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Novel Suturectomy Using Absorbable Plates in Early Surgery for Craniosynostosis. J Craniofac Surg 2020; 31:e724-e730. [PMID: 32890152 DOI: 10.1097/scs.0000000000006700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND In craniosynostosis patients under 3 months of age, suturectomy is a valuable early treatment improving their outcomes. However, conventional suturectomy might not be in severe patients. The efficacy of our developed suturectomy using absorbable plates was examined. METHODS Our method was indicated for craniosynostosis patients under 3 months old who had severe intracranial hypertension, scaphocephaly, plagiocephaly, or trigonocephaly between September 2011 and March 2018. All patients underwent suturectomy, and the bone edges on both sides of the cuts were covered with absorbable plates. Evaluation was conducted with 3-dimensional computed tomography and photographs, and cephalic index, distance from dorsum sellae to forehead on computed tomography were analyzed. RESULTS Twenty-one of the 25 patients were evaluated. The preoperative cranial shapes were 4 brachycephaly, 6 scaphocephaly, 5 oxycephaly, 2 clover-leaf deformity, and 4 plagiocephaly. There were 9 syndromic and 12 nonsyndromic patients. The mean age at the time of surgery was 52.3 days (7-89), and the mean follow-up period was 3.5 years (1-8).The cephalic index and cranial definition improved in 18 patients. The secondary surgery was not required in four syndromic and none of the 12 nonsyndromic patients. There were no major complications. CONCLUSION Placement of absorbable plates was able to prevent bone formation during the early postoperative period, and yet also promote bone formation after plate absorption. The authors believe syndromic craniosynostosis patients with severe deformities and nonsyndromic ones with scaphocephaly or plagiocephaly, successfully avoided secondary surgeries. This approach is less invasive for craniosynostosis and is expected to be highly effective.
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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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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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Gilbert J, Karski M, Smith TD, Burrows AM, Norbutt C, Siegel MI, Costello BJ, Cray JJ, Losee JE, Moursi AM, Cooper GM, Mooney MP. Transforming Growth Factor-β3 Therapy Delays Postoperative Reossification and Improves Craniofacial Growth in Craniosynostotic Rabbits. Cleft Palate Craniofac J 2015; 53:210-21. [PMID: 26090789 DOI: 10.1597/14-298] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Postoperative reossification is a common clinical correlate following surgery. It has been suggested that an underexpression of transforming growth factor-β3 (TGF-β3) may be related to craniosynostosis and postoperative reossification. Adding TGF-β3 may delay reossification and improve postoperative growth. The present study was designed to test this hypothesis. Thirty 10-day-old New Zealand white rabbits with hereditary coronal suture synostosis were divided into three groups: (1) suturectomy controls (n = 14), (2) suturectomy treated with bovine serum albumin (n = 8), and (3) suturectomy treated with TGF-β3 protein (n = 8). At 10 days of age, a 3-mm × 15-mm coronal suturectomy was performed, and serial three-dimensional (3D) computed tomography (CT) scans and cephalographs were taken at 10, 25, 42, and 84 days of age. Calvaria were harvested at 84 days of age for histomorphometric analysis. Mean differences were analyzed using a group by age analysis of variance. Analysis of the 3D CT scan data revealed that sites treated with TGF-β3 had significantly (P < .05) greater defect areas and significantly (P < .05) greater intracranial volumes through 84 days of age compared with controls. Histomorphometry showed that sites treated with TGF-β3 had patent suturectomy sites and significantly (P < .001) less new bone in the suturectomy site compared with controls. Serial radiograph data revealed significant (P < .05) differences in craniofacial growth from 25 to 84 days in TGF-β3-treated rabbits compared with controls. Data show that TGF-β3 administration delayed reossification and improved craniofacial growth in this rabbit model. These findings also suggest that this molecular-based therapy may have potential clinical use.
