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He KH, Bruse JL, Rodriguez-Florez N, Dunaway D, Jeelani O, Schievano S, Borghi A. Understanding the influence of surgical parameters on craniofacial surgery outcomes: a computational study. ROYAL SOCIETY OPEN SCIENCE 2024; 11:231158. [PMID: 38577216 PMCID: PMC10987985 DOI: 10.1098/rsos.231158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 11/03/2023] [Accepted: 01/29/2024] [Indexed: 04/06/2024]
Abstract
Sagittal craniosynostosis (SC) is a congenital condition whereby the newborn skull develops abnormally owing to the premature ossification of the sagittal suture. Spring-assisted cranioplasty (SAC) is a minimally invasive surgical technique to treat SC, where metallic distractors are used to reshape the newborn's head. Although safe and effective, SAC outcomes remain uncertain owing to the limited understanding of skull-distractor interaction and the limited information provided by the analysis of single surgical cases. In this work, an SC population-averaged skull model was created and used to simulate spring insertion by means of the finite-element analysis using a previously developed modelling framework. Surgical parameters were varied to assess the effect of osteotomy and spring positioning, as well as distractor combinations, on the final skull dimensions. Simulation trends were compared with retrospective measurements from clinical imaging (X-ray and three-dimensional photogrammetry scans). It was found that the on-table post-implantation head shape change is more sensitive to spring stiffness than to the other surgical parameters. However, the overall end-of-treatment head shape is more sensitive to spring positioning and osteotomy size parameters. The results of this work suggest that SAC surgical planning should be performed in view of long-term results, rather than immediate on-table reshaping outcomes.
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Affiliation(s)
- K. H. He
- Ningbo University, Ningbo, People's Republic of China
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - J. L. Bruse
- Vicomtech Foundation, Basque Research and Technology Alliance (BRTA), San Sebastian, Spain
| | - N. Rodriguez-Florez
- Universidad de Navarra, TECNUN Escuela de Ingenieros, San Sebastian, Spain
- Ikerbasque, Basque Foundation for Science, Bilbao, Spain
| | - D. Dunaway
- Great Ormond Street Institute of Child Health, University College London, London, UK
- Craniofacial Unit, Great Ormond Street Hospital for Children, London, UK
| | - O. Jeelani
- Great Ormond Street Institute of Child Health, University College London, London, UK
- Craniofacial Unit, Great Ormond Street Hospital for Children, London, UK
| | - S. Schievano
- Great Ormond Street Institute of Child Health, University College London, London, UK
- Institute of Cardiovascular Science, University College London, London, UK
- Craniofacial Unit, Great Ormond Street Hospital for Children, London, UK
| | - A. Borghi
- Great Ormond Street Institute of Child Health, University College London, London, UK
- Craniofacial Unit, Great Ormond Street Hospital for Children, London, UK
- Department of Engineering, Durham University, Durham, UK
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Kurniawan MS, Tio PA, Abdel Alim T, Roshchupkin G, Dirven CM, Pleumeekers MM, Mathijssen IM, van Veelen MLC. 3D Analysis of the Cranial and Facial Shape in Craniosynostosis Patients: A Systematic Review. J Craniofac Surg 2024; 35:00001665-990000000-01410. [PMID: 38498012 PMCID: PMC11045556 DOI: 10.1097/scs.0000000000010071] [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: 12/18/2023] [Accepted: 01/29/2024] [Indexed: 03/19/2024] Open
Abstract
With increasing interest in 3D photogrammetry, diverse methods have been developed for craniofacial shape analysis in craniosynostosis patients. This review provides an overview of these methods and offers recommendations for future studies. A systematic literature search was used to identify publications on 3D photogrammetry analyses in craniosynostosis patients until August 2023. Inclusion criteria were original research reporting on 3D photogrammetry analyses in patients with craniosynostosis and written in English. Sixty-three publications that had reproducible methods for measuring cranial, forehead, or facial shape were included in the systematic review. Cranial shape changes were commonly assessed using heat maps and curvature analyses. Publications assessing the forehead utilized volumetric measurements, angles, ratios, and mirroring techniques. Mirroring techniques were frequently used to determine facial asymmetry. Although 3D photogrammetry shows promise, methods vary widely between standardized and less conventional measurements. A standardized protocol for the selection and documentation of landmarks, planes, and measurements across the cranium, forehead, and face is essential for consistent clinical and research applications.
