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Ros B, Iglesias S, Selfa A, Ruiz F, Arráez MÁ. Conventional posterior cranial vault expansion: indications and results-review of the literature. Childs Nerv Syst 2021; 37:3149-3175. [PMID: 34604916 DOI: 10.1007/s00381-021-05318-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 07/30/2021] [Indexed: 11/26/2022]
Abstract
In the late 1980s, craniofacial surgery units reported suboptimal cosmetic results, cranial volume restriction, and intracranial hypertension after anterior cranial vault remodeling in bilateral coronal synostosis associated with severe brachyturricephaly. A possible explanation was a severe associated growth restriction of the posterior calvaria with radiological synostosis at the lambda sutures. "Conventional" or "fixed" posterior cranial vault expansion techniques were developed to address these limitations, sometimes as the first surgical step in a two-staged protocol of total calvarial reconstruction, combined with suboccipital decompression in cases of symptomatic cerebellar tonsillar herniation or, more easily, to resolve the characteristic occipital flattening of lambdoid synostosis. Various surgical approaches have been described; however, the indications for and timing of surgical treatment and postoperative evaluation of results still remain controversial. Although more invasive, conventional posterior cranial vault expansion has proven to be safe and offers a remodeled and protective bony vault immediately after surgery, but the underlying cranial base malformation remained untreated, with implications in the postoperative growth of the facial skeleton. Overcorrection, rigid stabilization, and grafting are also concerns to be addressed.
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Affiliation(s)
- Bienvenido Ros
- Pediatric Neurosurgery Section, Department of Neurosurgery, Regional University Hospital, Av. De Carlos Haya, 84, 29010, Malaga, Spain.
- Craniofacial Surgery Unit, Regional University Hospital, Av. De Carlos Haya, 84, 29010, Malaga, Spain.
| | - Sara Iglesias
- Pediatric Neurosurgery Section, Department of Neurosurgery, Regional University Hospital, Av. De Carlos Haya, 84, 29010, Malaga, Spain
- Craniofacial Surgery Unit, Regional University Hospital, Av. De Carlos Haya, 84, 29010, Malaga, Spain
| | - Antonio Selfa
- Pediatric Neurosurgery Section, Department of Neurosurgery, Regional University Hospital, Av. De Carlos Haya, 84, 29010, Malaga, Spain
| | - Francisco Ruiz
- Department of Maxillofacial Surgery, Regional University Hospital, Av. De Carlos Haya, 84, 29010, Malaga, Spain
- Craniofacial Surgery Unit, Regional University Hospital, Av. De Carlos Haya, 84, 29010, Malaga, Spain
| | - Miguel Ángel Arráez
- Pediatric Neurosurgery Section, Department of Neurosurgery, Regional University Hospital, Av. De Carlos Haya, 84, 29010, Malaga, Spain
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Deformational plagiocephaly: State of the art and review of the literature. Neurochirurgie 2019; 65:322-329. [PMID: 31562882 DOI: 10.1016/j.neuchi.2019.09.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 09/01/2019] [Accepted: 09/03/2019] [Indexed: 01/21/2023]
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Klimo P, Lingo PR, Baird LC, Bauer DF, Beier A, Durham S, Lin AY, McClung-Smith C, Mitchell L, Nikas D, Tamber MS, Tyagi R, Mazzola C, Flannery AM. Guidelines: Congress of Neurological Surgeons Systematic Review and Evidence-Based Guideline on the Management of Patients With Positional Plagiocephaly: The Role of Repositioning. Neurosurgery 2016; 79:E627-E629. [PMID: 27759673 DOI: 10.1227/neu.0000000000001428] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Plagiocephaly, involving positional deformity of the calvarium in infants, is one of the most common reasons for pediatric neurosurgical consultation. OBJECTIVE To answer the question: "what is the evidence for the effectiveness of repositioning for positional plagiocephaly?" Treatment recommendations are provided based on the available evidence. METHODS The National Library of Medicine MEDLINE database and the Cochrane Library were queried using MeSH headings and key words relevant to repositioning as a means to treat plagiocephaly and brachycephaly. Abstracts were reviewed to identify which studies met the inclusion criteria. An evidentiary table was assembled summarizing the studies and the quality of evidence (Classes I-III). Based on the quality of the literature, a recommendation was rendered (Level I, II, or III). RESULTS There were 3 randomized trials (Class I), 1 prospective cohort study (Class II), and 6 retrospective cohort studies (Class III). Repositioning education was found to be equal to a repositioning device and inferior to a physical therapy program. Five of the 7 cohort studies comparing repositioning with a helmet reported helmets to be better and take less time. CONCLUSION Within the limits of this systematic review, repositioning education is effective in affording some degree of correction in virtually all infants with positional plagiocephaly or brachycephaly. Most studies suggest that a molding helmet corrects asymmetry more rapidly and to a greater degree than repositioning education. In a Class I study, repositioning education was as effective as repositioning education in conjunction with a repositioning wrap/device. Another Class I study demonstrated that a bedding pillow was superior to physical therapy for some infants. However, in keeping with the American Academy of Pediatrics' warning against the use of soft positioning pillows in the sleeping environment, the Task Force recommends physical therapy over any positioning device. The full guidelines document can be located at https://www.cns.org/guidelines/guidelines-management-patients-positional-plagiocephaly/Chapter_3.