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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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Abstract
LEARNING OBJECTIVES After studying this article, the participant should be able to: (1) Make the appropriate diagnosis for each of the single-sutural synostoses, based on the physical examination. (2) Explain the functional concerns associated with these synostoses and why surgical correction is indicated. (3) Distinguish between the different types of surgical corrections available, the timing for these various interventions, and in what ways these treatments achieve overall management objectives. (4) Identify the basic goals involved in caring for the syndromic synostoses. SUMMARY This article provides an overview of the diagnosis and management of infants with craniosynostosis. This review also incorporates some of the treatment philosophies followed at The Craniofacial Center in Dallas, but is not intended to be an exhaustive treatise on the subject. It is designed to serve as a reference point for further in-depth study by review of the reference articles presented. This information base is then used for self-assessment and benchmarking in parts of the Maintenance of Certification process of the American Board of Plastic Surgery.
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Delayed Synostoses of Uninvolved Sutures After Surgical Treatment of Nonsyndromic Craniosynostosis. J Craniofac Surg 2014; 25:119-23. [DOI: 10.1097/scs.0b013e3182a75102] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Maternal reports of satisfaction with care and outcomes for children with craniosynostosis. J Craniofac Surg 2009; 20:138-42. [PMID: 19165011 DOI: 10.1097/scs.0b013e318190e28c] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Craniosynostosis is a congenital deformity caused by premature fusion of cranial suture(s). Surgical outcomes of craniosynostosis have been well documented; however, limited published data are available regarding access to care and social and psychological health outcomes for children with craniosynostosis. The authors conducted a population-based, multistate study of maternal perceptions of care and outcomes for children with craniosynostosis born from January 1998 through December 2003. Mothers of 147 children were contacted and asked to complete a structured telephone interview; 82 mothers (55.8%) participated. Overall, the mean ages of children and their mothers at the time of interview were 4.4 and 34.8 years, respectively. Mothers interviewed tended to be white and, at a minimum, high school graduates. Most mothers reported being satisfied with the craniosynostosis-related information and support provided by medical care providers, and access to primary and specialty care was most often rated as satisfactory. Mothers tended to report the physical health of their child to be good; however, delays in cognitive and emotional development, hearing loss, and speech problems were identified. In addition, statistically significant differences among mothers in each state were noted for reports of the quality of team care, primary care, learning interventions, and perceived need for additional surgeries. These results suggest some limitations in craniosynostosis-related care and provide guidance to medical and surgical care providers in making need-based improvements in craniosynostosis surgery and care. Future studies are recommended to replicate this evaluation in additional populations.
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Ex vivo Noggin gene therapy inhibits bone formation in a mouse model of postoperative resynostosis. Plast Reconstr Surg 2009; 123:94S-103S. [PMID: 19182668 DOI: 10.1097/prs.0b013e318191c05b] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Resynostosis following surgical correction of primary craniosynostosis necessitates further surgical intervention, thereby increasing morbidity and mortality. Bone morphogenetic proteins are known to be expressed during normal bone healing. This study tested the hypothesis that treatment of suturectomy sites with Noggin, an extracellular antagonist of bone morphogenetic proteins, would inhibit postoperative resynostosis in a mouse suturectomy model. METHODS Healing of small interfrontal suturectomies was assessed in three groups of mice using radiographic, micro-computed tomographic, and histologic analyses. The groups were as follows: group 1, no treatment (n = 36); group 2, green fluorescent protein (GFP)-labeled cells in a collagen scaffold (n = 36); and group 3, Noggin/GFP-expressing cells in a collagen scaffold (n = 36). RESULTS Radiographic analysis of defect area showed that Noggin-treated suturectomy sites were significantly larger than untreated sites 4 and 8 weeks postoperatively (p < 0.05). Analysis of defect volume showed that Noggin-treated defects were significantly larger than untreated defects at all time points after surgery. The GFP-treated defects demonstrated some inhibition of bone formation, but this inhibition was not significant compared with untreated controls 12 weeks after surgery. CONCLUSIONS These findings suggest that Noggin is an effective inhibitor of bone formation within small suturectomy sites and that Noggin may be useful in avoiding postoperative resynostosis. Noggin treatment may be useful as an adjunct to traditional surgical intervention for the treatment of children with craniosynostosis.
