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Said AM, Zubovic E, Pfeifauf KD, Skolnick GB, Agboada J, Acayo-Laker P, Naidoo SD, Politi MC, Smyth M, Patel KB. Shared Decision-Making: Process for Design and Implementation of a Decision Aid for Patients With Craniosynostosis. Cleft Palate Craniofac J 2024; 61:138-143. [PMID: 36128842 DOI: 10.1177/10556656221128413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
To describe the process of developing a craniosynostosis decision aid. We conducted a mixed-methods exploratory study between August 2019 and March 2020 to develop a decision aid about surgical treatment for single suture craniosynostosis. A single tertiary care academic children's hospital. The decision aid development team consisted of surgeons, research fellows, a clinical nurse practitioner, clinical researchers with expertise in decision science, and a university-affiliated design school. Qualitative interviews (N = 5) were performed with families, clinicians (N = 2), and a helmeting orthotist to provide feedback on decision aid content, format, and usability. After cycles of revisions and iterations, 3 related decision aids were designed and approved by the marketing arm of our institution. Distinct booklets were created to enable focused discussion of treatment options for the 3 major types of single suture craniosynostosis (sagittal, metopic, unicoronal). Three decision aids representing the 3 most common forms of single suture craniosynostosis were developed. Clinicians found the decision aids could help facilitate discussions about families' treatment preferences, goals, and concerns. We developed a customizable decision aid for single suture craniosynostosis treatment options. This tool lays the foundation for shared decision-making by assessing family preferences and providing clear, concise, and credible information regarding surgical treatment. Future research can evaluate this tool's impact on patient-clinician discussions about families' goals and preferences for treatment.
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Affiliation(s)
- Abdullah M Said
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University in St. Louis, St. Louis, MO, USA
| | - Ema Zubovic
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University in St. Louis, St. Louis, MO, USA
| | - Kristin D Pfeifauf
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University in St. Louis, St. Louis, MO, USA
| | - Gary B Skolnick
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University in St. Louis, St. Louis, MO, USA
| | - Jude Agboada
- Graphic Design, Lindquist College of Arts & Humanities, Weber State University, Ogden, UT, USA
| | - Penina Acayo-Laker
- Communication Design, Sam Fox School of Design & Visual Arts, Washington University in St. Louis, St. Louis, MO, USA
| | - Sybill D Naidoo
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University in St. Louis, St. Louis, MO, USA
| | - Mary C Politi
- Division of Public Health Sciences, Department of Surgery, Washington University in St. Louis, St. Louis, MO, USA
| | - Matthew Smyth
- Department of Neurosurgery, Johns Hopkins University Division of Pediatric Neurosurgery, Institute for Brain Protection Sciences, Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA
| | - Kamlesh B Patel
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University in St. Louis, St. Louis, MO, USA
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Choudhary A, Edgar M, Raman S, Alkureishi LW, Purnell CA. Craniometric and Aesthetic Outcomes in Craniosynostosis Surgery: A Systematic Review and Meta-Analysis. Cleft Palate Craniofac J 2023:10556656231204506. [PMID: 37859464 DOI: 10.1177/10556656231204506] [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: 10/21/2023] Open
Abstract
OBJECTIVE To systematically review the published comparative aesthetic outcomes, and its determinants, for craniosynostoses surgically treated by minimally-invasive cranial procedures and open cranial vault remodeling (CVR). DESIGN PRISMA-compliant systematic review. SETTING Not-applicable. PATIENTS/PARTICIPANTS Articles were included if they compared spring cranioplasty, strip minimally-invasive craniectomy or CVR for outcomes related to aesthetics or head shape. Forty-two studies were included, comprising 2402 patients. INTERVENTIONS None. MAIN OUTCOME MEASURE(S) The craniometric and PROM used to determine surgical outcomes. RESULTS Twenty-five studies (59%) evaluated sagittal craniosynostosis, with metopic (7;17%) and unicoronal (4;10%) the next most prevalent. Thirty-eight studies (90%) included CVR, 24 (57%) included strip craniectomy with helmeting, 9 (22%) included strip craniectomy without helmeting, 11 (26%) included spring cranioplasty, and 3 (7%) included vault distraction. A majority of studies only used 1 (43%) or 2 (14%) craniometric measures to compare techniques. In sagittal synostosis, 13 (59%) studies showed no difference in craniometric outcomes, 5 (23%) showed better results with CVR, 3 (14%) with strip craniectomy, and 1 (5%) with springs. In studies describing other synostoses, 10/14 (71%) were equivocal. Subjective outcome measures followed similar trends. Meta-analysis shows no significant difference in cranial index (CI) outcomes between CVR and less invasive procedures in patients with sagittal synostosis. CONCLUSIONS There is no difference in CI outcomes between CVR and less invasive procedures. The majority of literature comparing craniometric and aesthetic outcomes between CVR and less invasive procedures shows equivocal results for sagittal synostosis. However, the heterogeneity of data for other craniosynostoses did not allow meta-analysis.