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Affiliation(s)
| | | | - Tareq Abdel Alim
- Department of Neurosurgery
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center
| | - Gennady Roshchupkin
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center
- Department of Epidemiology, Erasmus MC, University Medical Center
| | | | | | | | - Marie-Lise C. van Veelen
- Department of Neurosurgery
- Child Brain Center, Erasmus MC Sophia Children’s Hospital, Rotterdam, The Netherlands
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Garate Andikoetxea B, Ajami S, Rodriguez-Florez N, Jeelani NUO, Dunaway D, Schievano S, Borghi A. Towards a radiation free numerical modelling framework to predict spring assisted correction of scaphocephaly. Comput Methods Biomech Biomed Engin 2023:1-10. [PMID: 38108140 DOI: 10.1080/10255842.2023.2294262] [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: 07/28/2023] [Accepted: 12/08/2023] [Indexed: 12/19/2023]
Abstract
Sagittal Craniosynostosis (SC) is a congenital craniofacial malformation, involving premature sagittal suture ossification; spring-assisted cranioplasty (SAC) - insertion of metallic distractors for skull reshaping - is an established method for treating SC. Surgical outcomes are predictable using numerical modelling, however published methods rely on computed tomography (CT) scans availability, which are not routinely performed. We investigated a simplified method, based on radiation-free 3D stereophotogrammetry scans.Eight SAC patients (age 5.1 ± 0.4 months) with preoperative CT and 3D stereophotogrammetry scans were included. Information on osteotomies, spring model and post-operative spring opening were recorded. For each patient, two preoperative models (PREOP) were created: i) CT model and ii) S model, created by processing patient specific 3D surface scans using population averaged skin and skull thickness and suture locations. Each model was imported into ANSYS Mechanical (Analysis System Inc., Canonsburg, PA) to simulate spring expansion. Spring expansion and cranial index (CI - skull width over length) at times equivalent to immediate postop (POSTOP) and follow up (FU) were extracted and compared with in-vivo measurements.Overall expansion patterns were very similar for the 2 models at both POSTOP and FU. Both models had comparable outcomes when predicting spring expansion. Spring induced CI increase was similar, with a difference of 1.2%±0.8% for POSTOP and 1.6%±0.6% for FU.This work shows that a simplified model created from the head surface shape yields acceptable results in terms of spring expansion prediction. Further modelling refinements will allow the use of this predictive tool during preoperative planning.
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Affiliation(s)
| | - Sara Ajami
- University College London, United Kingdom
- Great Ormond Street Hospital, London, United Kingdom
| | | | | | - David Dunaway
- Great Ormond Street Hospital, London, United Kingdom
| | - Silvia Schievano
- University College London, United Kingdom
- Great Ormond Street Hospital, London, United Kingdom
| | - Alessandro Borghi
- University College London, United Kingdom
- Great Ormond Street Hospital, London, United Kingdom
- Department of Engineering, Durham University, Durham, United Kingdom
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Borghi A, Heutinck P, Rodriguez-Florez N, Koudstaal M, Ruggiero F, Ajami S, Schievano S, Jeelani N, Dunaway D. The Esthetic Perception of Morphological Severity in Scaphocephalic Patients is Correlated With Specific Head Geometrical Features. Cleft Palate Craniofac J 2023; 60:1591-1599. [PMID: 35786009 PMCID: PMC10588271 DOI: 10.1177/10556656221111307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To investigate the relationship between perception of craniofacial deformity, geometric head features, and 3D head shape analyzed by statistical shape modeling (SSM). PATIENTS A total of 18 unoperated patients with scaphocephaly (age = 5.2 ± 1.1m)-6 were followed-up after spring-assisted cranioplasty (SAC) (age = 9.6 ± 1.5m)-and 6 controls (age = 6.7 ± 2.5m). MAIN OUTCOME MEASURES 3D head shapes were retrieved from 3D scans or computed tomography (CTs). Various geometrical features were measured: anterior and posterior prominence, take-off angle, average anterior and posterior lateral and horizontal curvatures, cranial index (CI) (cranial width over length), and turricephaly index (TI) (cranial height over length). SSM and principal component analysis (PCA) described shape variability. All models were 3D printed; the perception of deformity was blindly scored by 9 surgeons and 1 radiologist in terms of frontal bossing (FB), occipital bulleting (OB), biparietal narrowing (BN), low posterior vertex (LPV), and overall head shape (OHS). RESULTS A moderate correlation was found between FB and anterior prominence (r = 0.56, P < .01) and take-off angle (r = - 0.57, P < .01). OB correlated with average posterior lateral curvature (r = 0.43, P < 0.01) similarly to BPN (r = 0.55, P < .01) and LPV (r = 0.43, P < .01). OHS showed strong correlation with CI (r = - 0.68, P < .01) and TI (r = 0.63, P< .01). SSM Mode 1 correlated with OHS (r = 0.66, p < .01) while Mode 3 correlated with FB (r = - 0.58, P < .01). CONCLUSIONS Esthetic cranial appearance in craniofacial patients is correlated to specific geometric parameters and could be estimated using automated methods such as SSM.