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Cooper GM, Curry C, Barbano TE, Burrows AM, Vecchione L, Caccamese JF, Norbutt CS, Costello BJ, Losee JE, Moursi AM, Huard J, Mooney MP. Noggin inhibits postoperative resynostosis in craniosynostotic rabbits. J Bone Miner Res 2007; 22:1046-54. [PMID: 17437358 DOI: 10.1359/jbmr.070410] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
UNLABELLED Inhibition of bone formation after surgery to correct craniosynostosis would alleviate the need for secondary surgeries and decrease morbidity and mortality. This study used a single dose of Noggin protein to prevent resynostosis and improve postoperative outcomes in a rabbit model of craniosynostosis. INTRODUCTION Craniosynostosis is defined as the premature fusion of one or more of the cranial sutures, which causes secondary deformations of the cranial vault, cranial base, and brain. Current surgical intervention involves extirpation of the fused suture to allow unrestricted brain growth. However, resynostosis of the extirpated regions often occurs. Several bone morphogenetic proteins (BMPs), well-described inducers of ossification, are involved in bone healing. This study tested the hypothesis that a postoperative treatment with Noggin, an extracellular BMP inhibitor, can inhibit resynostosis in a rabbit model of human familial nonsyndromic craniosynostosis. MATERIALS AND METHODS Thirty-one New Zealand white rabbits with bilateral coronal suture synostosis were divided into three groups: (1) suturectomy controls (n = 13); (2) suturectomy with BSA in a slow-resorbing collagen vehicle, (n = 8); and (3) suturectomy with Noggin in a slow-resorbing collagen vehicle (n = 10). At 10 days of age, a 3 x 15-mm coronal suturectomy was performed. The sites in groups 2 and 3 were immediately filled with BSA-loaded gel or Noggin-loaded gel, respectively. Serial 3D-CT scan reconstructions of the defects and standard radiographs were obtained at 10, 25, 42, and 84 days of age, and the sutures were harvested for histological analysis. RESULTS Radiographic analysis revealed that Noggin-treated animals had significantly greater coronal suture marker separation by 25 days and significantly greater craniofacial length at 84 days of age compared with controls. 3D-CT analysis revealed that Noggin treatment led to significantly greater defect areas through 84 days and to increased intracranial volumes at 84 days of age compared with other groups. Histological analysis supported CT data, showing that the untreated and BSA-treated groups had significant healing of the suturectomy site, whereas the Noggin-treated group had incomplete wound healing. CONCLUSIONS These data support our hypothesis that inhibition of BMP activity using Noggin may prevent postoperative resynostosis in this rabbit model. These findings also suggest that Noggin therapy may have potential clinical use to prevent postoperative resynostosis in infants with craniosynostosis.
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Affiliation(s)
- Gregory M Cooper
- Department of Surgery, Division of Pediatric Plastic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania 15213, USA.
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Mooney MP, Losken HW, Moursi AM, Bradley J, Azari K, Acarturk TO, Cooper GM, Thompson B, Opperman LA, Siegel MI. Anti-TGF-??2 Antibody Therapy Inhibits Postoperative Resynostosis in Craniosynostotic Rabbits. Plast Reconstr Surg 2007; 119:1200-1212. [PMID: 17496591 DOI: 10.1097/01.prs.0000258403.49584.ec] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Postoperative resynostosis is a common clinical finding. It has been suggested that an overexpression of transforming growth factor (TGF)-beta2 may be related to craniosynostosis and may contribute to postoperative resynostosis. Interference with TGF-beta2 function with the use of neutralizing antibodies may inhibit resynostosis. The present study was designed to test this hypothesis. METHODS New Zealand White rabbits with bilateral coronal suture synostosis were used as suturectomy controls (group 1, n = 9) or given suturectomy with nonspecific, control immunoglobulin G antibody (group 2, n = 9) or suturectomy with anti-TGF-beta2 antibody (group 3, n = 11). At 10 days of age, a 3 x 15-mm coronal suturectomy was performed. The sites in groups 2 and 3 were immediately filled with 0.1 cc of a slowly resorbing collagen gel mixed with either immunoglobulin G (100 mug per suture) or anti-TGF-beta2 (100 mug per suture). Three-dimensional computed tomography scan reconstructions of the defects were obtained at 10, 25, 42, and 84 days of age, and the sutures were harvested for histomorphometric analysis. RESULTS Computed tomography scan data revealed that the suturectomy sites treated with anti-TGF-beta2 showed significantly (p < 0.05) greater areas through 84 days of age compared with controls. Histomorphometry also showed that suturectomy sites treated with anti-TGF-beta2 had patent suturectomy sites and more fibrous tissue in the defects compared with sites in control rabbits and had significantly (p < 0.001) less new bone area (by approximately 215 percent) in the suturectomy site. CONCLUSIONS These data support the initial hypothesis that interference with TGF-beta2 function inhibited postoperative resynostosis in this rabbit model. They also suggest that this biologically based therapy may be a potential surgical adjunct to retard postoperative resynostosis in infants with craniosynostosis.
