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Talwar AA, Lazar SV, Reategui AA, Sun AH, Kameni LH, Lopez J, Steinbacher DM. A Systematic Review of Idiopathic Secondary Stenosis Following Index Surgery for Craniosynostosis. J Craniofac Surg 2023; 34:1709-1712. [PMID: 37316986 DOI: 10.1097/scs.0000000000009495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 05/16/2023] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND Primary craniosynostosis is a congenital craniofacial disorder in which cranial sutures prematurely close. Iatrogenic secondary stenosis is abnormal cranial suture closure caused by surgical manipulation of the suture. In contrast, idiopathic secondary stenosis develops in a suture that did not undergo surgical manipulation. The objective of this systematic review was to consolidate and characterize the incidence, classification, and management of idiopathic secondary stenosis in the literature. METHODS Literature from PubMed, Web Of Science, and EMBASE from 1970 to March 2022 was reviewed. The following information was extracted for individual patients: incidence of idiopathic secondary stenosis, index primary craniosynostosis, primary surgical correction, presenting signs of secondary stenosis, management, and further complications. RESULTS Seventeen articles detailing 1181 patients were included. Ninety-one developed idiopathic secondary stenosis (7.7%). Only 3 of these patients were syndromic. The most common index craniosynostosis was sagittal synostosis (83.5%). The most common suture undergoing idiopathic secondary stenosis was the coronal suture (91.2%). Patients presented at a median age of 24 months. The most common presenting sign was a radiologic finding (85.7%), although some patients presented with headache or head deformity. Only 2 patients, both syndromic, had complications following surgical correction of secondary stenosis. CONCLUSIONS Idiopathic secondary stenosis is a rare, long-term complication following index surgical repair of craniosynostosis. It can occur following any surgical technique. It most commonly affects the coronal suture but can affect any of the sutures, including pansynostosis. Surgical correction is curative in nonsyndromic patients.
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Affiliation(s)
| | | | - Alvaro A Reategui
- Division of Plastic Surgery, Yale University School of Medicine, New Haven, CT
| | - Alexander H Sun
- Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Joseph Lopez
- Division of Plastic Surgery, Yale University School of Medicine, New Haven, CT
- Department of Surgery, Division of Pediatric Head & Neck Surgery, AdventHealth For Children, Orlando, FL
| | - Derek M Steinbacher
- Division of Plastic Surgery, Yale University School of Medicine, New Haven, CT
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Dibbs RP, Ferry AM, Davies L, Bauer DF, Buchanan EP, Beh HZ. Elevated Intracranial Pressure After Primary Surgical Correction of Sagittal Suture Craniosynostosis. Craniomaxillofac Trauma Reconstr 2023; 16:70-77. [PMID: 36824189 PMCID: PMC9941297 DOI: 10.1177/19433875211064680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Study Design: A Case Report. Objective: Craniosynostosis is a craniofacial condition defined by premature fusion of at least one cranial suture. Resynostosis or secondary craniosynostosis of a previously patent adjacent suture following primary repair is a relatively common complication. While studies have assessed the rates of secondary craniosynostosis and subsequent reoperation, extremely limited data regarding reoperation techniques is available. Methods: We present a unique case of a pediatric patient with sagittal craniosynostosis who previously underwent a modified pi procedure and later developed resynostosis of the sagittal suture and secondary synostosis of the bicoronal sutures. We subsequently performed total cranial vault reconstruction with virtual surgical planning (VSP). Results: At his 31-month postoperative follow-up, he displayed normal head shape and denied any clinical signs of elevated intracranial pressures with a normal ophthalmological exam. Conclusions: The reoperation was successful with no significant postoperative complications noted. Performing geometric expansion with VSP to manage fusion of a previously open suture following primary treatment of sagittal synostosis should be considered within the armamentarium of operative options.
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Affiliation(s)
- Rami P. Dibbs
- Division of Plastic Surgery, Texas Children’s Hospital, Houston, TX, USA
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Andrew M. Ferry
- Division of Plastic Surgery, Texas Children’s Hospital, Houston, TX, USA
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Lesley Davies
- Division of Plastic Surgery, Texas Children’s Hospital, Houston, TX, USA
| | - David F. Bauer
- Department of Neurosurgery, Texas Children’s Hospital, Houston, TX, USA
| | - Edward P. Buchanan
- Division of Plastic Surgery, Texas Children’s Hospital, Houston, TX, USA
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Han Zhuang Beh
- Division of Plastic Surgery, Texas Children’s Hospital, Houston, TX, USA
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
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The utility and post-operative evolution of head circumference in nonsyndromic single-suture craniosynostosis: a prospective study in Vietnamese children. Childs Nerv Syst 2023; 39:471-479. [PMID: 35804268 DOI: 10.1007/s00381-022-05580-x] [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: 02/19/2022] [Accepted: 05/31/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE Head circumference (HC) is an important clinical tool for following head growth in children with craniosynostosis (CS). The purpose of this study is to quantify the usefulness of HC along continuum of CS care, from diagnosis to pre- and post-operative (pre-op, post-op) follow-up in Vietnamese children. METHODS A prospective cohort of 54 nonsyndromic single-suture CS patients undergoing open surgery from January 2015 to January 2020 was collected at Children's Hospital 2, Vietnam. HC z-score on admission was compared with World Health Organization (WHO) standards to evaluate for utility in initial diagnosis. Pre-op and post-op HC were compared to demonstrate the evolution of head growth following reconstruction. RESULTS Nonsyndromic single-suture CS was more predominant in males (79.6%) than in females (20.4%). The mean HC z-score was - 0.38 [Formula: see text] 1.29 similar to normal WHO standards regardless of which sutural involvement. The HC z-score increased above + 1 standard deviation (SD) significantly at 3 months of follow-up (p < 0.001); however, the trajectory gradually decreased after the first year of surgery. One patient (1.8%, 1/54) demonstrated restenosis and delayed intracranial hypertension (DIH) 4 years after reconstruction. CONCLUSIONS The HC in nonsyndromic single-suture CS children presents similarly to the values of healthy children. Additionally, HC reliably increased after reconstruction and gradually normalized over subsequent years. This indicator is consistent in Southeast Asian populations and should be used to follow all patients to assess the normal progression of post-op head growth and as a useful indicator of suspected recurrent synostosis.