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Affiliation(s)
- Alessandro Borghi
- UCL Great Ormond Street Institute of Child Health, London, UK
- Great Ormond Street Hospital for Children, London, UK
| | - P. Heutinck
- UCL Great Ormond Street Institute of Child Health, London, UK
- Erasmus University Hospital, Rotterdam, the Netherlands
| | - N. Rodriguez-Florez
- Universidad de Navarra, TECNUN Escuela de Ingenieros, Donostia-San Sebastián, Spain
- Ikerbasque, Basque Foundation for Science, Bilbao, Spain
| | - M. Koudstaal
- UCL Great Ormond Street Institute of Child Health, London, UK
- Great Ormond Street Hospital for Children, London, UK
- Erasmus University Hospital, Rotterdam, the Netherlands
| | - F. Ruggiero
- Great Ormond Street Hospital for Children, London, UK
- DIBIDEM, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - S. Ajami
- UCL Great Ormond Street Institute of Child Health, London, UK
- Great Ormond Street Hospital for Children, London, UK
| | - S. Schievano
- UCL Great Ormond Street Institute of Child Health, London, UK
- Great Ormond Street Hospital for Children, London, UK
| | - N.U.O. Jeelani
- UCL Great Ormond Street Institute of Child Health, London, UK
- Great Ormond Street Hospital for Children, London, UK
| | - D. Dunaway
- UCL Great Ormond Street Institute of Child Health, London, UK
- Great Ormond Street Hospital for Children, London, UK
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5
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Chowdhury AM, Patel R, Silva AHD, Dunaway DJ, Jeelani NUO, Ong J, Hayward R, James G. Sagittal synostosis: does choice of intervention and its timing affect the long-term aesthetic and neurodevelopmental outcome? A single-institution study of 167 children. J Neurosurg Pediatr 2023; 31:169-178. [PMID: 36461830 DOI: 10.3171/2022.10.peds22135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 10/21/2022] [Indexed: 12/05/2022]
Abstract
OBJECTIVE Sagittal craniosynostosis (SC) is the most commonly encountered form of craniosynostosis. Despite its relative frequency, there remains significant heterogeneity in both operative management and follow-up between centers and a relative paucity of long-term outcome data in the literature. At the authors' institution, families of children presenting with SC are offered the following options: 1) conservative management with ophthalmic surveillance, 2) minimally invasive surgery at < 6 months of age (spring-assisted cranioplasty [SAC]) or 3) calvarial vault remodeling at any age (CVR). The authors reviewed outcomes for all children presenting with SC during a 5-year period, regardless of the treatment received. METHODS Consecutive children born between January 1, 2008, and December 31, 2012, presenting with SC were identified, and detailed chart reviews were undertaken. Demographic, surgical, perioperative, head shape, scar, and neurodevelopmental (behavioral, education, speech, and language) data were analyzed. The cohort was divided by type of surgery (none, SAC, or CVR) and by age at surgery (early, defined as ≤ 6 months; or late, defined as > 6 months) for comparison purposes. RESULTS A total of 167 children were identified, 129 boys and 38 girls, with a median age at presentation of 5.0 (range 0.4-135) months. Three families opted for conservative management. Of the 164 children who underwent surgery, 83 underwent SAC, 76 underwent CVR, and 5 underwent a "hybrid" procedure (CVR with springs). At a median age of 7.0 (range 0.5-12.3) years, there was no significant difference in concerns regarding head shape, scar, or neurodevelopmental outcomes between the early and late intervention groups over all procedures performed, or between the early or late SAC and CVR cohorts. There were more head shape concerns in the SAC group than in the CVR group overall (25.7% vs 11.8%, respectively; p = 0.026), although most of these concerns were minor and did not require revision. CONCLUSIONS In this cohort, regardless of operative intervention and timing of intervention, infants achieved similar neurodevelopmental outcomes. Minimally invasive surgery (SAC) appears to result in less complete correction of head shape than CVR, but this may be balanced by advantages in reduced operative time, hospitalization, and blood loss. SAC was equal to CVR in neuropsychological outcomes.