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Affiliation(s)
- Mark P Mooney
- Pittsburgh, Pa.; Chapel Hill, N.C.; Columbus, Ohio; Los Angeles, Calif.; Ankara, Turkey; and Dallas, Texas From the Departments of Oral Medicine and Pathology, Anthropology, Plastic and Reconstructive Surgery, Orthodontics, and Orthopedic Surgery, the Cleft Palate-Craniofacial Center, and the School of Dental Medicine, University of Pittsburgh; the Department of Plastic Surgery, School of Medicine, University of North Carolina; Department of Pediatric Dentistry, College of Dentistry, Ohio State University; Division of Plastic and Reconstructive Surgery, University of California, Los Angeles; Division of Plastic Surgery, University of Pittsburgh Medical Center; Department of Plastic and Reconstructive Surgery, Gülhane Military Medical Academy; and Department of Biomedical Sciences, Baylor College of Dentistry, Texas A & M University System Health Science Center
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Mooney MP, Losken HW, Moursi AM, Shand JM, Cooper GM, Curry C, Ho L, Burrows AM, Stelnicki EJ, Losee JE, Opperman LA, Siegel MI. Postoperative Anti-Tgf-β2 Antibody Therapy Improves Intracranial Volume and Craniofacial Growth in Craniosynostotic Rabbits. J Craniofac Surg 2007; 18:336-46; discussion 347-9. [PMID: 17414283 DOI: 10.1097/scs.0b013e3180336047] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Postoperative resynostosis and secondary craniofacial growth abnormalities are common sequelae after craniofacial surgery. It has been suggested that an overexpression of transforming growth factor-beta2 (Tgf-beta2) may be related to craniosynostosis and contribute to postoperative resynostosis. Interference with Tgf-beta2 function using neutralizing antibodies may inhibit resynostosis and improve postoperative craniofacial growth; the present study was designed to test this hypothesis. Twenty-nine New Zealand white rabbits with bilateral coronal suture synostosis were used: 1) suturectomy controls (n=9); 2) suturectomy with nonspecific, control IgG antibody (n=9); and 3) suturectomy with anti-Tgf-beta2 antibody (n=11). At 10 days of age, a 3 mm x 15-mm coronal suturectomy was performed. The sites in groups 2 and 3 were immediately filled with 0.1 cc of a slow resorbing collagen gel mixed with either IgG (100 microg/suture) or anti-Tgf-beta2 (100 microg/suture). Three-dimensional computed tomography scan reconstructions of the skulls and cephalographs were obtained at 10, 25, 42, and 84 days of age. Computed tomography scan data revealed patent suturectomy sites and significantly (P<0.05) greater intracranial volumes by 84 days of age in rabbits treated with anti-Tgf-beta2 compared with controls. Cephalometric analysis revealed significant (P<0.05) differences in craniofacial, cranial vault, and cranial base growth by 84 days of age in rabbits treated with anti-Tgf-beta2 compared with controls. These data support the initial hypothesis that interference with Tgf-beta2 function inhibited postoperative resynostosis and improved cranial vault growth in this rabbit model. Thus, this biologically based therapy may be a potential surgical adjunct in the treatment of infants with craniosynostosis.
