Do standard surgical techniques lead to satisfying aesthetic results in nonsyndromic sagittal suture synostosis?

Abstract

OBJECTIVE Surgical correction of synostotic cranial sutures is typically performed early in an affected child’s life. Depending on the severity of the cranial synostoses, different aspects of the surgical treatment may have varying degrees of importance. In this sense, the aesthetic appearance in children with normal neurological development in single-suture synostosis plays an important role in self-perception and social acceptance for both the patients themselves and their caregivers. Therefore, in this study, the authors aimed to evaluate the aesthetic outcome after surgical correction in a cohort of patients with nonsyndromic sagittal suture synostosis. METHODS Between December 2002 and December 2019, a total of 99 patients underwent surgical correction of a synostotic sagittal suture at the Medical University of Vienna. Depending on their age, patients underwent either an extended midline strip craniectomy (EMSC) (< 4 months) or a modified pi procedure (MPP) (≥ 4 months). After the surgical procedure, the outcome was evaluated by the treating neurosurgeon at 1- and 12-month follow-up visits, and after approximately 5 years, before the patient entered elementary school. In addition to that, the patients’ caregivers were asked to evaluate the aesthetic outcome of the surgical procedure after 12 months. These results were then compared to evaluate potential differences in the perception of the surgical outcome. RESULTS After 12 months, the majority of the included patients were evaluated as having a good aesthetic outcome by the treating neurosurgeon (97%) and by their caregivers (89%). These differences did not show statistical significance (p = 0.11). Similarly, no differences in the aesthetic outcome depending on the surgical procedure performed could be found (p = 0.55). At the last follow-up visit, before entering elementary school, all available patients had an excellent or good surgical outcome. Moreover, the majority of caregivers (73%) reported that their child had a normal head shape appearance after surgical correction. CONCLUSIONS The results of this study have suggested that surgical correction of sagittal suture synostosis by simple operative techniques leads to a good aesthetic outcome and a normal head shape appearance in the majority of patients. An analysis of the evaluation of the surgical outcome by either the treating neurosurgeon or the patient caregivers showed comparable results and, thus, early intervention with simple surgical techniques can be recommended.

Cosmetic satisfaction and patient-reported outcomes following surgical treatment of single-suture craniosynostosis: a systematic review

“…Ten of the 12 included studies reported on the type of surgical treatment performed, which included open reconstructive surgery (ORS), endoscopy-assisted suturectomy, extended midline strip craniectomy (EMSC), modified pi procedure (mPP), frontal orbital advancement (FOA), cranial vault remodelling (CVR), strip craniectomy (ST), suturectomy (ST), orbitofrontal bandeau resection (OFBR), spring-assisted cranioplasty (SAS), pi procedure (PP) and burring of the metopic ridge (MRB) [ 7 , 12 , 14 – 20 , 22 ]. The age at treatment ranged from 0.3 months to 12 years [ 7 , 12 , 14 , 18 , 19 , 22 ] and the weighted mean was 6.4 months [ 7 , 12 , 14 – 17 , 19 , 20 ]. The duration of follow-up ranged from 6 months to 37 years [ 7 , 12 , 17 – 20 ] and had a weighted mean of 7.9 years [ 7 , 12 , 17 , 19 , 20 ].…”

The Accuracy of Classification Systems in Nonsyndromic Sagittal Craniosynostosis

“…Novel approaches aim to characterize NSC morphology in yet other ways—through three-dimensional measurements of the skull or computer simulations of its growth 24,25 . The genetic factor responsible for the diversity of NSC is also sought, 26 and the morphology itself is used for the evaluation of aesthetic 27–29 and functional outcomes 30,31 …”

“…2 Novel approaches aim to characterize NSC morphology in yet other ways-through three-dimensional measurements of the skull or computer simulations of its growth. 24,25 The genetic factor responsible for the diversity of NSC is also sought, 26 and the morphology itself is used for the evaluation of aesthetic [27][28][29] and functional outcomes. 30,31 Regarding the tendency to systematize the NSC morphology, we feel that the number of definitions and terms used in the literature may be confusing, that is, the term "scaphocephaly" refers to all types of deformations caused by premature closure of the sagittal suture, but the term "dolichocephaly," formerly used for description of cranial deformities, does not strictly mean pathology, but a variant of a normal skull, characterized by the predominance of the longitudinal dimension over the transverse dimension.…”

A Photo Score For Aesthetic Outcome In Sagittal Synostosis: An ERN CRANIO Collaboration

“…Previous studies on aesthetic outcomes in scaphocephaly have often used a general assessment of skull/head shape or used scores that only assess aesthetic outcomes after surgical intervention and the need for re-intervention. [3][4][5][6][10][11][12][13] However, literature on photo scores that assess phenotypical severity of specific scaphocephaly features is limited, and to our knowledge, only 2 prior studies investigated such photo scores. 14,15 First, Van Veelen et al 15 used a scaphocephaly photo score to assess aesthetic outcomes after spring-assisted strip craniotomy by comparing preoperative and postoperative photo score assessments.…”

“…Previous studies on aesthetic outcomes in scaphocephaly have often used a general assessment of skull/head shape or used scores that only assess aesthetic outcomes after surgical intervention and the need for re-intervention 3–6,10–13 . However, literature on photo scores that assess phenotypical severity of specific scaphocephaly features is limited, and to our knowledge, only 2 prior studies investigated such photo scores 14,15 .…”