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Secondary Surgery in Metopic Craniosynostosis: Outcomes in a Tertiary Care Craniofacial Center in Australia. J Craniofac Surg 2022; 33:539-542. [DOI: 10.1097/scs.0000000000008333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Secondary Raised Intracranial Pressure After Cranial Vault Remodeling for Isolated Sagittal Craniosynostosis. J Craniofac Surg 2021; 32:2651-2655. [PMID: 34238873 DOI: 10.1097/scs.0000000000007886] [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 The management of sagittal craniosynostosis has evolved over the decades as teams seek to refine their surgical approaches to idealize head shape with the least possible morbidity. Here, the authors identify the incidence of raised intracranial pressure (ICP) and its risk factors, requiring secondary surgical intervention after cranial vault remodeling (CVR) procedure at a single tertiary referral craniofacial unit. A retrospective case-control study was performed on the patients with isolated non-syndromic sagittal craniosynostosis. All patients who underwent CVR in our unit and had a minimum of 1.5 years follow-up were included. One hundred and eighty-four patients (134 male and 50 female) who underwent primary CVR surgery for isolated sagittal craniosynostosis were included. Thirteen patients (7.07%) had clinical evidence of late raised ICP resulting in repeat CVR procedures. Higher incidence of raised ICP in patients who had primary surgery before 6 months than after or at 6 months of age (P = 0.001). There were 23.5%, 5.6%, 3.2%, and 1.9% of secondary raised ICP patients who underwent the primary surgery between 1999-2004, 2005-2010, 2011-2015 and 2016-2018, respectively (P = 0.024). The risk of secondary raised ICP was higher in patients with isolated sagittal craniosynostosis whose primary surgery occurred before the age of 6 months (two times more likely). More extensive CVR can be performed safely in sagittal synostosis with promising outcomes. The late presentation with raised ICP reinforces the importance of long-term multidisciplinary protocol-based follow-up.
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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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Chiari Malformation Type 1 and Syringomyelia in a Patient With Prior Surgically-Treated Sagittal Synostosis Effectively Treated With Posterior Cranial Vault Distraction Osteogenesis. J Craniofac Surg 2021; 32:2110-2113. [PMID: 33405455 DOI: 10.1097/scs.0000000000007401] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
ABSTRACT The presenting report describes the use of a posterior cranial vault distraction procedure in resolving a Chiari malformation with associated syringomyelia following a surgically-treated nonsyndromic craniosynostosis. Chiari malformations are typically treated with posterior fossa decompression with or without expansion duraplasty. The objective of this report is to describe the effectiveness in resolving both Chiari malformation and secondary syringomyelia with posterior cranial vault distraction osteogenesis. A 5-year-old male, with a history of surgery for sagittal synostosis during infancy, presented with daily severe headaches and dysesthesias in the hands and feet. Imaging demonstrated a copper-beaten calvarium and a Chiari 1 malformation with a 7 mm diameter C4-T1 syrinx. He underwent posterior cranial vault distraction osteogenesis over 3 months to increase his intracranial volume. The patients' headaches improved significantly, and his dysesthesias resolved postoperatively. A magnetic resonance imaging performed 7 months after completion of distraction demonstrated resolution of the Chiari malformation and decompression of his syrinx. A computed tomography scan at 9 months postdistraction showed resolution of the copper-beaten calvarium. Patients with a history of craniosynostosis can develop inadequate cranial volume over time due to abnormal skull growth, leading to secondary Chiari malformation with or without syringomyelia. Posterior vault distraction is an effective strategy to address these conditions and can be employed later in childhood to treat the underlying pathology. The mechanism potentially expands both calvarium and dura, which in turn addresses both the Chiari malformation and secondary syringomyelia.