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Affiliation(s)
- Mark P Mooney
- Department of Oral Biology, Cleft Palate-Craniofacial Center, University of Pittsburgh, and Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania 15261, USA.
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Discussion. J Craniofac Surg 2007. [DOI: 10.1097/scs.0b013e318053d13d] [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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Sikorski CW, Iteld L, McKinnon M, Yamini B, Frim DM. Correction of sagittal craniosynostosis using a novel parietal bone fixation technique: results over a 10-year period. Pediatr Neurosurg 2007; 43:19-24. [PMID: 17190983 DOI: 10.1159/000097520] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2005] [Accepted: 06/15/2006] [Indexed: 02/05/2023]
Abstract
Isolated sagittal synostosis is a common form of craniosynostosis affecting roughly 1 in 5,000 children at birth. This results in a scaphocephalic head shape with a characteristically elongated anterior-posterior dimension and narrowed biparietal diameter. We present our experience with the correction of scaphocephaly due to sagittal synostosis using cranial vault reconstruction with a novel form of parietal bone fixation in 21 patients over 10 years. The medial fixation results in a hinging effect whereby transverse brain growth at the squamoid suture is enhanced. This results in excellent cosmetic results that are immediate and durable without the need for postoperative molding helmets. Furthermore, the complications associated with this procedure are limited.
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Affiliation(s)
- Christian W Sikorski
- Section of Neurosurgery, Comer Children's Hospital, The University of Chicago, Chicago, IL 60637, USA
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Abstract
The birth prevalence of craniosynostosis (premature suture fusion) is 300-500 per 1,000,000 live births. Surgical management involves the release of the synostosed suture. In many cases, however, the suturectomy site rapidly reossifies, further restricts the growing brain and alters craniofacial growth. This resynostosis requires additional surgery, which increases patient morbidity and mortality. New findings in bone biology and molecular pathways involved with suture fusion, combined with novel tissue engineering techniques, may allow the design of targeted and complementary therapies to decrease complications inherent in high-risk surgical procedures. This paper selectively reviews recent advances in i) identifying genetic mutations and the aetiopathogenesis of a number of craniosynostotic conditions; ii) cranial suture biology and molecular biochemical pathways involved in suture fusion; and iii) the design, development and application of various vehicles and tissue engineered constructs to deliver cytokines and genes to cranial sutures. Such biologically based therapies may be used as surgical adjuncts to rescue fusing sutures or help manage postoperative resynostosis.
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Affiliation(s)
- Mark P Mooney
- Department of Oral Medicine and Pathology, School of Dental Medicine, 329 Salk Hall, University of Pittsburgh, Pittsburgh, PA 15261, USA.
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McCarthy JG, Bradley JP, Stelnicki EJ, Stokes T, Weiner HL. Hung span method of scaphocephaly reconstruction in patients with elevated intracranial pressure. Plast Reconstr Surg 2002; 109:2009-18. [PMID: 11994607 DOI: 10.1097/00006534-200205000-00035] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Joseph G McCarthy
- Institute of Plastic and Reconstructive Surgery and the Department of Neurosurgery, New York University Medical Center, New York, NY, USA.