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Affiliation(s)
- Adnan-Mustafiz Chowdhury
- 1Barts and the London School of Medicine and Dentistry, Queen Mary University of London
- 2Craniofacial Unit, Great Ormond Street Hospital, London; and
| | - Ryan Patel
- 1Barts and the London School of Medicine and Dentistry, Queen Mary University of London
- 2Craniofacial Unit, Great Ormond Street Hospital, London; and
| | | | - David J Dunaway
- 2Craniofacial Unit, Great Ormond Street Hospital, London; and
- 3Great Ormond Street Institute of Child Health, University College London, United Kingdom
| | - Noor Ul Owase Jeelani
- 2Craniofacial Unit, Great Ormond Street Hospital, London; and
- 3Great Ormond Street Institute of Child Health, University College London, United Kingdom
| | - Juling Ong
- 2Craniofacial Unit, Great Ormond Street Hospital, London; and
- 3Great Ormond Street Institute of Child Health, University College London, United Kingdom
| | - Richard Hayward
- 2Craniofacial Unit, Great Ormond Street Hospital, London; and
- 3Great Ormond Street Institute of Child Health, University College London, United Kingdom
| | - Greg James
- 2Craniofacial Unit, Great Ormond Street Hospital, London; and
- 3Great Ormond Street Institute of Child Health, University College London, United Kingdom
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Chi D, Gibson E, Chiang SN, Lee K, Naidoo SD, Lee A, Birgfeld C, Pollack IF, Goldstein J, Golinko M, Bonfield CM, Siddiqi FA, Kestle JRW, Smyth MD, Patel KB. A multi-institutional survey on calvarial vault remodeling techniques for sagittal synostosis and outcomes analysis for patients treated at 12 months and older. J Neurosurg Pediatr 2022; 30:490-498. [PMID: 35986730 DOI: 10.3171/2022.7.peds22139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 07/12/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Surgical treatment of sagittal craniosynostosis is challenging in older patients. This study aimed to assess the effect of increasing age on open surgical technique selection and patient outcomes using the multi-institutional Synostosis Research Group (SynRG) collaboration. METHODS Surgeons in SynRG were surveyed for key influences on their preferred open calvarial vault remodeling techniques at various patient ages: < 6, 6-12, and > 12 months. The SynRG database was then queried for open repairs of nonsyndromic sagittal craniosynostosis performed for patients older than 12 months of age. Perioperative measures, complications, and preoperative and postoperative cephalic indices were reviewed. RESULTS All surgeons preferred to treat patients at an earlier age, and most (89%) believed that less-optimal outcomes were achieved at ages older than 12 months. The modified pi procedure was the dominant technique in those younger than 12 months, while more involved open surgical techniques were performed for older patients, with a wide variety of open calvarial vault remodeling techniques used. Forty-four patients met inclusion criteria, with a mean (± SD) age at surgery of 29 ± 16 months. Eleven patients underwent parietal reshaping, 10 parietal-occipital switch, 9 clamshell craniotomy, 7 geometric parietal expansion, 6 modified pi procedure, and 1 parietal distraction. There were no readmissions, complications, or mortality within 30 days postoperatively. Patients' cephalic indices improved a mean of 6.4% ± 4.0%, with a mean postoperative cephalic index of 74.2% ± 4.9%. Differences in postoperative cephalic index (p < 0.04) and hospital length of stay (p = 0.01) were significant between technique cohorts. Post hoc Tukey-Kramer analysis identified the parietal reshaping technique as being significantly associated with a reduced hospital length of stay. CONCLUSIONS Patient age is an important driver in technique selection, with surgeons selecting a more involved calvarial vault remodeling technique in older children. A variety of surgical techniques were analyzed, with the parietal reshaping technique being significantly associated with reduced length of stay; however, multiple perioperative factors may be contributory and require further analysis. When performed at high-volume centers by experienced pediatric neurosurgeons and craniofacial surgeons, open calvarial vault techniques can be a safe method for treating sagittal craniosynostosis in older children.