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Pech Gourg G, Serratrice N, Gallucci A, Scavarda D. Upward vectors for osteogenic distraction treatment in secondary chronic intracranial hypertension in children undergoing scaphocephaly surgery: 2 cases reported. Childs Nerv Syst 2020; 36:1325-1330. [PMID: 31925509 DOI: 10.1007/s00381-019-04491-8] [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: 11/08/2019] [Accepted: 12/30/2019] [Indexed: 10/25/2022]
Abstract
The occurrence of secondary synostosis of coronal sutures at distance from H-craniectomy surgery for scaphocephaly concerns about 10% of children. Intracranial hypertension in these children remains exceptional but generally requires a surgical reoperation. Two children aged 3 and 5- months- old had been operated for scaphocephaly by H-craniectomy in two different hospital centers. Their clinical follow-up described a partial persistence of dolichocephalic deformity and an impression of parietal stenosis. During their growth, chronic headaches appeared with a complaint expressed at the ages of 4 and 5 years. In both cases, ophthalmic examination revealed significant bilateral papillary edema without loss of visual acuity. The imaging assessment (CT-scan and MRI) showed the absence of Chiari malformation and venous abnormality. For both, there was a compression image of the parietal lobes in relation to the persistence of a temporoparietal synostosis. An osteogenic parietal distraction permitted a volumetric brain expansion consecutive to the skull and meninges remodeling in only 6 months, associated with a leap forward acquisition, a normalization of the ophthalmic examination, and a complete loss of headaches. In conclusion, this new approach could be used in the case of chronic intracranial hypertension consecutive to a secondary parietal synostosis after a scaphocephaly surgery.
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Affiliation(s)
- G Pech Gourg
- Department of Pediatric Neurosurgery, La Timone Enfant Hospital, Assistance Publique - Hôpitaux de Marseille, Marseille, France
| | - N Serratrice
- Department of Pediatric Neurosurgery, La Timone Enfant Hospital, Assistance Publique - Hôpitaux de Marseille, Marseille, France.
| | - A Gallucci
- Department of Maxillofacial Surgery, La Timone Enfant Hospital, Assistance Publique - Hôpitaux de Marseille, Marseille, France
| | - D Scavarda
- Department of Pediatric Neurosurgery, La Timone Enfant Hospital, Assistance Publique - Hôpitaux de Marseille, Marseille, France
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Incidence of delayed intracranial hypertension in children with isolated sagittal synostosis following open calvarial vault reconstruction. Childs Nerv Syst 2020; 36:545-550. [PMID: 31811369 DOI: 10.1007/s00381-019-04406-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 10/02/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE Delayed intracranial hypertension (DIH) occurs most frequently in children with syndromic or multi-suture synostosis after surgical correction. The rarity of DIH in children with isolated non-syndromic sagittal synostosis (ISS) warrants follow-up evaluation by large craniofacial centers until skeletal maturity. This study reports the incidence of DIH in children following open repair for ISS by our center's craniofacial team. METHODS A single-center retrospective study of patients who underwent open calvarial vault remodeling (CVR) for ISS at our institution between November 2000 and November 2012 was performed. Syndromic and multi-suture synostosis patients were excluded. Demographic and follow-up data were extracted from the medical record for analysis until July 2017. RESULTS One hundred five patients with ISS were identified who had undergone CVR in the aforementioned timeframe. Average age at initial surgery was 11.7 ± 15.32 months. Mean follow-up in our craniofacial clinic was 4.94 ± 3.53 years, with 69 patients (65.7%) having follow-up in craniofacial clinic ≥ 3 years and 74 (70.5%) having follow-up ≥ 3 years in any clinic at our institution. Four patients (3.8%) had intracranial pressure (ICP) monitors placed for symptoms concerning for DIH, one of which (0.95%) had confirmed DIH and underwent a second surgical procedure at 7.4 years of age. The patient presented late initially, having his first operation at 1.56 years of age. CONCLUSION One patient out of 105 (0.95%) developed DIH, confirmed by ICP monitoring, and required reoperation. The occurrence of DIH, albeit rare, remains an important topic to include in parental discussions and mandates long-term follow-up in this population.
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Secondary Suture Fusion after Primary Correction of Nonsyndromic Craniosynostosis: Recognition of the Problem and Identification of Risk Factors. Plast Reconstr Surg 2020; 145:493-503. [DOI: 10.1097/prs.0000000000006491] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Zipfel J, Jager B, Collmann H, Czosnyka Z, Schuhmann MU, Schweitzer T. The role of ICP overnight monitoring (ONM) in children with suspected craniostenosis. Childs Nerv Syst 2020; 36:87-94. [PMID: 31273495 DOI: 10.1007/s00381-019-04288-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 06/30/2019] [Indexed: 12/27/2022]
Abstract
PURPOSE Secondary craniostenosis is a relevant problem pediatric neurosurgeons are confronted with and poses challenges regarding reliable diagnosis of raised ICP, especially in case of absent or questionable papilledema. How to identify children with elevated ICP is still controversial and diagnostics vary. We report on our experience with computerized ICP ONM in relation to imaging derived parameters. METHODS Thirty-four children with primary or secondary craniostenosis and clinical suspicion of raised ICP were investigated. We compared clinical signs, history, and radiographic assessment with the results of computerized ICP ONM. Differences were significant at a p < 0.05. RESULTS Baseline ICP was significantly higher in patients with combined suture synostosis, who also had a higher rate of questionable papilledema. Children with narrowed external CSF spaces in MRI had significantly higher ICP levels during REM sleep. Mean RAP was significantly elevated in patients with multi-suture synostosis, indicating poor intracranial compensatory reserve. Syndromal craniostenosis was associated with elevated ICP, RAP was significantly lower, and skull X-rays showed more impressions (copper beaten skull). RAP increased with more severe impressions only to decline in most severe abnormalities, indicating exhaustion of cerebrovascular reserve at an upper ICP breakpoint of 23.9 mmHg. Headaches correlated to lower ICP and were not associated with more severe X-ray abnormalities. CONCLUSION Narrowed external CSF spaces in MRI seem to be associated to elevated ICP. Skull X-rays can help to identify patients at risk for chronically elevated ICP. Severe X-ray changes correlate with exhausted cerebrovascular reserve as indicated by RAP decline. Only ICP monitoring clearly identifies raised ICP and low brain compliance. Thus, in cases with ambiguous imaging, ONM constitutes an effective tool to acquire objective data for identification of surgical candidates.