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Mooney MP, Burrows AM, Smith TD, Losken HW, Opperman LA, Dechant J, Kreithen AM, Kapucu R, Cooper GM, Ogle RC, Siegel MI. Correction of Coronal Suture Synostosis Using Suture and Dura Mater Allografts in Rabbits With Familial Craniosynostosis. Cleft Palate Craniofac J 2001. [DOI: 10.1597/1545-1569(2001)038<0206:cocssu>2.0.co;2] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Mooney MP, Burrows AM, Smith TD, Losken HW, Opperman LA, Dechant J, Kreithen AM, Kapucu R, Cooper GM, Ogle RC, Siegel MI. Correction of coronal suture synostosis using suture and dura mater allografts in rabbits with familial craniosynostosis. Cleft Palate Craniofac J 2001; 38:206-25. [PMID: 11386428 DOI: 10.1597/1545-1569_2001_038_0206_cocssu_2.0.co_2] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Resynostosis following surgical correction of craniosynostosis is a common clinical correlate. Recent studies suggest that the dura mater is necessary to maintain suture patency. It has also been hypothesized that dura mater from synostotic individuals may provide aberrant biochemical signals to the osteogenic fronts of the calvaria, which result in premature suture fusion and subsequent resynostosis following surgery. This study was designed to test this hypothesis by surgically manipulating the coronal suture and dura mater in rabbits with familial craniosynostosis to prevent postsurgical resynostosis. DESIGN Craniofacial growth and histomorphometric data were collected from 129 rabbits: 72 normal controls and 57 rabbits with bilateral coronal suture synostosis (15 unoperated on controls; 13 surgical controls; 9 dura mater transplant only; 10 suture transplant only; and 10 suture and dura mater transplant). At 10 days of age, all rabbits had radiopaque amalgam markers placed on either side of the coronal, frontonasal, and anterior lambdoidal sutures. At 25 days of age, 42 synostosed rabbits had a 3 to 5-mm wide coronal suturectomy. Coronal sutures and/or underlying dura mater allografts were harvested from same-aged, wild-type, isohistogenic control rabbits and transplanted onto the dura mater of synostosed host rabbits. Serial radiographs were taken at 10, 25, 42, and 84 days of age, and the suturectomy sites were harvested at 84 days of age in 44 rabbits and serially sectioned for histomorphometric examination. RESULTS Results revealed that cranial vault growth was significantly (p < .05) improved following surgical release of the fused coronal suture compared with synostosed rabbits who were not operated on but was still significantly different (p < .05) from that of normal control rabbits. By 84 days of age, significant (p < .05) differences were noted in calvarial suture marker separation, cranial vault shape indices, and cranial base angles between rabbits with and without dura mater allografts, probably as a result of resynostosis of the suturectomy site or suture-only allografts. Qualitative histological examination revealed that at 84 days of age rabbits with suture and dura allografts had patent coronal sutures, suture-only allografts had fused coronal sutures with extensive endosteal hyperostosis, dura mater-only allografts had some new bone in the suturectomy site that resembled rudimentary osteogenic fronts, and suturectomy controls had extensive endosteal bone formation and resynostosis of the suturectomy site. Significantly (p < .05) more bone was found in the suturectomy sites of rabbits without dura mater allografts compared with rabbits with dura mater allografts. CONCLUSIONS Results support the initial hypothesis that normal dura mater allografts will maintain suture or suturectomy site patency and allow unrestricted craniofacial growth. However, it is still unclear whether the dura mater from normal rabbits was providing biochemical signals to the transplanted sutures or suturectomy sites or simply acting as a barrier to prevent abnormal biochemical signals from the dura mater of synostosed rabbits from reaching the calvaria. The clinical and therapeutic implications of these procedures are discussed.
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Affiliation(s)
- M P Mooney
- Department of Oral Medicine and Pathology, University of Pittsburgh, Pennsylvania 15261, USA. mpm4+@pitt.edu
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Christophis P, Jünger TH, Howaldt HP. Surgical correction of scaphocephaly: experiences with a new procedure and follow-up investigations. J Craniomaxillofac Surg 2001; 29:33-8. [PMID: 11467492 DOI: 10.1054/jcms.2000.0182] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Simple resection of the sagittal suture and the use of alloplastic material or extensive skull resections have long been proven to be unsatisfactory in the treatment of sagittal synostosis. In contrast to these experiences, the immediate correction of skull shape seems to yield the best results without significant morbidity. PATIENTS Thirty-six scaphocephalic infants with an average age of 6.5 (3.5-14) months underwent operation by our craniofacial team since 1994. METHODS Wide resection of the sagittal suture was used in combination with a bone-strip resection along the coronal and lambdoid sutures. Occasionally partial resection and reshaping of the frontal or occipital bone was necessary to correct an extremely bulging skull. The cranial growth and shape was monitored by anthropometric skull measurements in the last 20 patients. RESULTS Except in two cases, in which the dura mater was minimally injured intraoperatively, no complications occurred in any patient. Craniofacial oedema always occurred but disappeared after 72 h. The immediate correction of the skull shape was successful in all cases and was completed within 6 months postoperatively. There was no iatrogenic bone defect one year after surgery. Postoperative skull shape and growth was normal. CONCLUSION These procedures seem to be effective in the treatment of scaphocephalus. Further normalization of skull shape is achieved by unrestricted postoperative brain growth.