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Affiliation(s)
- Paul Klimo
- *Semmes-Murphey Neurologic & Spine Institute; Department of Neurosurgery, University of Tennessee Health Science Center; Le Bonheur Children's Hospital, Memphis, Tennessee; ‡University of Tennessee Health Science Center, Memphis, Tennessee; §Department of Neurological Surgery, Oregon Health and Science University, Portland, Oregon; ¶Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire; ‖Division of Pediatric Neurosurgery, University of Florida Health Jacksonville, Jacksonville, Florida; #Division of Neurosurgery, University of Vermont Medical Center, Burlington, Vermont; **St. Louis Cleft-Craniofacial Center, SSM Health Cardinal Glennon Children's Hospital at Saint Louis University, Division of Plastic Surgery, Saint Louis University School of Medicine, St. Louis, Missouri; ‡‡Department of Neurosurgery, Palmetto Health University of South Carolina Medical Group, Columbia, South Carolina; §§Guidelines Department, Congress of Neurological Surgeons, Schaumburg, Illinois; ¶¶Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois; ‖‖Advocate Children's Hospital, Oak Lawn, Illinois; ##Department of Pediatric Neurological Surgery, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania; ***Department of Surgery, Division of Neurosurgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey; ‡‡‡Goryeb Children's Hospital of Atlantic Health Systems, Morristown, New Jersey; §§§Kids Specialty Center, Women's & Children's Hospital, Lafayette, Louisiana
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Shweikeh F, Nuño M, Danielpour M, Krieger MD, Drazin D. Positional plagiocephaly: an analysis of the literature on the effectiveness of current guidelines. Neurosurg Focus 2014; 35:E1. [PMID: 24079780 DOI: 10.3171/2013.8.focus13261] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECT Positional plagiocephaly (PP) has been on the rise in recent years. In this review, the authors' aim was to assess the effectiveness of current recommendations to parents on this exceedingly common problem through a comprehensive literature search. Additionally, the current treatment options and the most recent studies on PP are reviewed. METHODS A search of the existing literature was conducted to obtain all relevant studies on guidelines, recommendations, parental and clinician practices, and epidemiological aspects. RESULTS Although the incidence and risk factors for PP have been well delineated, there continues to be debates on its management and association with developmental delays. Current guidelines and recommendations on prevention set by the American Association of Pediatrics may not be easily followed by both parents and clinicians. There is also evidence that certain populations, including those with lower education, socioeconomic status, and in particular geographic regions may be more affected by the condition. Additionally, the marketing and financial aspects of PP treatments exist and should be addressed. CONCLUSIONS Better awareness and education are necessary to inform the population as a whole, although certain populations should be given special attention. Additionally, current guidelines and recommendations can be modified to foster a better grasp of the condition by both parents and clinicians. Adjusting current recommendations, introducing initiatives, and offering elaborate educational campaigns would help deliver these aims. Educating parents on PP as early as possible through clearer guidelines and close monitoring is central to preventing and managing this common condition.