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Affiliation(s)
- David Chi
- 1Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Ella Gibson
- 1Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Sarah N Chiang
- 1Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Koeun Lee
- 1Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Sybill D Naidoo
- 1Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Amy Lee
- 2Department of Neurosurgery, Seattle Children's Hospital, University of Washington, Seattle, Washington
| | - Craig Birgfeld
- 3Division of Plastic Surgery, Seattle Children's Hospital, University of Washington, Seattle, Washington
| | | | - Jesse Goldstein
- 5Plastic Surgery, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pennsylvania
| | | | | | - Faizi A Siddiqi
- 8Division of Plastic and Reconstructive Surgery, University of Utah, Salt Lake City, Utah
| | - John R W Kestle
- 9Division of Pediatric Neurosurgery, Department of Neurosurgery, University of Utah, Salt Lake City, Utah
| | - Matthew D Smyth
- 10Division of Pediatric Neurosurgery, Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri; and
- 11Division of Pediatric Neurosurgery, Johns Hopkins All Children's Hospital, St. Petersburg, Florida
| | - Kamlesh B Patel
- 1Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
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Heutinck P, Knoops P, Florez NR, Biffi B, Breakey W, James G, Koudstaal M, Schievano S, Dunaway D, Jeelani O, Borghi A. Statistical shape modelling for the analysis of head shape variations. J Craniomaxillofac Surg 2021; 49:449-455. [PMID: 33712336 DOI: 10.1016/j.jcms.2021.02.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 01/24/2021] [Accepted: 02/19/2021] [Indexed: 11/26/2022] Open
Abstract
The aim of this study is, firstly, to create a population-based 3D head shape model for the 0 to 2-year-old subjects to describe head shape variability within a normal population and, secondly, to test a combined normal and sagittal craniosynostosis (SAG) population model, able to provide surgical outcome assessment. 3D head shapes of patients affected by non-cranial related pathologies and of SAG patients (pre- and post-op) were extracted either from head CTs or 3D stereophotography scans, and processed. Statistical shape modelling (SSM) was used to describe shape variability using two models - a normal population model (MODEL1) and a combined normal and SAG population model (MODEL2). Head shape variability was described via principal components analysis (PCA) which calculates shape modes describing specific shape features. MODEL1 (n = 65) mode 1 showed statistical correlation (p < 0.001) with width (125.8 ± 13.6 mm), length (151.3 ± 17.4 mm) and height (112.5 ± 11.1 mm) whilst mode 2 showed correlation with cranial index (83.5 mm ± 6.3 mm, p < 0.001). The remaining 9 modes showed more subtle head shape variability. MODEL2 (n = 159) revealed that post-operative head shape still did not achieve full shape normalization with either spring cranioplasty or total calvarial remodelling. This study proves that SSM has the potential to describe detailed anatomical variations in a paediatric population.
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Affiliation(s)
- Pam Heutinck
- UCL GOS Institute of Child Health, London, UK, Great Ormond Street Hospital, London, UK; Erasmus MC Hospital, Rotterdam, the Netherlands
| | - Paul Knoops
- UCL GOS Institute of Child Health, London, UK, Great Ormond Street Hospital, London, UK
| | - Naiara Rodriguez Florez
- Universidad de Navarra, TECNUN Escuela de Ingenieros, San Sebastian, Spain; Ikerbasque, Basque Foundation for Science, Bilbao, Spain
| | | | - William Breakey
- UCL GOS Institute of Child Health, London, UK, Great Ormond Street Hospital, London, UK
| | - Greg James
- UCL GOS Institute of Child Health, London, UK, Great Ormond Street Hospital, London, UK
| | | | - Silvia Schievano
- UCL GOS Institute of Child Health, London, UK, Great Ormond Street Hospital, London, UK; UCL Institute of Cardiovascular Science, London, UK
| | - David Dunaway
- UCL GOS Institute of Child Health, London, UK, Great Ormond Street Hospital, London, UK
| | - Owase Jeelani
- UCL GOS Institute of Child Health, London, UK, Great Ormond Street Hospital, London, UK
| | - Alessandro Borghi
- UCL GOS Institute of Child Health, London, UK, Great Ormond Street Hospital, London, UK.
