Pancraniosynostosis following endoscope-assisted strip craniectomy and helmet orthosis for sagittal suture craniosynostosis in a nonsyndromic patient

Jenkins, Gregory H; Smith, N. Robinson; McNeely, P. Daniel

doi:10.3171/2013.4.peds12445

Cited by 11 publications

(10 citation statements)

References 15 publications

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“…This explains the observation that older infants with sagittal synostosis present with a smaller anterior fontanelle. An interesting notion to consider is the phenomenon of delayed synostosis of uninvolved sutures or even pansynostosis (premature fusion of all sutures) after surgical intervention (Greene, 1998;Jenkins et al 2013;Yarbrough et al 2014;Sivakumar et al 2015). With our findings indicating a tendency to early closure at metopic and coronal sutures in the sagittal synostosis cohort, it is worthwhile to investigate the effects of the surgery and the synostosis on the uninvolved sutures separately.…”

Section: Premature Closure Of Uninvolved Suturesmentioning

confidence: 82%

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Cranial growth in isolated sagittal craniosynostosis compared with normal growth in the first 6 months of age

2019

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Sagittal craniosynostosis (SCS), the most common type of premature perinatal cranial suture fusion, results in abnormal head shape that requires extensive surgery to correct. It is important to find objective and repeatable measures of severity and surgical outcome to examine the effect of timing and technique on different SCS surgeries. The purpose of this study was to develop statistical models of infant (0–6 months old) skull growth in both normative and SCS subjects (prior to surgery). Our goal was to apply these models to the assessment of differences between these two groups in overall post‐natal growth patterns and sutural growth rates as a first step to develop methods for predictive models of surgical outcome. We identified 81 patients with isolated, non‐syndromic SCS from Seattle Children's Craniofacial Center patient database who had a preoperative CT exam before the age of 6 months. As a control group, we identified 117 CT exams without any craniofacial abnormalities or bone fractures in the same age group. We first created population‐level templates from the CT images of the SCS and normal groups. All CT images from both groups, as well as the canonical templates of both cohorts, were annotated with anatomical landmarks, which were used in a growth model that predicted the locations of these landmarks at a given age based on each population. Using the template images and the landmark positions predicted by the growth models, we created 3D meshes for each week of age up to 6 months for both populations. To analyze the growth patterns at the suture sites, we annotated both templates with additional semi‐landmarks equally spaced along the metopic, coronal, sagittal and lambdoidal cranial sutures. By transferring these semi‐landmarks to meshes produced from the growth model, we measured the displacement of the bone borders and suture closure rates. We found that the growth at the metopic and coronal sutures were more rapid in the SCS cohort than in the normal cohort. The antero‐posterior displacement of the semi‐landmarks also indicated a more rapid growth in the sagittal plane in the SCS model than in the normal model. Statistical templates and geometric morphometrics are promising tools for understanding the growth patterns in normal and synostotic populations and to produce objective and reproducible measurements of severity and outcome. Our study is the first of its kind to quantify the bone growth for the first 6 months of life in both normal and sagittal synostosis patients.

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Section: Premature Closure Of Uninvolved Suturesmentioning

confidence: 82%

“…An interesting notion to consider is the phenomenon of delayed synostosis of uninvolved sutures or even pansynostosis (premature fusion of all sutures) after surgical intervention (Greene, ; Jenkins et al. ; Yarbrough et al. ; Sivakumar et al.…”

Section: Discussionmentioning

confidence: 99%

Cranial growth in isolated sagittal craniosynostosis compared with normal growth in the first 6 months of age

2019

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“…A single or a combination of clinical and radiological findings did not reliably predict raised ICP. 34,38,39 The incidence of raised ICP following primary surgical correction in single-suture SC ranges widely from 1.5% to 44% 1,2,5,29,34,35,40,41 and adjacent synostoses occur following both ES 17,44 and CVR. 5,9,44 The addition of a syndromic diagnosis further increases the risk of restenosis and raised ICP.…”

Section: Icp and Need For Secondary Interventionmentioning

confidence: 99%

Analysis of clinical outcomes for treatment of sagittal craniosynostosis: a comparison of endoscopic suturectomy and cranial vault remodeling

Isaac¹,

Meara²,

Proctor

2018

Journal of Neurosurgery: Pediatrics

104

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OBJECTIVEComparative effectiveness studies are needed for analyzing the clinical outcomes of treatment of sagittal craniosynostosis (SC) with endoscopic suturectomy (ES) or cranial vault remodeling (CVR).METHODSFrom 2004–2015, patients were consecutively reviewed and data recorded for operative details and complications. Cranial growth was measured by head circumference percentile (HCP) and cranial index (CI) Z-score. Aesthetic outcomes were compared using the Whitaker classification.RESULTSA total of 207 patients with nonsyndromic SC were treated with ES (n = 187) or CVR (n = 20). The ES group had a lower median operative duration (45 vs 195 minutes), length of stay (1 vs 3 days), and transfusion rate (2% vs 85%; p < 0.0001). Median age at follow-up was 3.0 years (interquartile range [IQR] 2.5–4.5, ES) and 3.9 years (IQR 2–5, CVR; p = 0.12). In both groups, HCP gradually decreased during a 3-year follow-up (p = 0.282). CI Z-scores were initially more favorable in the ES group (p < 0.05); 3 years following surgical intervention, Z-scores were equal between groups (p = 0.392). One nonsyndromic patient treated with ES (0.5%) demonstrated reossification and required secondary expansion. Most patients were Whitaker class I (99% of ES, 95% of CVR); 5% of CVR patients were class II and 1% of ES patients were class III. Four syndromic patients presented without clear evidence of a syndrome, were treated by ES, and subsequently required secondary expansion for raised intracranial pressure.CONCLUSIONSES is an effective treatment for nonsyndromic SC with comparable head growth, aesthetic outcomes, and less morbidity relative to CVR. In the absence of a syndrome, secondary cranial expansion following ES is rarely required.

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“…Several recent reports suggest that this type of manipulation can alter normal sutural patency and induce premature fusion of previously uninvolved sutures. [35][36][37][38][39][40][41] This can affect subsequent cranial growth and may increase the risk of latent intracranial hypertension.…”

Section: Discussionmentioning

confidence: 99%

Treatment Type Is Associated with Population Hand Preferences in Patients with Unilateral Coronal Synostosis

Rogers

Wood

Amdur

et al. 2015

Plastic and Reconstructive Surgery

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Patients who underwent endoscopic suturectomy and helmet therapy for nonsyndromic unilateral coronal synostosis and healthy controls demonstrated functional cerebral lateralization with respect to handedness that differed from patients who underwent fronto-orbital advancement. The reason may be related to the type of procedure, secondary effects of general anesthesia, or age at which the procedure was performed.

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Pancraniosynostosis following endoscope-assisted strip craniectomy and helmet orthosis for sagittal suture craniosynostosis in a nonsyndromic patient

Cited by 11 publications

References 15 publications

Cranial growth in isolated sagittal craniosynostosis compared with normal growth in the first 6 months of age

Cranial growth in isolated sagittal craniosynostosis compared with normal growth in the first 6 months of age

Analysis of clinical outcomes for treatment of sagittal craniosynostosis: a comparison of endoscopic suturectomy and cranial vault remodeling

Treatment Type Is Associated with Population Hand Preferences in Patients with Unilateral Coronal Synostosis

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