Long-Term Characterization of Cranial Defects After Surgical Correction for Single-Suture Craniosynostosis

Abstract

Introduction-Craniosynostosis is typically corrected surgically within the first year of life through cranial vault reconstruction. These procedures often leaves open calvarial defects at the time of surgery, which are anticipated to close over time in a large proportion of cases. However, residual calvarial defects may result as long-term sequelae from cranial vault remodeling. When larger defects are present, they may necessitate further reconstruction for closure.Better understanding of the calvarial osseous healing process may help to identify which defects will resolve or shrink to acceptable size and which will require further surgery. Our study aims to assess the long-term changes in defect size after cranial vault reconstruction for craniosynostosis.Methods-One year post-operative and long-term computed tomography scans were retrieved from the craniofacial anomalies archive. Analysis used custom software. All defects above the size of 1 cm 2 were analyzed and tracked for calvarial location, surface area, and circularity. Monte Carlo simulation was performed to model the effect of initial defect size on the rate of defect closure.Results-We analyzed a total of 74 defects. The average initial defect surface area was 3.27 ± 3.40 cm 2 . The average final defect surface area was 1.71 ± 2.54 cm 2 . The average percent decrease was 55.06 ± 28.99 %. There was a significant difference in the percentage decrease of defects in the parietal and fronto-parietal locations: 68.4% and 43.7%, respectively (p = 0.001). Monte Carlo simulation results suggest that less than 10% of defects above the size of 9 cm 2 will close to the size of 2.5 cm 2 or less.Conclusions-We describe and make available a novel, validated method of measuring cranial defects. We find that the large majority of initial defects greater than 9cm 2 remain at least one square inch in size (2.5cm 2 ) one year post-operatively. Additionally, there appear to be regional differences in closure rates across the cranium, with front-parietal defects closing more slowly than those in the parietal region. This information will aid surgeons in the decision-making process regarding cranioplasty after craniosynostosis correction.

Sport participation and related head injuries following craniosynostosis correction: a survey study

“…Previously, authors have suggested that persistent defects sized 2-2.5 cm 2 may be considered "clinically relevant" and cranioplasty should be considered. 6,18,19 Published rates of these relevant defects are generally around 20%-25%, 18,20 while we found that about 44% of CS patients who have participated in sports had a second surgery. While this may suggest a more aggressive approach toward providing cranioplasty for those children wishing to participate in sport, the high rate of second surgeries may be a result of survey selection biases where parents and patients with more complicated surgical courses are more likely to belong to support groups and online communities.…”

Vascularized Pericranial Flap as a Method to Prevent Persistent Skull Defects After Craniectomy for Sagittal Synostosis

“…The additional surgery results in additional risks of infection, hematoma, dural tear/cerebrospinal fluid leak, and anesthesia for children with craniosynostosis. 3 In children, cranioplasty may itself interfere with skull growth. 4 There is also increased cost of care, especially when prostheses are implanted.…”

“…Persistent cranial defects large enough several years after surgery that cranioplasty is considered have been an occasional problem at our institution. The additional surgery results in additional risks of infection, hematoma, dural tear/cerebrospinal fluid leak, and anesthesia for children with craniosynostosis 3 . In children, cranioplasty may itself interfere with skull growth 4 .…”

Personalized Bone Reconstruction and Regeneration in the Treatment of Craniosynostosis

“…The resulting cranial defects may represent a serious issue in paediatric neurosurgery [81,82]. The common procedures adopted in these cases involve the use of either autologous bone grafts, or allogeneic grafts, or alloplastic materials to fill the bone gap.…”