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Affiliation(s)
- Faris Shweikeh
- Department of Neurosurgery, Cedars-Sinai Medical Center; and
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Couture DE, Crantford JC, Somasundaram A, Sanger C, Argenta AE, David LR. Efficacy of passive helmet therapy for deformational plagiocephaly: report of 1050 cases. Neurosurg Focus 2014; 35:E4. [PMID: 24079783 DOI: 10.3171/2013.8.focus13258] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT There has been a tremendous increase in the incidence of deformational plagiocephaly in children throughout the world. Therapeutic options include observation, active counterpositioning, external orthotics, and surgery. The current treatment in the US is highly debated, but it typically includes external orthotic helmets in patients with moderate to severe plagiocephaly presenting between 4 and 10 months of age or in children with significant comorbidities limiting passive (no-pressure) therapy. The present study was designed to evaluate 3 key issues: 1) the accuracy of the Argenta classification in defining a progressive degree of severity, 2) identification of an upper age limit when treatment is no longer effective, and 3) the effectiveness of an off-the-shelf prefabricated helmet in correcting deformational plagiocephaly. METHODS An institutional review board-approved retrospective study was conducted of all patients at the authors' clinic in whom deformational plagiocephaly was assessed using the Argenta classification system over a 6-year period; the patients underwent helmet therapy, and a minimum of 3 clinic visits were recorded. Inclusion criteria consisted of an Argenta Type II-V plagiocephalic deformity. Patients' conditions were categorized both by severity of the deformity and by patients' age at presentation. Statistical analysis was conducted using survival analysis. RESULTS There were 1050 patients included in the study. Patients with Type III, IV, and V plagiocephaly required progressively longer for deformity correction to be achieved than patients with Type II plagiocephaly (53%, 75%, and 81% longer, respectively [p < 0.0001]). This finding verified that the Argenta stratification indicated a progressive severity of deformity. No statistically significant difference in the time to correction was noted among the different age categories, which suggests that the previously held upper time limit for correction may be inaccurate. An overall correction rate to Type I plagiocephaly of 81.6% was achieved irrespective of severity and degree of the original deformity. This suggests that an inexpensive off-the-shelf molding helmet is highly effective and that expensive custom-fitted orthoses may not be necessary. The patients in the older age group (> 12 months) did not have a statistically significant longer interval to correction than the patients in the youngest age group (< 3 months). The mean length of follow-up was 6.3 months. CONCLUSIONS Patients treated with passive helmet therapy in the older age group (> 12 months) had an improvement in skull shape within the same treatment interval as the patients in the younger age group (< 3 months). This study supports the use of passive helmet therapy for improvement in deformational plagiocephaly in infants from birth to 18 months of age and verifies the stratification of degree of deformity used in the Argenta classification system.
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Treatment of deformational plagiocephaly and torticollis using a weight distribution ring: a report of three cases. J Pediatr Orthop B 2013; 22:275-81. [PMID: 23358241 DOI: 10.1097/bpb.0b013e32835e38d6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Plagiocephaly, from the Greek 'plagios' (slanting) and 'kephale' (head), refers to a condition of an infant's head deformation by forces acting upon a malleable cranium. Marked plagiocephaly causes distress and stigma towards the baby and their family and has knock-on effects with craniofacial abnormalities, visual-field defects and delay in motor skills, and may also cause developmental difficulties. Current treatment methods have multiple drawbacks. This small, illustrated case series presents a novel, cost-effective, practical first-line treatment using a horseshoe-shaped gel head ring to redistribute pressure, allowing uniform growth and reshaping. Our early experience suggests that this method represents an effective treatment option with promising results so far.
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Khonsari R, Friess M, Nysjö J, Odri G, Malmberg F, Nyström I, Messo E, Hirsch J, Cabanis E, Kunzelmann K, Salagnac J, Corre P, Ohazama A, Sharpe P, Charlier P, Olszewski R. Shape and volume of craniofacial cavities in intentional skull deformations. AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY 2013; 151:110-9. [DOI: 10.1002/ajpa.22263] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2012] [Accepted: 02/19/2013] [Indexed: 11/10/2022]
Affiliation(s)
| | - M. Friess
- Département Hommes; Natures, Sociétés & CNRS UMR 7206; Muséum National d'Histoire Naturelle; Musée de l'Homme; Paris; France
| | - J. Nysjö
- Centre for Image Analysis; Uppsala University; Uppsala; Sweden
| | - G. Odri
- Clinique Chirurgicale Orthopédique et Traumatologique; CHU Hôtel-Dieu; Nantes; France
| | - F. Malmberg
- Centre for Image Analysis; Uppsala University; Uppsala; Sweden
| | - I. Nyström
- Centre for Image Analysis; Uppsala University; Uppsala; Sweden
| | - E. Messo
