AS, Skolnick GB, Naidoo SD, Proctor MR, Smyth MD, Patel KB. The Temporal Region in Unilateral Coronal Craniosynostosis: Fronto-orbital Advancement Versus Endoscopy-Assisted Strip Craniectomy. Cleft Palate Craniofac J 2017; 55:423-429. [PMID: 29437517 DOI: 10.1177/1055665617739000] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To compare postoperative temporal expansion in patients treated with fronto-orbital advancement or endoscopy-assisted craniectomy with cranial orthotic therapy. DESIGN This is a retrospective, multicenter cohort study of patients with unilateral coronal craniosynostosis (UCS). SETTING Computed tomographic (CT) scans were drawn from UCS patients treated at Boston Children's Hospital or St Louis Children's Hospital. PATIENTS The study included 56 patients with UCS after fronto-orbital advancement (n = 32) or endoscopic repair (n = 24) and 10 age-matched controls. INTERVENTION Fronto-orbital advancement entails a craniotomy of the frontal bone and superior orbital rim followed by reshaping and forward advancement. Endoscopic repair is the release of the synostotic suture and guidance of further growth of the cranium using a molding orthotic. MAIN OUTCOME MEASURES Measures included posterior temporal width, anterior temporal width, orbital width, and anterior cranial fossa area taken preoperatively and 1 year postoperatively. Linear regression was performed to assess 1 year postoperative improvement in symmetry; covariates included preoperative symmetry and type of surgery. RESULTS Both treatments showed improvement in orbital width and anterior cranial fossa area symmetry 1 year postoperatively ( P < .001), but no significant improvement in posterior or anterior temporal width symmetry. Linear regression revealed no difference between the 2 procedures in any of the 4 measurements (.096 ≤ P ≤ .898). CONCLUSIONS Fronto-orbital advancement and endoscopic repair show equivalent outcomes 1 year postoperatively in all 3 width measurements and anterior cranial fossa area. Neither procedure produced significant improvement in temporal width.
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Affiliation(s)
- Benjamin Masserano
- 1 Division of Plastic and Reconstructive Surgery, Washington University in St Louis, St Louis, MO, USA
| | - Albert S Woo
- 1 Division of Plastic and Reconstructive Surgery, Washington University in St Louis, St Louis, MO, USA
| | - Gary B Skolnick
- 1 Division of Plastic and Reconstructive Surgery, Washington University in St Louis, St Louis, MO, USA
| | - Sybill D Naidoo
- 1 Division of Plastic and Reconstructive Surgery, Washington University in St Louis, St Louis, MO, USA
| | - Mark R Proctor
- 2 Department of Neurosurgery, Children's Hospital Boston/Harvard Medical School, Boston, MA, USA
| | - Matthew D Smyth
- 3 Department of Neurosurgery, Washington University in St Louis, St Louis, MO, USA
| | - Kamlesh B Patel
- 1 Division of Plastic and Reconstructive Surgery, Washington University in St Louis, St Louis, MO, USA
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Effect of Preoperative Molding Helmet in Patients With Sagittal Synostosis. J Craniofac Surg 2017; 28:898-903. [DOI: 10.1097/scs.0000000000003512] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Lattanzi W, Barba M, Di Pietro L, Boyadjiev SA. Genetic advances in craniosynostosis. Am J Med Genet A 2017; 173:1406-1429. [PMID: 28160402 DOI: 10.1002/ajmg.a.38159] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Revised: 12/30/2016] [Accepted: 01/06/2017] [Indexed: 12/22/2022]
Abstract
Craniosynostosis, the premature ossification of one or more skull sutures, is a clinically and genetically heterogeneous congenital anomaly affecting approximately one in 2,500 live births. In most cases, it occurs as an isolated congenital anomaly, that is, nonsyndromic craniosynostosis (NCS), the genetic, and environmental causes of which remain largely unknown. Recent data suggest that, at least some of the midline NCS cases may be explained by two loci inheritance. In approximately 25-30% of patients, craniosynostosis presents as a feature of a genetic syndrome due to chromosomal defects or mutations in genes within interconnected signaling pathways. The aim of this review is to provide a detailed and comprehensive update on the genetic and environmental factors associated with NCS, integrating the scientific findings achieved during the last decade. Focus on the neurodevelopmental, imaging, and treatment aspects of NCS is also provided.