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Affiliation(s)
- P Christophis
- Department of Neurosurgery, Medical School, Justus Liebig-University Giessen, Germany.
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Boop FA, Chadduck WM, Shewmake K, Teo C. Outcome analysis of 85 patients undergoing the pi procedure for correction of sagittal synostosis. J Neurosurg 1996; 85:50-5. [PMID: 8683282 DOI: 10.3171/jns.1996.85.1.0050] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The authors present a retrospective review of their experience with 85 cases using the pi procedure to correct sagittal synostosis. A male preponderance of four to one was recognized in this group. Sixty-five infants underwent computerized tomography scanning of the head prior to surgery; these scans revealed unexpected intracranial pathology in 5% of cases. Surgical complications included three intraoperative dural lacerations. All children received blood transfusions with no complications. Cosmetic outcomes were excellent in 53%, good in 43%, and poor in 4% of cases. One patient required reoperation. All poor outcomes were in infants who were younger than 8 weeks of age at the time of surgery and who underwent a "reverse pi" procedure. Most of the excellent outcomes occurred in infants who were between 3 and 6 months of age at the time of surgery. Although more extensive than strip craniectomy, the pi procedure can be accomplished with minimal morbidity. In the authors' opinion, the pi procedure provides better immediate and long-term cosmetic results than synostectomy alone.
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Affiliation(s)
- F A Boop
- Arkansas Children's Hospital, Little Rock, USA
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Turtas S, Tondi M, Tola G, Sehrbundt Viale E, Martinez PL. Neuropsychological evaluation in a series of 17 cases operated on for craniosynostosis. Acta Neurochir (Wien) 1993; 120:123-5. [PMID: 8460562 DOI: 10.1007/bf02112029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
In a study of patients suffering from craniosynostosis various pre- and post-operative parameters were identified that may affect subsequent intellectual capacity. In particular, facial malformations appeared to be closely correlated with impaired intellectual development. Other parameters included measurement of cranial circumference and volume; their subaverage values correlated with slight mental insufficiency. However, in the pre-operative period they cannot be used as prognostic indices because these relations were statistically not significant. The remaining parameters (neurological and electroencephalographic findings, post-operative re-ossification of the skull, pre-operative digital impressions, CT findings) did not seem to be related to intellectual development.
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Affiliation(s)
- S Turtas
- Institute of Neurosurgery, Sassari University Medical School, Italy
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25
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Abstract
For early correction of craniosynostosis in the newborn or in early infancy, strip craniectomy may produce satisfactory results. For late correction, however, more radical cranial reconstruction procedures are essential in order to achieve adequate remodeling of cranial deformities and normalization of intracranial pressure. Craniosynostosis presents various types of cranial deformity, and different procedures for its correction have been reported. Expanding cranioplasty is presented for the increase of cranial volume and immediate correction of the cranial deformity. This cranioplasty can be applied not only for late correction of various types of craniosynostosis but also for other cranial deformities.
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Affiliation(s)
- K Mori
- Department of Neurosurgery, Kochi Medical School, Japan
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26
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Alberius P, Brandt L, Selvik G. Calvarial growth after linear craniectomy in scaphocephaly as evaluated by X-ray stereophotogrammetry. J Craniomaxillofac Surg 1987; 15:2-9. [PMID: 3470311 DOI: 10.1016/s1010-5182(87)80005-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
An roentgen stereophotogrammetric system for the evaluation of skeletal adjustments following corrective surgery in craniosynostosis is described. Four illustrative cases of scaphocephaly, all treated with midline linear craniectomy, with uneventful postoperative follow-up periods of more than 4 years, are reported. The postoperative development, as evaluated by volumetric and kinematic analyses, was uniform but still rich in individual and local growth variations. This study confirms that roentgen stereometry ( = exact measurements from stereoradiographs), being an accurate and objective method, adds greatly to previous methods of postoperative assessment in craniofacial skeletal disorders.