- Department of Surgical Sciences, Oral and Maxillo-facial Surgery; Medical Faculty; Uppsala University; Uppsala; Sweden
| | - J.M. Hirsch
- Department of Surgical Sciences, Oral and Maxillo-facial Surgery; Medical Faculty; Uppsala University; Uppsala; Sweden
| | - E.A.M. Cabanis
- Service de Neuroradiologie; Centre Hospitalier National Ophtalmologique des XV-XX; Paris; France
| | - K.H. Kunzelmann
- Poliklinic für Zahnerhaltung und Parodontologie; Ludwig-Maximilians-Universität; Münich; Germany
| | - J.M. Salagnac
- Service de Chirurgie Maxillofaciale et Stomatologie; CHU Hôtel-Dieu; Nantes; France
| | - P. Corre
- Service de Chirurgie Maxillofaciale et Stomatologie; CHU Hôtel-Dieu; Nantes; France
| | - A. Ohazama
- Department of Craniofacial Development and Stem Cell Research; Dental Institute; King's College London; UK
| | - P.T. Sharpe
- Department of Craniofacial Development and Stem Cell Research; Dental Institute; King's College London; UK
| | - P. Charlier
- Service d'anatomopathologie; Hôpital Raymond-Poincaré; Garches; France
| | - R. Olszewski
- Service de Chirurgie Maxillofaciale et Stomatologie; Hôpital Saint-Luc, Université Catholique de Louvain; Bruxelles; Belgique
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Flannery ABK, Looman WS, Kemper K. Evidence-based care of the child with deformational plagiocephaly, part II: management. J Pediatr Health Care 2012; 26:320-31. [PMID: 22920774 DOI: 10.1016/j.pedhc.2011.10.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2011] [Revised: 10/04/2011] [Accepted: 10/10/2011] [Indexed: 10/28/2022]
Abstract
Non-synostotic deformational plagiocephaly (DP) is a common condition that affects as many as one in five infants in the first 2 months of life. The purpose of this article, the second in a two-part series, is to present a synthesis of the evidence related to management of deformational plagiocephaly and an evidence-based clinical decision tool for multidisciplinary management of DP. We systematically reviewed and graded the literature on management of DP from 2000 to 2011 based on level of evidence and quality. The evidence suggests that although many cases of DP will improve over time, conservative management strategies such as repositioning, physical therapy, and cranial molding devices can safely and effectively minimize the degree of skull asymmetry when implemented in the first year of life. Outcomes are best when the timing of diagnosis and severity of asymmetry guide decision making related to interventions and referrals for DP. Prevention and management of early signs of DP are best achieved in a primary care setting, with multidisciplinary management based on the needs of the child and the goals of the family.
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Di Rocco F, Marchac A, Duracher C, Perié AC, Vergnaud E, Renier D, Arnaud E. Posterior remodeling flap for posterior plagiocephaly. Childs Nerv Syst 2012; 28:1395-7. [PMID: 22872254 DOI: 10.1007/s00381-012-1842-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2012] [Accepted: 06/13/2012] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Nonsynostotic posterior plagiocephaly has become the most common skull deformation since pediatricians have suggested the supine position for the newborns to reduce the risk of sudden death. Prevention of such a "positional" deformation or its management once it has occurred is mainly based on physical maneuvers such as physiotherapy and active positional corrective measures. SELECTION CRITERIA Surgical correction, however, may be suggested in rare cases where deformation of the skull is so severe or the referral of the child is so late that physical corrective treatment cannot be taken into consideration. Surgical management is based on the creation of a posterior bone flap to be repositioned after the opportune contouring and rotation. PURPOSE The aim of this paper is to describe the surgical technique used for posterior vault remodeling in posterior plagiocephaly at the craniofacial unit of Hopital Necker Enfants Malades (French National Referral Center for Faciocraniosynostosis) focusing on its advantages and limitations.
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Affiliation(s)
- Federico Di Rocco
- Craniofacial Unit, Department of Pediatric Neurosurgery, Necker Enfants Malades Hospital, 156 rue de Vaugirard, 75015, Paris, France.
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Positional plagiocephaly: what the pediatrician needs to know. A review. Childs Nerv Syst 2011; 27:1867-76. [PMID: 21614494 DOI: 10.1007/s00381-011-1493-y] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2011] [Accepted: 05/12/2011] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Positional or deformational plagiocephaly is the most common type of cranial asymmetry in infancy and has become more prevalent after the introduction of the "Back to Sleep" campaign in Western countries. However, the supine position cannot be considered as the only etiologic factor and different predisposing variables have been investigated in the last few years. DISCUSSION The pediatrician should correctly diagnose this condition and exclude the possibility of craniosynostosis in any child with plagiocephaly in order to optimize management and reduce potential morbidity associated with different conditions other than positional ones. In addition, the pediatrician needs to be able to educate parents on methods to proactively decrease the likelihood of the development of occipital flattening, initiate appropriate management, and make referrals when necessary.
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