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Affiliation(s)
- Akriti Choudhary
- Division of Plastic, Reconstructive and Cosmetic Surgery, University of Illinois College of Medicine, Chicago, IL, USA
| | - Michael Edgar
- Division of Plastic, Reconstructive and Cosmetic Surgery, University of Illinois College of Medicine, Chicago, IL, USA
| | - Shreya Raman
- Division of Plastic, Reconstructive and Cosmetic Surgery, University of Illinois College of Medicine, Chicago, IL, USA
| | - Lee W Alkureishi
- Division of Plastic, Reconstructive and Cosmetic Surgery, University of Illinois College of Medicine, Chicago, IL, USA
- Department of Plastic Surgery, Shriners Children's Hospital, Chicago, IL, USA
| | - Chad A Purnell
- Division of Plastic, Reconstructive and Cosmetic Surgery, University of Illinois College of Medicine, Chicago, IL, USA
- Department of Plastic Surgery, Shriners Children's Hospital, Chicago, IL, USA
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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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Villavisanis DF, Cho DY, Shakir S, Kalmar CL, Wagner CS, Cheung L, Blum JD, Lang SS, Heuer GG, Madsen PJ, Bartlett SP, Swanson JW, Taylor JA, Tucker AM. Parietal bone thickness for predicting operative transfusion and blood loss in patients undergoing spring-mediated cranioplasty for nonsyndromic sagittal craniosynostosis. J Neurosurg Pediatr 2022; 29:419-426. [PMID: 35090136 DOI: 10.3171/2021.12.peds21541] [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: 11/19/2021] [Accepted: 12/16/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Variables that can predict outcomes in patients with craniosynostosis, including bone thickness, are important for surgical decision-making, yet are incompletely understood. Recent studies have demonstrated relative risks and benefits of surgical techniques for correcting head shape in patients with nonsyndromic sagittal craniosynostosis. The purpose of this study was to characterize the relationships between parietal bone thickness and perioperative outcomes in patients who underwent spring-mediated cranioplasty (SMC) for nonsyndromic sagittal craniosynostosis. METHODS Patients who underwent craniectomy and SMC for nonsyndromic sagittal craniosynostosis at a quaternary pediatric hospital between 2011 and 2021 were included. Parietal bone thickness was determined on patient preoperative CT at 27 suture-related points: at the suture line and at 0.5 cm, 1.0 cm, 1.5 cm, and 2.0 cm from the suture at the anterior parietal, midparietal, and posterior parietal bones. Preoperative skull thickness was compared with intraoperative blood loss, need for intraoperative transfusion, and hospital length of stay (LOS). RESULTS Overall, 124 patients with a mean age at surgery ± SD of 3.59 ± 0.87 months and mean parietal bone thickness of 1.83 ± 0.38 mm were included in this study. Estimated blood loss (EBL) and EBL per kilogram were associated with parietal bone thickness 0.5 cm (ρ = 0.376, p < 0.001 and ρ = 0.331, p = 0.004; respectively) and 1.0 cm (ρ = 0.324, p = 0.007 and ρ = 0.245, p = 0.033; respectively) from the suture line. Patients with a thicker parietal bone 0.5 cm (OR 18.08, p = 0.007), 1.0 cm (OR 7.16, p = 0.031), and 1.5 cm (OR 7.24, p = 0.046) from the suture line were significantly more likely to have undergone transfusion when controlling for age, sex, and race. Additionally, parietal bone thickness was associated with hospital LOS (β 0.575, p = 0.019) when controlling for age, sex, and race. Patient age at the time of surgery was not independently associated with these perioperative outcomes. CONCLUSIONS Parietal bone thickness, but not age at the time of surgery, may predict perioperative outcomes including transfusion, EBL, and LOS. The need for transfusion and EBL were most significant for parietal bone thickness 0.5 cm to 1.5 cm from the suture line, within the anticipated area of suturectomy. For patients undergoing craniofacial surgery, parietal bone thickness may have important implications for anticipating the need for intraoperative transfusion and hospital LOS.
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Affiliation(s)
- Dillan F Villavisanis
- 1Division of Plastic and Reconstructive Surgery, Children's Hospital of Philadelphia, Department of Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania; and.,2Division of Neurosurgery, Children's Hospital of Philadelphia, Department of Neurosurgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Daniel Y Cho
- 1Division of Plastic and Reconstructive Surgery, Children's Hospital of Philadelphia, Department of Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania; and
| | - Sameer Shakir
- 1Division of Plastic and Reconstructive Surgery, Children's Hospital of Philadelphia, Department of Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania; and
| | - Christopher L Kalmar
- 1Division of Plastic and Reconstructive Surgery, Children's Hospital of Philadelphia, Department of Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania; and
| | - Connor S Wagner
- 1Division of Plastic and Reconstructive Surgery, Children's Hospital of Philadelphia, Department of Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania; and
| | - Liana Cheung
- 1Division of Plastic and Reconstructive Surgery, Children's Hospital of Philadelphia, Department of Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania; and
| | - Jessica D Blum
- 1Division of Plastic and Reconstructive Surgery, Children's Hospital of Philadelphia, Department of Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania; and
| | - Shih-Shan Lang
- 2Division of Neurosurgery, Children's Hospital of Philadelphia, Department of Neurosurgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Gregory G Heuer
- 2Division of Neurosurgery, Children's Hospital of Philadelphia, Department of Neurosurgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Peter J Madsen
- 2Division of Neurosurgery, Children's Hospital of Philadelphia, Department of Neurosurgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Scott P Bartlett
- 1Division of Plastic and Reconstructive Surgery, Children's Hospital of Philadelphia, Department of Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania; and
| | - Jordan W Swanson
- 1Division of Plastic and Reconstructive Surgery, Children's Hospital of Philadelphia, Department of Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania; and
| | - Jesse A Taylor
- 1Division of Plastic and Reconstructive Surgery, Children's Hospital of Philadelphia, Department of Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania; and
| | - Alexander M Tucker
- 2Division of Neurosurgery, Children's Hospital of Philadelphia, Department of Neurosurgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania
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Utility of Preoperative Helmet Molding Therapy in Patients With Isolated Sagittal Craniosynostosis. J Craniofac Surg 2022; 33:480-484. [DOI: 10.1097/scs.0000000000008251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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