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27
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Brandt L, Alberius P, Ljunggren B. The use of Zenker's solution in linear craniectomy for craniosynostosis: technical modification and reappraisal. Acta Neurochir (Wien) 1986; 83:67-70. [PMID: 3799251 DOI: 10.1007/bf01420511] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Regrowth of bone after craniectomy for craniosynostosis is still a problem, despite the advent of newer and extensive surgical techniques. A clinical study on 25 consecutive patients was undertaken to determine whether a modification of previous routines could retain the advantages of a tissue fixative, Zenker's solution, while eliminating the drawback of convulsive activity. After brief coagulation, Zenker's solution was sparingly applied to the dural surface for maximally one minute followed by copious irrigation of the surgical field. The results were satisfactory and postoperative complications unrelated to the fixative. The present procedure seems safe, effective, and easy to use.
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28
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Abe H, Ikota T, Akino M, Kitami K, Tsuru M. Functional prognosis of surgical treatment of craniosynostosis. Childs Nerv Syst 1985; 1:53-61. [PMID: 3986842 DOI: 10.1007/bf00706732] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Twenty-three cases of craniosynostosis were studied with regard to age at operation, symptoms, operative methods, and long-term results. Long-term results of 20 cases that were followed up for more than 1 year after surgery showed that mental retardation remained in 8 cases; a slight improvement in mental function was observed in only 2 cases. Of the 8 patients with mental retardation, 7 were operated on more than 6 months after birth, 7 showed striking digital impression on skull X-ray films and 5 were suffering from oxycephaly. Of the 8 patients with mental retardation, 5 had suffered from perinatal asphyxia or had seizures during delivery and subsequent past history. From these observations, factors affecting prognosis are: (1) age at operation; (2) the degree and duration of increased intracranial pressure; (3) the extent and degree of suture closures; (4) perinatal asphyxia and seizure disorders.
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29
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Vollmer DG, Jane JA, Park TS, Persing JA. Variants of sagittal synostosis: strategies for surgical correction. J Neurosurg 1984; 61:557-62. [PMID: 6747694 DOI: 10.3171/jns.1984.61.3.0557] [Citation(s) in RCA: 92] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Sagittal synostosis is discussed with respect to the variations seen with the deformity. The morphological spectrum ranging from marked frontal bossing to prominent occipital bulging is described. Surgical techniques have been specifically designed for these variants. These techniques provide an immediate correction of scaphocephaly, and achieve a reduction of the specific deformity with morbidity comparable to that associated with conventional operations. The lack of large areas of craniectomy and the avoidance of synthetic materials are cited as additional advantages of these techniques. The importance of altering the surgical approach to the specific clinical problem is underscored. Two illustrative cases of sagittal synostosis variants are described, and recent experience with the modified operative techniques in treating these and similar cases is discussed.
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30
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Giuffrè R, Vagnozzi R, Savino S. Infantile craniosynostosis: clinical, radiological, and surgical considerations based on 100 surgically treated cases. Acta Neurochir (Wien) 1978; 44:49-67. [PMID: 726961 DOI: 10.1007/bf01401630] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
One hundred children affected by craniosynostosis were operated on from January 1952 to February 1977. Forty-six patients were operated on within the first year of life, and only 9 after six years of age. In 27 cases only one cranial suture was synostotic (mostly the coronal: 15 cases). In 36 cases two sutures were involved (mostly coronal plus sagittal: 25 cases). In 28 cases all the cranial sutures were involved. Also included in this series are seven cases of Crouzon's, one of Apert's, and one of Carpenter's syndromes. The clinical, radiological, and surgical features of this condition are discussed, and the long-term results are reported.
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