Cranial Base and Posterior Cranial Vault Asymmetry After Open and Endoscopic Repair of Isolated Lambdoid Craniosynostosis

Abstract

Background Previous studies have shown that open cranial vault remodeling does not fully address the endocranial deformity. This study aims to compare endoscopic-assisted suturectomy with postoperative molding helmet therapy to traditional open reconstruction by quantifying changes in cranial base morphology and posterior cranial vault asymmetry. Methods Anthropometric measurements were made on pre- and 1-year postoperative three-dimensionally reconstructed computed tomography scans of 12 patients with unilateral lambdoid synostosis (eight open and four endoscopic-assisted). Cranial base asymmetry was analyzed using: posterior fossa deflection angle (PFA), petrous ridge angle (PRA), mastoid cant angle (MCA), and vertical and anterior-posterior (A-P) displacement of external acoustic meatus (EAM). Posterior cranial vault asymmetry was quantified by volumetric analysis. Results Preoperatively, patients in the open and endoscopic groups were statistically equivalent in PFA, PRA, MCA, and A-P EAM displacement. At one year postoperatively, open and endoscopic patients were statistically equivalent in all measures. Mean postoperative PFA for the open and endoscopic groups was 6.6 and 6.4 degrees, PRA asymmetry was 6.4 and 7.6 percent, MCA was 4.0 and 3.2 degrees, vertical EAM displacement was −2.3 and −2.3 millimeters, and A-P EAM displacement was 6.8 and 7.8 millimeters, respectively. Mean volume asymmetry was significantly improved in both open and endoscopic groups, with no difference in postoperative asymmetry between the two groups (p=0.934). Conclusions Patients treated with both open and endoscopic repair of lambdoid synostosis show persistent cranial base and posterior cranial vault asymmetry. Results of endoscopic-assisted suturectomy with postoperative molding helmet therapy are similar to those of open calvarial vault reconstruction.

Minimally Invasive Suturectomy and Postoperative Helmet Therapy : Advantages and Limitations

“…Suturectomy itself is not different from open strip craniectomy, but its minimal invasiveness enabled the operation to be used with early infants. Comparable esthetic outcomes were also reported in the literature, and this technique was acceptable to many surgeons 12 14 15 27 34 40) . Smaller incisions, less blood loss and shorter operative times and lengths of hospital stay were achieved with minimally invasive suturectomy 13 19 31 34 40) .…”

“…In view of its safety and minimal invasiveness, the outcomes of minimally invasive suturectomy are remarkable. Transfusion rates in minimally invasive suturectomy during the perioperative period range from 3.3% to 25%, while almost patients need transfusion in extensive cranial vault remodeling 13 19 27 31 40) . The operating time (45–100 minutes) is also shorter than in extensive cranial vault remodeling (4–8 hours) 4 19 31 34) .…”

Cost comparison of surgical management of nonsagittal synostosis: traditional open versus endoscope-assisted techniques

“…with helmet therapy, equal or superior to those of open CVR. 11,16,24,28,32,35,40,42 With an increased focus on cost-effective healthcare delivery, previous studies have shown a significant decrease in financial burden with endoscopic treatment, most often demonstrated in patients with sagittal synostosis. 1,8,19,23,31,39 Fewer data are available on the charges associated with surgical treatment of nonsagittal synostosis (metopic, coronal, and lambdoid), for which traditional open remodeling procedures are distinct from those for sagittal synostosis.…”

Endoscopic Strip Craniectomy for Craniosynostosis

“…17 Subsequent to its description, the use of endoscopic strip craniectomy has been reported in multiple clinical scenarios involving diverse presentations of craniosynostosis. [18][19][20][21][22][23][24][25][26] In addition to the reports of wide applicability and decreased morbidity, others have discussed the cost-effectiveness of the endoscopic approach as opposed to traditional open cranial vault remodeling. 27,28 For these reasons, endoscopic strip craniectomy with postoperative helmet therapy has been lauded by some to be a safe and effective way to treat many forms of craniosynostosis.…”