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A Technique for Minimizing the Need for Hemotransfusion in Non-Syndromic Craniosynostosis Surgery. J Craniofac Surg 2020; 32:247-251. [PMID: 32868732 DOI: 10.1097/scs.0000000000006949] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ABSTRACT Surgery for craniosynostosis is associated with excessive blood loss, as well as morbidity and mortality risks. This study investigated the effectiveness of a surgical technique for nonsyndromic craniosynostosis intervention in controlling bleeding, assessed based on the volume of blood transfused. The cohort included 73 children who underwent nonsyndromic craniosynostosis surgery during a 3-year period. Retrospective evaluation of patient parameters included sex, weight, and age at the time of surgery; type of craniosynostosis; duration of surgery; hemoglobin concentration before and after surgery; rate of transfusion; and volume of transfused blood (mL/kg). The surgical technique involved skin incision and subgaleal dissection using electrocautery with a Colorado needle tip. The pericranium was not removed but instead kept in situ, and orbiectomy was performed using piezosurgery. Of the 73 children in the cohort, 75.3% underwent fronto-orbital advancement and were included in the analysis. The average age was 10.9 months (range: 4-96 months), with 68.5% boys and 31.5% girls (P < 0.001). The most common type of craniosynostosis was trigonocephaly (57.5%), followed by scaphocephaly (19.2%). The mean duration of the surgery was 2 hours and 55 minutes. Blood transfusion was needed in 56.2% of patients, with a mean volume of 8.7 mL/kg body weight transfused intraoperatively. No complications or fatalities were observed. These results suggested that meticulous, continuous control of homeostasis is paramount in minimizing blood loss during surgical repair of nonsyndromic craniosynostosis.
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Three-Dimensional Calvarial Growth in Spring-Assisted Cranioplasty for Correction of Sagittal Synostosis. J Craniofac Surg 2020; 31:2084-2087. [PMID: 32804823 DOI: 10.1097/scs.0000000000006863] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Spring-assisted cranioplasty (SAC) is a minimally invasive technique for treating sagittal synostosis in young infants. Yet, follow-up data on cranial growth in patients who have undergone SAC are lacking. This project aimed to understand how the cranial shape develops during the postoperative period, from spring insertion to removal. 3D head scans of 30 consecutive infants undergoing SAC for sagittal synostosis were acquired using a handheld scanner pre-operatively, immediately postoperatively, at follow-up and at spring removal; 3D scans of 41 age-matched control subjects were also acquired. Measurements of head length, width, height, circumference, and volume were taken for all subjects; cephalic index (CI) was calculated. Statistical shape modeling was used to compute 3D average head models of sagittal patients at the different time points. SAC was performed at a mean age of 5.2 months (range 3.3-8.0) and springs were removed 4.3 months later. CI increased significantly (P < 0.001) from pre-op (69.5% ± 2.8%) to spring removal (74.4% ± 3.9%), mainly due to the widening of head width, which became as wide as for age-matched controls; however, the CI of controls was not reached (82.3% ± 6.8%). The springs did not constrain volume changes and allowed for natural growth. Population mean shapes showed that the bony prominences seen at the sites of spring engagement settle over time, and that springs affect the overall 3D head shape of the skull. In conclusion, results reaffirmed the effectiveness of SAC as a treatment method for nonsyndromic single suture sagittal synostosis.
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10
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Osteoclastic craniectomy for scaphocephaly in infants results in physiological head shapes. J Craniomaxillofac Surg 2019; 47:1891-1897. [DOI: 10.1016/j.jcms.2019.10.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Revised: 09/14/2019] [Accepted: 10/27/2019] [Indexed: 11/21/2022] Open
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