Long-term 3D CT follow-up after endoscopic sagittal craniosynostosis repair

Abstract

<jats:sec><jats:title>OBJECTIVE</jats:title><jats:p>Surgical treatment of sagittal synostosis involves various surgical modalities. Long-term follow-up issues include increased intracranial pressure, secondary sutural fusion, incomplete reossification, and suboptimal cosmetic appearance. The authors’ objective in this study was to review their long-term endoscopic surgical results in children with sagittal synostosis using 3D CT.</jats:p></jats:sec><jats:sec><jats:title>METHODS</jats:title><jats:p>The authors reviewed the long-term results of their first 38 patients who underwent endoscopic sagittal synostosis repair at age 16 weeks or younger. A standard vertex craniectomy with biparietal wedges was done in each case. After surgery, the children were fitted with a helmet, which they wore until 8 months of age. Patients were followed up for 5 years or longer, at which point a 3D CT scan was obtained. The authors examined data on the cranial index, area of bony defect, presence or absence of secondary sutural fusion, neosuture formation, and scalloping of the inner table of the skull.</jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p>Thirty-two of 38 children met inclusion criteria. There was a small but significant recession of the cranial index after the completion of helmeting (from 0.772 after completion of helmeting to 0.755 at 5 years). Of 32 children, 14 had a bony defect area &gt; 4 cm<jats:sup>2</jats:sup>. Three children had secondary sutural fusion (two unilateral coronal, one bicoronal). Ten of 32 patients had partial neosuture formation.</jats:p></jats:sec><jats:sec><jats:title>CONCLUSIONS</jats:title><jats:p>The authors report their experience with 32 of their first 38 children who underwent endoscopic sagittal synostosis repair at 16 weeks of age or younger. With a minimum duration of 5 years, this is the longest clinicoradiological follow-up utilizing 3D CT to date in children with sagittal synostosis treated with endoscopic surgery. The authors report detailed measurements of bony loss, adjacent sutural fusion, and neosuture formation.</jats:p></jats:sec>

Sagital Kraniosinostoz Tanılı Bebeklerde Endoskopik Süturektomi Sonrası Kask Tedavisinin Uzun Süreli Takibi

“…The results indicate that the pre-post CR improved significantly with endoscopic suturectomy and remodeling helmet and the correction established in CR was maintained at the 5 year follow-up (23). Even though the infants were followed-up for a longer term in the present study, our findings correlate with this study.…”

Long-term Outcomes of Non-syndromic and Syndromic Craniosynostosis: Analysis of Demographic, Morphologic, and Surgical Factors

“…According to previous reports, the incidence of repeat surgery widely varied from 0% to 39% (Table 4). 19,20,[22][23][24][25][26][27] However, the previous reports included short-term follow-up of patients, and the average follow-up period was 4.4-13.2 years, which is much shorter than that in this study. It is difficult to conclude the incidence of repeat surgery for craniosynostosis according to such short-term follow-up studies.…”

“…17) Although many surgical procedures have been introduced in the past four decades, 18) there are few reports on long-term postoperative outcomes in craniosynostosis. [19][20][21][22][23][24][25][26][27] Furthermore, there are almost no reports that denote the procedures for optimizing longterm outcomes in syndromic and non-syndromic cases, although outcomes may differ between the two types of the disease. Therefore, in this study, we retrospectively analyzed the long-term outcomes of children with craniosynostosis who were followed for at least 5 years after surgery and attempted to determine the prognosis in syndromic and non-syndromic groups.…”

Neosagittal Suture Formation after Endoscopic Sagittal Strip Craniectomy: A Case Report and Literature Review

“…Since the initial observation of neosuture formation following suturectomy in the 1960s, there have been a limited number of case series exploring this finding (Table 1 ). 2 , 9 – 14 Early reports relied upon plain radiographic evaluation, whereas more recent case series have employed postoperative CT to examine the behavior of the area of the excised synostotic suture. In comparison with plain radiograph, CT can detect finer details, such as bony interdigitation, that characterize normal cranial sutures.…”