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Affiliation(s)
- Wanda Lattanzi
- Institute of Anatomy and Cell Biology, Università Cattolica del Sacro Cuore, Rome, Italy.,Latium Musculoskeletal Tıssue Bank, Rome, Italy
| | - Marta Barba
- Institute of Anatomy and Cell Biology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Lorena Di Pietro
- Institute of Anatomy and Cell Biology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Simeon A Boyadjiev
- Division of Genomic Medicine, Department of Pediatrics, Davis Medical Center, University of California, Sacramento, California
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Markiewicz MR, Alden T, Momin MV, Olsson AB, Jurado RJ, Abdullah F, Miloro M. Does Receiving a Blood Transfusion Predict for Length of Stay in Children Undergoing Cranial Vault Remodeling for Craniosynostosis? Outcomes Using the Pediatric National Surgical Quality Improvement Program Dataset. J Oral Maxillofac Surg 2017; 75:1732-1741. [PMID: 28238822 DOI: 10.1016/j.joms.2017.01.029] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 01/23/2017] [Accepted: 01/24/2017] [Indexed: 10/20/2022]
Abstract
PURPOSE Recent interventions have aimed at reducing the need for blood transfusions in the perioperative period in patients with craniosynostosis undergoing cranial vault remodeling. However, little is known regarding whether the receipt of a blood transfusion influences the length of hospital stay. The purpose of this study was to assess whether the receipt of a blood transfusion in patients undergoing cranial vault remodeling is associated with an increased length of stay. MATERIALS AND METHODS To address the research purposes, we designed a retrospective cohort study using the 2014 Pediatric National Surgical Quality Improvement Program (NSQIP Peds) dataset. The primary predictor variable was whether patients received a blood transfusion during cranial vault remodeling. The primary outcome variable was length of hospital stay after the operation. The association between the receipt of blood transfusions and length of stay was assessed using the Student t test. The association between other covariates and the outcome variable was assessed using linear regression, analysis of variance, and the Tukey test for post hoc pair-wise comparisons. RESULTS The sample was composed of 756 patients who underwent cranial vault remodeling: 503 who received blood transfusions and 253 who did not. The primary predictor variable of blood transfusion was associated with an increased length of stay (4.1 days vs 3.0 days, P = .03). Other covariates associated with an increased length of stay included race, American Society of Anesthesiologists status, premature birth, presence of a congenital malformation, and number of sutures involved in craniosynostosis. CONCLUSIONS The receipt of a blood transfusion in the perioperative period in patients with craniosynostosis undergoing cranial vault remodeling was associated with an increased length of stay.
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Affiliation(s)
- Michael R Markiewicz
- Assistant Professor, Department of Oral & Maxillofacial Surgery, University of Illinois at Chicago, Attending Physician, Division of Oral and Maxillofacial Surgery, Department of Otolaryngology-Head and Neck Surgery, Feinberg School of Medicine, Northwestern University Chicago, IL, Division of Dentistry, Department of Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Ann & Robert H. Lurie Children's Hospital of Chicago, Feinberg School of Medicine, Northwestern University, Chicago, IL.
| | - Tord Alden
- Attending Physician, Neurosurgery; Chief Medical Informatics Officer; Assistant Professor, Pediatric Neurosurgery, Department of Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Mohmed Vasim Momin
- Resident, Department of Oral & Maxillofacial Surgery, University of Illinois at Chicago, Chicago, IL
| | - Alexis B Olsson
- Chief and Clinical Professor, Division of Oral and Maxillofacial Surgery, Department of Otolaryngology-Head and Neck Surgery; Feinberg School of Medicine, Northwestern University, Division of Dentistry, Department of Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Ray J Jurado
- Head, Division of Dentistry, Department of Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Fizan Abdullah
- Vice-Chair, Department of Surgery; Head, Division of Pediatric Surgery; Program Director, Fellowship in Pediatric Surgery; Professor of Surgery, Department of Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Michael Miloro
- Professor and Head, Department of Oral & Maxillofacial Surgery, University of Illinois at Chicago, Clinical Professor, Division of Oral and Maxillofacial Surgery, Department of Otolaryngology-Head and Neck Surgery, Feinberg School of Medicine, Northwestern University Chicago, IL
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Endoscopic Strip Craniectomy for Craniosynostosis: Do We Really Understand the Indications, Outcomes, and Risks? J Craniofac Surg 2016; 27:293-8. [PMID: 26886293 DOI: 10.1097/scs.0000000000002364] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Endoscopic strip craniectomy with postoperative helmet therapy has been introduced as a means to correct various forms of craniosynostosis. Although some authors have deemed the procedure safe and effective, many questions remain regarding this promising yet developing approach. The authors discuss 4 cases where patients were inadequately treated with endoscopic strip craniectomy resulting in a recommendation of complete secondary open cranial vault reconstruction. In addition, the authors present the findings from an informal survey of craniofacial colleagues to highlight an important discrepancy between published and anecdotal reports of complications. Finally, the authors highlight the need for further investigation into the proper indications and clinical outcomes of endoscopic strip craniectomy to better understand the role of this technique in the treatment of craniosynostosis.