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Affiliation(s)
- J Zipfel
- Division of Pediatric Neurosurgery, Department of Neurosurgery, University Hospital of Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany.
- Section of Pediatric Neurosurgery, Department of Neurosurgery, University Hospital of Wuerzburg, Wuerzburg, Germany.
| | - B Jager
- Section of Pediatric Neurosurgery, Department of Neurosurgery, University Hospital of Wuerzburg, Wuerzburg, Germany
| | - H Collmann
- Section of Pediatric Neurosurgery, Department of Neurosurgery, University Hospital of Wuerzburg, Wuerzburg, Germany
| | - Z Czosnyka
- Department of Clinical Neurosciences, Division of Neurosurgery, Cambridge University Hospital, Hills Road, Cambridge, UK
| | - M U Schuhmann
- Division of Pediatric Neurosurgery, Department of Neurosurgery, University Hospital of Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany
| | - T Schweitzer
- Section of Pediatric Neurosurgery, Department of Neurosurgery, University Hospital of Wuerzburg, Wuerzburg, Germany
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Dalmas F, Pech-Gourg G, Gallucci A, Denis D, Scavarda D. Craniosynostosis and oculomotor disorders. Neurochirurgie 2019; 66:91-96. [PMID: 31866515 DOI: 10.1016/j.neuchi.2019.10.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 09/28/2019] [Accepted: 10/13/2019] [Indexed: 10/25/2022]
Abstract
Simple, complex or syndromic craniosynostosis may be responsible for ocular and especially oculomotor pathologies. Among simple craniosynostosis, anterior plagiocephaly is the most frequently associated with oculomotor disorders. Oculomotor disorders encountered in craniosynostosis are specific to this pathology. They may be related to orbital deformities or oculomotor muscle malformations. Early craniofacial surgery reduces the onset and severity of these oculomotor disorders which is very important for ophtalmological patient care. Indeed, these oculomotor disorders are difficult to treat for the ophthalmologist with most of the time several surgeries needed, and lead to amblyopia if neglected.
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Affiliation(s)
- F Dalmas
- Department of Ophthalmology, Marseille University Hospital, Marseille, 13015 France
| | - G Pech-Gourg
- Department of Pediatric Neurosurgery, Marseille University Hospital, Marseille, 13005 France.
| | - A Gallucci
- Department of Maxillofacial Surgery, Marseille University Hospital, Marseille, 13005 France
| | - D Denis
- Department of Ophthalmology, Marseille University Hospital, Marseille, 13015 France
| | - D Scavarda
- Department of Pediatric Neurosurgery, Marseille University Hospital, Marseille, 13005 France
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Herlin C, Captier G, Bigorre M, Chan-Seng E, Roujeau T. Partial hybrid cranial vault remodeling in late correction of scaphocephaly and revision surgery. A monocentric retrospective study of nine consecutive cases. Neurochirurgie 2019; 66:110-115. [PMID: 31655099 DOI: 10.1016/j.neuchi.2019.10.004] [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: 09/19/2019] [Revised: 10/04/2019] [Accepted: 10/06/2019] [Indexed: 11/30/2022]
Abstract
There is currently no consensus on the surgical attitude to be adopted for late management of sagittal synostosis or for revision scaphocephaly surgeries without prolapse of the cerebellar tonsils. We present here a monocentric retrospective study of nine patients operated consecutively by a fixed expansion method of the cranial vault which may be associated with a fronto-orbital remodeling. The procedure consists in the realization of multiple parietal tongue-in-groove osteotomies fixed by resorbable plates. Simultaneous fronto-orbital remodeling have been performed when needed. No intraoperative complication was noted. The average operating time was 141min. Six patients (66.7%) had a blood transfusion during the perioperative period. The average hospital stay was 4.8days. With a mean follow-up of 26,7months, no surgical revision was noted. In all patients with clinical or ophthalmologic signs of intracranial hypertension, we highlighted a disappearance of signs within 4months. No protective helmet has been used. The craniofacial remodeling was judged very good by the family and the surgical team. Multiple tongue-in-groove tenons remolding cranioplasty associated or not with a fronto-orbital advancement is a safe technique. It seems to us to be a good alternative to floating or fixed bi-parietal or bi-parieto-frontal cranial flaps because of the very large increase in endocranial volume and the possibility of physiologically and aesthetically remodeling the parietal and fronto-orbital regions.
