Endoscopic Strip Craniectomy and Helmet Therapy for Sagittal Craniosynostosis: An Analysis of Cranial Growth Changes in the Early Postoperative Period

Abstract

Objective The purpose of this study is to analyze cranial width and length growth curves in the early postoperative period of patients by undergoing endoscopic sagittal strip craniectomy (ESC) to determine the timing of the maximal growth curve change. By analyzing the complex interplay of cephalic length and width measurements, we hope to better understand the cephalic index (CI) growth curve during this early period. This is the first of a multistep process to elucidate the ideal cranial remolding orthosis (CRO) treatment duration. Design Retrospective review. Setting Tertiary academic institution. Patients Children with isolated sagittal craniosynostosis. Interventions ESC and postoperative CRO treatment (2015-2019). Main Outcome Measures One cranial orthotist obtained preoperative and postoperative measurements. The maximal rate of change of width, length, and CI were compared against the postoperative week these occurred. Results Thirteen children (mean age: 3.3 months, average preoperative CI: 73.4) underwent this intervention. CI reached its highest growth rate by 4.9 average weeks postoperatively, which correlated with the maximal width growth rate (5.2 weeks). Length curves reached their maximal growth rate by 15.5 weeks. CI peaked (81.3) by 22.7 weeks postoperatively, a significant increase from baseline. Conclusions Following ESC, in the early postoperative period, the CI growth curve has 4 phases: initial rapid expansion, early and late slowed expansion, and plateau, followed by possible regression phases. This highlights the importance of early postoperative CRO initiation, CRO compliance, and properly fitting CROs, especially in the first 2 phases. This data sets the stage for investigating the ideal treatment length.

Characterization of Regional Morphological Changes in Sagittal Craniosynostosis Following Endoscopic Strip Craniectomy With Post-operative Helmeting: Predictors for Success

“…The treatment objective is to decrease growth in the anterior-posterior direction with a compensatory growth perpendicular to the sagittal suture. 2,13,14 There are several limitations to this study. First, this study was conducted in a single institution with a small sample size.…”

“…This is consistent with the treatment goals of ESC with helmeting therapy for SC. The treatment objective is to decrease growth in the anterior-posterior direction with a compensatory growth perpendicular to the sagittal suture 2,13,14 …”

Discussion: Longitudinal Three-Dimensional Follow-Up and Surgical Safety Outcomes after Endoscopic and Open Scaphocephaly Surgery

“…Their analyses reveal that the CI regresses following helmeting, although not for those treated with remodeling, an observation also reported by others. 7 However, by their study’s endpoint, no significant differences were noted between their two treatment groups. It would be interesting to know whether, and when, the helmeted group’s CI eventually stabilizes.…”