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Salehi A, Ott K, Skolnick GB, Nguyen DC, Naidoo SD, Kane AA, Woo AS, Patel KB, Smyth MD. Neosuture formation after endoscope-assisted craniosynostosis repair. J Neurosurg Pediatr 2016; 18:196-200. [PMID: 27128960 DOI: 10.3171/2016.2.peds15231] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The goal of this study was to identify the rate of neosuture formation in patients with craniosynostosis treated with endoscope-assisted strip craniectomy and investigate whether neosuture formation in sagittal craniosynostosis has an effect on postoperative calvarial shape. METHODS The authors retrospectively reviewed 166 cases of nonsyndromic craniosynostosis that underwent endoscope-assisted repair between 2006 and 2014. Preoperative and 1-year postoperative head CT scans were evaluated, and the rate of neosuture formation was calculated. Three-dimensional reconstructions of the CT data were used to measure cephalic index (CI) (ratio of head width and length) of patients with sagittal synostosis. Regression analysis was used to calculate significant differences between patients with and without neosuture accounting for age at surgery and preoperative CI. RESULTS Review of 96 patients revealed that some degree of neosuture development occurred in 23 patients (23.9%): 16 sagittal, 2 bilateral coronal, 4 unilateral coronal, and 1 lambdoid synostosis. Complete neosuture formation was seen in 14 of those 23 patients (9 of 16 sagittal, 1 of 2 bilateral coronal, 3 of 4 unilateral coronal, and 1 of 1 lambdoid). Mean pre- and postoperative CI in the complete sagittal neosuture group was 67.4% and 75.5%, respectively, and in the non-neosuture group was 69.8% and 74.4%, respectively. There was no statistically significant difference in the CI between the neosuture and fused suture groups preoperatively or 17 months postoperatively in patients with sagittal synostosis. CONCLUSIONS Neosuture development can occur after endoscope-assisted strip craniectomy and molding helmet therapy for patients with craniosynostosis. Although the authors did not detect a significant difference in calvarial shape postoperatively in the group with sagittal synostosis, the relevance of neosuture formation remains to be determined. Further studies are required to discover long-term outcomes comparing patients with and without neosuture formation.
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Affiliation(s)
| | | | - Gary B Skolnick
- Plastic and Reconstructive Surgery, Washington University School of Medicine, St. Louis, Missouri; and
| | - Dennis C Nguyen
- Plastic and Reconstructive Surgery, Washington University School of Medicine, St. Louis, Missouri; and
| | - Sybill D Naidoo
- Plastic and Reconstructive Surgery, Washington University School of Medicine, St. Louis, Missouri; and
| | - Alex A Kane
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Albert S Woo
- Plastic and Reconstructive Surgery, Washington University School of Medicine, St. Louis, Missouri; and
| | - Kamlesh B Patel
- Plastic and Reconstructive Surgery, Washington University School of Medicine, St. Louis, Missouri; and
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Mazzoleni F, Meazzini MC, Novelli G, Basile V, Giussani C, Bozzetti A. Photometric evaluation of cranial and facial symmetry in hemicoronal single suture synostosis treated with surgical fronto-orbital remodeling. J Craniomaxillofac Surg 2016; 44:1037-46. [PMID: 27288326 DOI: 10.1016/j.jcms.2016.05.012] [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: 02/25/2016] [Revised: 03/26/2016] [Accepted: 05/09/2016] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE Evaluation of frontal vault symmetry and progressive facial symmetrization in a cohort of patients with hemicoronal single suture synostosis treated with a standardized cranioplasty and rigid fixation. PATIENTS AND METHODS Fifty-four patients with hemicoronal synostosis operated between 1999 and 2014 were reviewed retrospectively. Pre, immediately postoperative and yearly photographs from the top of the skull and frontal views of the face were taken with the same head position and projection. A photogrammetric method was applied to quantify the pre and postoperative contour changes. The anterior skull hemispheres were traced, divided into two equal parts and the areas were compared. Angular measurements obtained by the intersection of the interpupillary line and the glabella perpendicular vertical line were calculated. The average photographic follow-up was 6.8 years. Range 1-14 years. RESULTS The average advancement on the affected side was 18 mm (range: 16-23 mm). The pre-surgical cranial area on the affected side was increased on average 14.6 + 2.4% (range: 10-18%). The angular measurements documented the frontal symmetry obtained and the progressive improvement of facial symmetry. CONCLUSION Cranioplasty with rigid fixation achieved a stable correction of anterior plagiocephaly leading to subsequent symmetrical facial growth. Photogrammetry allowed fora quantitative long-term validation.
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Affiliation(s)
- Fabio Mazzoleni
- Department of Maxillofacial Surgery, San Gerardo Hospital - Monza, University of Milano Bicocca, Italy.
| | - Maria Costanza Meazzini
- Department of Maxillofacial Surgery, San Gerardo Hospital - Monza, University of Milano Bicocca, Italy
| | - Giorgio Novelli
- Department of Maxillofacial Surgery, San Gerardo Hospital - Monza, University of Milano Bicocca, Italy
| | - Valentina Basile
- Department of Maxillofacial Surgery, San Gerardo Hospital - Monza, University of Milano Bicocca, Italy
| | - Carlo Giussani
- Department of Neurosurgery, San Gerardo Hospital - Monza, University of Milano Bicocca, Italy
| | - Alberto Bozzetti
- Department of Maxillofacial Surgery, San Gerardo Hospital - Monza, University of Milano Bicocca, Italy
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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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The Effects of Whole-Vault Cranioplasty versus Strip Craniectomy on Long-Term Neuropsychological Outcomes in Sagittal Craniosynostosis. Plast Reconstr Surg 2015; 135:925e-926e. [DOI: 10.1097/prs.0000000000001194] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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