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Affiliation(s)
- C Herlin
- Department of Plastic and Craniofacial Pediatric Surgery, Lapeyronie University Hospital, Avenue du Doyen-Gaston-Giraud, 34295 Montpellier, France; Department of Plastic and Reconstructive Surgery and Burns, Lapeyronie University Hospital, Avenue du Doyen-Gaston-Giraud, 34295 Montpellier, France.
| | - G Captier
- Department of Plastic and Craniofacial Pediatric Surgery, Lapeyronie University Hospital, Avenue du Doyen-Gaston-Giraud, 34295 Montpellier, France
| | - M Bigorre
- Department of Plastic and Craniofacial Pediatric Surgery, Lapeyronie University Hospital, Avenue du Doyen-Gaston-Giraud, 34295 Montpellier, France
| | - E Chan-Seng
- Department of Pediatric Neurosurgery, Gui de Chauliac University Hospital, Avenue Augustin-Fliche, 34295 Montpellier, France
| | - T Roujeau
- Department of Pediatric Neurosurgery, Gui de Chauliac University Hospital, Avenue Augustin-Fliche, 34295 Montpellier, France
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van de Beeten SDC, Cornelissen MJ, van Seeters RM, van Veelen MLC, Versnel SL, Loudon SE, Mathijssen IMJ. Papilledema in unicoronal synostosis: a rare finding. J Neurosurg Pediatr 2019; 24:139-144. [PMID: 31100720 DOI: 10.3171/2019.3.peds18624] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 03/22/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Unicoronal synostosis results in frontal plagiocephaly and is preferably treated before the patient is 1 year of age to prevent intracranial hypertension (ICH). However, data on the prevalence of ICH in these patients is currently lacking. This study aimed to establish the prevalence of preoperative and postoperative signs of ICH in a large cohort of patients with unicoronal synostosis and to test whether there is a correlation between papilledema and occipitofrontal head circumference (OFC) curve stagnation in unicoronal synostosis. METHODS The authors included all patients with unicoronal synostosis treated before 2 years of age at a single center between 2003 and 2013. The presence of ICH was evaluated by routine fundoscopy. The OFC growth curve was analyzed for deflection and in relationship to signs of ICH. RESULTS In total, 104 patients were included in this study, 84 (81%) of whom were considered to have nonsyndromic unicoronal synostosis. Preoperatively, none of the patients had papilledema as determined by fundoscopy (mean age at surgery 11 months). Postoperatively, 5% of patients with syndromic synostosis and 3% of those with nonsyndromic synostosis had papilledema, and this was confirmed by optical coherence tomography. Raised intracranial pressure was confirmed in 1 patient with syndromic unicoronal synostosis. Six of 78 patients had OFC stagnation, which was not significantly correlated to papilledema (p = 0.22). One child with syndromic unicoronal synostosis required repeated surgery for ICH (0.96%). CONCLUSIONS Papilledema was not found in patients with unicoronal synostosis when they underwent surgery before the age of 1 year and was also very rare during follow-up. There was no relationship between papilledema and OFC stagnation.
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Affiliation(s)
| | | | | | | | | | - Sjoukje E Loudon
- 3Ophthalmology, Sophia Children's Hospital, Erasmus University Medical Center, Rotterdam, The Netherlands
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Isaac KV, Meara JG, Proctor MR. Analysis of clinical outcomes for treatment of sagittal craniosynostosis: a comparison of endoscopic suturectomy and cranial vault remodeling. J Neurosurg Pediatr 2018; 22:467-474. [PMID: 30074449 DOI: 10.3171/2018.5.peds1846] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 05/10/2018] [Indexed: 12/21/2022]
Abstract
The authors compared the effectiveness of two main surgical techniques used for treating sagittal craniosynostosis (SC): endoscopic suturectomy (ES) and cranial vault remodeling (CVR). The safety, head growth, and aesthetic results following ES and CVR were compared by reviewing the charts of more than 200 patients. By comparing the effectiveness of these two treatments, this study will help guide selection of the optimal surgical treatment for patients with SC.
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Affiliation(s)
| | | | - Mark R Proctor
- 2Neurosurgery, Boston Children's Hospital, Boston, Massachusetts
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Evaluating Trends in Headache and Revision Surgery following Cranial Vault Remodeling for Craniosynostosis. Plast Reconstr Surg 2018; 141:725-734. [DOI: 10.1097/prs.0000000000004180] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Kim SY, Shin HJ, Lim SY. Determining the fate of cranial sutures after surgical correction of non-syndromic craniosynostosis. J Craniomaxillofac Surg 2017; 45:1801-1808. [DOI: 10.1016/j.jcms.2017.08.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 07/04/2017] [Accepted: 08/11/2017] [Indexed: 11/25/2022] Open
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LoPresti M, Daniels B, Buchanan EP, Monson L, Lam S. Virtual surgical planning and 3D printing in repeat calvarial vault reconstruction for craniosynostosis: technical note. J Neurosurg Pediatr 2017; 19:490-494. [PMID: 28156217 DOI: 10.3171/2016.10.peds16301] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Repeat surgery for restenosis after initial nonsyndromic craniosynostosis intervention is sometimes needed. Calvarial vault reconstruction through a healed surgical bed adds a level of intraoperative complexity and may benefit from preoperative and intraoperative definitions of biometric and aesthetic norms. Computer-assisted design and manufacturing using 3D imaging allows the precise formulation of operative plans in anticipation of surgical intervention. 3D printing turns virtual plans into anatomical replicas, templates, or customized implants by using a variety of materials. The authors present a technical note illustrating the use of this technology: a repeat calvarial vault reconstruction that was planned and executed using computer-assisted design and 3D printed intraoperative guides.
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Affiliation(s)
- Melissa LoPresti
- Departments of Neurosurgery and
- Divisions of Pediatric Neurosurgery and
| | - Bradley Daniels
- Departments of Neurosurgery and
- Divisions of Pediatric Neurosurgery and
| | - Edward P. Buchanan
- Plastic Surgery, Baylor College of Medicine; and
- Pediatric Plastic Surgery, Texas Children's Hospital, Houston, Texas
| | - Laura Monson
- Plastic Surgery, Baylor College of Medicine; and
- Pediatric Plastic Surgery, Texas Children's Hospital, Houston, Texas
| | - Sandi Lam
- Departments of Neurosurgery and
- Divisions of Pediatric Neurosurgery and
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20
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21
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Magnéli S, Howells T, Saiepour D, Nowinski D, Enblad P, Nilsson P. Telemetric intracranial pressure monitoring: a noninvasive method to follow up children with complex craniosynostoses. A case report. Childs Nerv Syst 2016; 32:1311-5. [PMID: 26861131 DOI: 10.1007/s00381-016-3023-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 01/19/2016] [Indexed: 11/29/2022]
Abstract
INTRODUCTION There are no reliable noninvasive methods of monitoring ICP. Most assessments are made by indirect measures and are difficult to follow over time. Invasive studies can be used but up until now have required in-hospital transcutaneous measurements. Accurate ICP recordings over longer periods of time can be very valuable in timing different surgical procedures in syndromal cases. This case shows that telemetric ICP monitoring can be used for long-term follow-up in patients that may need repeated surgeries related to their craniosynostosis condition. CASE REPORT In this report, the telemetric ICP probe (Raumedic Neurovent-P-tel) was implanted before surgery and was used for repeated "noninvasive" ICP recordings pre- and postoperatively in a patient with craniosynostosis. The patient was an eight-year-old girl with pansynostosis with only the right lambdoid suture open. A telemetric ICP probe was implanted the day before cranial vault remodeling and the ICP was monitored pre- and postoperatively. The ICP was above 15 mmHg 72.2 % of the monitoring time before surgery, and the amplitude of the curve was greater than normal suggesting impaired compliance. Direct postoperative ICP was normal, and the amplitude was lower. The ICP was then monitored both in out-patient clinic and in four longer hospital stays. Both the values and the curves were analyzed, and the time with ICP above 15 mmHg decreased over time, and the waveform amplitude of the curves improved. CONCLUSION This "noninvasive" way of recording ICP is a feasible and helpful tool in decision-making and intervening in patients with craniosynostosis.
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Affiliation(s)
- Sara Magnéli
- Department of Neurosurgery, Uppsala University Hospital, 751 85, Uppsala, Sweden
| | - Timothy Howells
- Department of Neurosurgery, Uppsala University Hospital, 751 85, Uppsala, Sweden
| | - Daniel Saiepour
- Department of Plastic Surgery, Uppsala University Hospital, 751 85, Uppsala, Sweden
| | - Daniel Nowinski
- Department of Plastic Surgery, Uppsala University Hospital, 751 85, Uppsala, Sweden
| | - Per Enblad
- Department of Neurosurgery, Uppsala University Hospital, 751 85, Uppsala, Sweden
| | - Pelle Nilsson
- Department of Neurosurgery, Uppsala University Hospital, 751 85, Uppsala, Sweden.
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Age at the Time of Surgery and Maintenance of Head Size in Nonsyndromic Sagittal Craniosynostosis. Plast Reconstr Surg 2016; 137:1557-1565. [DOI: 10.1097/prs.0000000000002049] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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23
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Lam S, Wagner KM, Middlebrook E, Luerssen TG. Delayed intracranial hypertension after surgery for nonsyndromic craniosynostosis. Surg Neurol Int 2015; 6:187. [PMID: 26759732 PMCID: PMC4697201 DOI: 10.4103/2152-7806.172532] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2015] [Accepted: 10/07/2015] [Indexed: 11/22/2022] Open
Affiliation(s)
- Sandi Lam
- Department of Neurosurgery, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
| | - Kathryn M Wagner
- Department of Neurosurgery, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
| | - Emily Middlebrook
- Department of Neurosurgery, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
| | - Thomas G Luerssen
- Department of Neurosurgery, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
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Hayward R, Britto JA, Dunaway D, Evans R, Jeelani NUO, Thompson D. Raised intracranial pressure and nonsyndromic sagittal craniosynostosis. J Neurosurg Pediatr 2015; 16:346-8. [PMID: 26053553 DOI: 10.3171/2014.11.peds14625] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Richard Hayward
- Great Ormond Street for Children NHS Trust, London, United Kingdom
| | | | - David Dunaway
- Great Ormond Street for Children NHS Trust, London, United Kingdom
| | - Robert Evans
- Great Ormond Street for Children NHS Trust, London, United Kingdom
| | | | - Dominic Thompson
- Great Ormond Street for Children NHS Trust, London, United Kingdom
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25
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Skull base development and craniosynostosis. Pediatr Radiol 2015; 45 Suppl 3:S485-96. [PMID: 26346154 DOI: 10.1007/s00247-015-3320-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Revised: 11/14/2014] [Accepted: 02/15/2015] [Indexed: 10/23/2022]
Abstract
Abnormal skull shape resulting in craniofacial deformity is a relatively common clinical finding, with deformity either positional (positional plagiocephaly) or related to premature ossification and fusion of the skull sutures (craniosynostosis). Growth restriction occurring at a stenosed suture is associated with exaggerated growth at the open sutures, resulting in fairly predictable craniofacial phenotypes in single-suture non-syndromic pathologies. Multi-suture syndromic subtypes are not so easy to understand without imaging. Imaging is performed to define the site and extent of craniosynostosis, to determine the presence or absence of underlying brain anomalies, and to evaluate both pre- and postoperative complications of craniosynostosis. Evidence for intracranial hypertension may be seen both pre- and postoperatively, associated with jugular foraminal stenosis, sinovenous occlusion, hydrocephalus and Chiari 1 malformations. Following clinical assessment, imaging evaluation may include radiographs, high-frequency US of the involved sutures, low-dose (20-30 mAs) CT with three-dimensional reformatted images, MRI and nuclear medicine brain imaging. Anomalous or vigorous collateral venous drainage may be mapped preoperatively with CT or MR venography or catheter angiography.
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Christian EA, Imahiyerobo TA, Nallapa S, Urata M, McComb JG, Krieger MD. Intracranial hypertension after surgical correction for craniosynostosis: a systematic review. Neurosurg Focus 2015; 38:E6. [DOI: 10.3171/2015.2.focus14853] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT
The authors’ aim was perform a systematic review on the incidence of intracranial hypertension (IH) after surgery for craniosynostosis.
METHODS
A systematic literature review was conducted using PubMed to assess the rate of postoperative IH in studies published between 1985 and 2014. Inclusion criteria were 1) English-language literature; 2) human subjects; 3) pediatric cases; and 4) postoperative IH confirmed with invasive intracranial pressure monitoring.
RESULTS
Seven studies met inclusion criteria. IH was reported to be present in 5% of patients postoperatively with sagittal synostosis and 4% of patients with all forms of nonsyndromic craniosynostosis. Inadequate numbers were available to determine the incidence of postoperative IH for syndromic and individual nonsyndromic sutural synostosis based on the inclusion criteria. Surgical groups were subdivided into cranial remodeling procedures without orbital advancement and craniofacial procedures with orbital advancement. IH was reported to be present in 5% of patients with all forms of nonsyndromic sutural stenosis after cranial remodeling procedures and 1% after craniofacial advancement.
CONCLUSIONS
Postoperative development of elevated intracranial pressure has been described by multiple institutions, but the variation in how IH is determined and the multiple surgical procedures to correct craniosynostosis has limited the number of studies subject to a meta-analysis. Nonetheless, this entity deserves special attention, and further studies are required to determine the true incidence of postoperative IH, including the role of various surgical procedures on its incidence. The long-term consequences of chronic IH in this group of patients also need to be evaluated.
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Affiliation(s)
| | | | | | - Mark Urata
- 2Plastic Surgery, Children’s Hospital Los Angeles, California
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Thomas GPL, Johnson D, Byren JC, Judge AD, Jayamohan J, Magdum SA, Richards PG, Wall SA. The incidence of raised intracranial pressure in nonsyndromic sagittal craniosynostosis following primary surgery. J Neurosurg Pediatr 2015; 15:350-60. [PMID: 25559921 DOI: 10.3171/2014.11.peds1426] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Raised intracranial pressure (ICP) is recognized to occur in patients with nonsyndromic isolated sagittal craniosynostosis (SC) prior to surgery. However, the incidence of raised ICP following primary surgery is rarely reported and there appears to be a widely held assumption that corrective surgery for SC prevents the later development of intracranial hypertension. This study reports the incidence of postoperative raised ICP in a large cohort of patients with SC treated by 1 of 2 surgical procedures in a single craniofacial unit. METHODS A retrospective review was performed of all patients with SC who underwent either a modified strip craniectomy (MSC) or calvarial remodeling (CR) procedure under the care of the Oxford Craniofacial Unit between 1995 and 2010 and who were followed up for more than 2 years. The influence of patient age at surgery, year of surgery, sex, procedure type, and the presence of raised ICP preoperatively were analyzed. RESULTS Two hundred seventeen children had primary surgery for SC and were followed up for a mean of 86 months. The overall rate of raised ICP following surgery was 6.9%, occurring at a mean of 51 months after the primary surgical procedure. Raised ICP was significantly more common in those patients treated by MSC (13 of 89 patients, 14.6%) than CR (2 of 128 patients, 1.6%). Also, raised ICP was more common in patients under 1 year of age, the majority of whom were treated by MCS. No other factor was found to have a significant effect. CONCLUSIONS Postoperative raised ICP was found in more than 1 in 20 children treated for nonsyndromic SC in this series. It was significantly influenced by the primary surgical procedure and age at primary surgery. Careful long-term follow-up is essential if children who develop raised ICP following surgery are not to be overlooked.
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Esmaeli A, Nejat F, Habibi Z, El Khashab M. Secondary bicoronal synostosis after metopic craniosynostosis surgical reconstruction. J Pediatr Neurosci 2015; 9:242-5. [PMID: 25624927 PMCID: PMC4302544 DOI: 10.4103/1817-1745.147578] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Re-synostosis after standard surgical procedures for nonsyndromic craniosynostosis is a rare event, which can occur at the same suture or rarely in adjacent sutures. Here, we report 2 patients with primary metopic craniosynostosis who developed bicoronal synostosis in previously opened sutures several months after surgery.
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Affiliation(s)
- Arash Esmaeli
- Department of Neurosurgery, Children's Hospital Medical Center, Tehran University of Medical Science, Tehran, Iran
| | - Farideh Nejat
- Department of Neurosurgery, Children's Hospital Medical Center, Tehran University of Medical Science, Tehran, Iran
| | - Zohreh Habibi
- Department of Neurosurgery, Children's Hospital Medical Center, Tehran University of Medical Science, Tehran, Iran
| | - Mostafa El Khashab
- Department of Neurosurgery, Hackensack University Medical Center, New Jersey, USA
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Kuang A, Selden NR. Secondary cranial vault remodeling for restenosis after primary sagittal synostosis repair. Pediatr Neurosurg 2015; 50:104-8. [PMID: 25832724 DOI: 10.1159/000380768] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Accepted: 02/08/2015] [Indexed: 11/19/2022]
Abstract
The mainstay of treatment for single-suture cranial synostosis is cranial vault reconstruction. After primary cranial vault remodeling, patients are at risk for cranial restenosis and delayed intracranial hypertension, which may result in developmental delay or blindness. Synostosis patients are therefore generally monitored periodically for signs and symptoms of intracranial hypertension that may indicate a second cranial expansion procedure. The authors present a carefully illustrated case of a patient who presented 2 years after primary cranial vault reconstruction for sagittal synostosis with a decrease in head circumference percentile, recurrent cranial dysmorphism, papilledema, headaches and computed tomographic imaging findings consistent with cranial restenosis. These findings resolved after secondary cranial vault remodeling. The authors advocate a protocol of prospective routine clinical and radiographic follow-up after primary cranial vault repair for single-suture cranial synostosis, and illustrate the specific clinical and radiographic findings suggestive of this late complication in a representative individual patient.
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Affiliation(s)
- Anna Kuang
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Oregon Health & Science University, Portland, Oreg., USA
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30
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Wall SA, Thomas GPL, Johnson D, Byren JC, Jayamohan J, Magdum SA, McAuley DJ, Richards PG. The preoperative incidence of raised intracranial pressure in nonsyndromic sagittal craniosynostosis is underestimated in the literature. J Neurosurg Pediatr 2014; 14:674-81. [PMID: 25259602 DOI: 10.3171/2014.8.peds1425] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT The presence of raised intracranial pressure (ICP) in untreated nonsyndromic, isolated sagittal craniosynostosis (SC) is an important functional indication for surgery. METHODS A retrospective review was performed of all 284 patients presenting with SC to the Oxford Craniofacial Unit between 1995 and 2010. RESULTS Intraparenchymal ICP monitoring was performed in 39 children following a standard unit protocol. Monitoring of ICP was offered for all patients in whom nonoperative management was considered on the basis of minimal deformity or in cases in which parents were reluctant to agree to corrective surgery. These patients presented at an older age than the rest of the cohort (mean age 56 months), with marked scaphocephaly (16/39, 41%), mild scaphocephaly (11, 28%), or no scaphocephalic deformity (12, 31%). Raised ICP was found in 17 (44%) patients, with no significant difference in its incidence among the 3 different deformity types. Raised ICP was not predicted by the presence of symptoms of ICP or developmental delay or by ophthalmological or radiological findings. CONCLUSIONS The incidence of raised ICP in SC reported here is greater than that previously published in the literature. The lack of a reliable noninvasive method to identify individuals with elevated ICP in SC mandates consideration of intraparenchymal ICP monitoring in all patients for whom nonoperative management is contemplated.
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Affiliation(s)
- Steven A Wall
- Oxford Craniofacial Unit, Oxford University Hospitals National Health Service Trust, Oxford, United Kingdom
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