Single Sutural Craniosynostoses: Surgical Outcomes and Long-Term Growth

Fearon, Jeffrey A.; Ruotolo, Rachel A.; Kolár, J

doi:10.1097/prs.0b013e318195661a

Cited by 175 publications

(122 citation statements)

References 23 publications

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“…2,4,6,12,15,18,22,23,[29][30][31][32]36,39,40,46,51 The decrease in CI that we observed over time is comparable to the limited available data on long-term outcome. 2,16 Adding a widening bridge complies with Fearon and colleagues' suggestion to overcorrect width to compensate for later growth restriction in that direction.…”

Section: Discussionmentioning

confidence: 90%

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Frontobiparietal remodeling with or without a widening bridge for sagittal synostosis: comparison of 2 cohorts for aesthetic and functional outcome

Veelen¹,

Mihajlović²,

Dammers³

et al. 2015

PED

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OBJECT Various techniques to correct sagittal synostosis have been described. The authors of this study assess the results of 2 techniques for late complete cranial remodeling and test the hypothesis that adding a widening bridge would improve outcome. METHODS In this retrospective study, the authors evaluated patients with nonsyndromic sagittal synostosis—those who underwent frontobiparietal remodeling (FBR) and those who underwent modified FBR (MFBR) involving the introduction of a bony bridge to increase the width of the skull. Outcomes for both groups are described in terms of the aesthetic results assessed on photographs and any changes in the cranial index (CI) and head circumference over time, the presence of papilledema, and complaints of headache. The effect of the surgical technique on CI and head circumference over time was assessed using linear regression analysis, with adjustment for preoperative CI and head circumference. RESULTS Sixty-nine patients with isolated sagittal synostosis were included in this study: 35 underwent MFBR and 34 underwent the original technique of FBR. The mean follow-up period was 7 years. In the 1st year after surgery, mean CI improved by 9% in the FBR group and by 12% in the MFBR group. One year after surgery, CI in the MFBR group was on average 4.7% higher than that in the FBR group (p < 0.001). During follow-up, CI decreased in both groups; however, at all time points CI was significantly higher in the MFBR group than in the FBR group. The impact of surgical technique on CI was less important than the impact of preoperative CI (R2= 0.26 vs 0.54), and this applied at all time points during follow-up. Head circumference declined during follow-up in both groups. It was influenced by preoperative head circumference, but not by surgical technique. Aesthetic outcome, prevalence of headache (42%), and papilledema (7%) were comparable in both groups. CONCLUSIONS Adding a widening bridge to late complete remodeling significantly improved CI and helped to prevent CI from decreasing in the long term. This addition did not affect the head circumference growth curve. Despite a mean head circumference remaining at +1 SD, patients continued to develop papilledema postoperatively (7%).

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Section: Discussionmentioning

confidence: 90%

“…Aesthetic results tend to decrease over time, as shown in several studies. 2,15,16 This phenomenon seems to occur regardless of the timing and extensiveness of the surgical correction. Moreover, the risk of developing increased ICP remains after remodeling.…”

mentioning

confidence: 99%

Frontobiparietal remodeling with or without a widening bridge for sagittal synostosis: comparison of 2 cohorts for aesthetic and functional outcome

Veelen¹,

Mihajlović²,

Dammers³

et al. 2015

PED

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“…On the one hand, FOA is a standardized and well-established surgical technique, which allows the abnormally closed suture to be opened and movement of the affected bone segments in the desired direction (Aryan et al, 2005;Fearon et al, 2009). On the other hand, FOA is usually accompanied with substantial blood loss and the need for RBC transfusion due to the infant's low circulating blood volume (Maugans et al, 2011;Oppenheimer et al, 2014).…”

Section: Discussionmentioning

confidence: 99%

The value of tranexamic acid during fronto-orbital advancement in isolated metopic craniosynostosis

Engel¹,

Bodem²,

Busch³

et al. 2015

Journal of Cranio-Maxillofacial Surgery

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“…It is unknown whether longer follow-up would uncover some anatomical differences, as it has previously been shown that the original dysmorphology may return. 3,22 It would be interesting to see if patients with neosutures have improved cranial morphology in the long term. Certainly, further studies must be carried out to better characterize the neosutures with a longer-term follow-up and with a larger sample size.…”

Section: 11mentioning

confidence: 99%

Neosuture formation after endoscope-assisted craniosynostosis repair

Salehi¹,

Ott²,

Skolnick

et al. 2016

PED

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OBJECTIVE The goal of this study was to identify the rate of neosuture formation in patients with craniosynostosis treated with endoscope-assisted strip craniectomy and investigate whether neosuture formation in sagittal craniosynostosis has an effect on postoperative calvarial shape. METHODS The authors retrospectively reviewed 166 cases of nonsyndromic craniosynostosis that underwent endoscope-assisted repair between 2006 and 2014. Preoperative and 1-year postoperative head CT scans were evaluated, and the rate of neosuture formation was calculated. Three-dimensional reconstructions of the CT data were used to measure cephalic index (CI) (ratio of head width and length) of patients with sagittal synostosis. Regression analysis was used to calculate significant differences between patients with and without neosuture accounting for age at surgery and preoperative CI. RESULTS Review of 96 patients revealed that some degree of neosuture development occurred in 23 patients (23.9%): 16 sagittal, 2 bilateral coronal, 4 unilateral coronal, and 1 lambdoid synostosis. Complete neosuture formation was seen in 14 of those 23 patients (9 of 16 sagittal, 1 of 2 bilateral coronal, 3 of 4 unilateral coronal, and 1 of 1 lambdoid). Mean pre- and postoperative CI in the complete sagittal neosuture group was 67.4% and 75.5%, respectively, and in the non-neosuture group was 69.8% and 74.4%, respectively. There was no statistically significant difference in the CI between the neosuture and fused suture groups preoperatively or 17 months postoperatively in patients with sagittal synostosis. CONCLUSIONS Neosuture development can occur after endoscope-assisted strip craniectomy and molding helmet therapy for patients with craniosynostosis. Although the authors did not detect a significant difference in calvarial shape postoperatively in the group with sagittal synostosis, the relevance of neosuture formation remains to be determined. Further studies are required to discover long-term outcomes comparing patients with and without neosuture formation.

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Single Sutural Craniosynostoses: Surgical Outcomes and Long-Term Growth

Cited by 175 publications

References 23 publications

Frontobiparietal remodeling with or without a widening bridge for sagittal synostosis: comparison of 2 cohorts for aesthetic and functional outcome

Frontobiparietal remodeling with or without a widening bridge for sagittal synostosis: comparison of 2 cohorts for aesthetic and functional outcome

The value of tranexamic acid during fronto-orbital advancement in isolated metopic craniosynostosis

Neosuture formation after endoscope-assisted craniosynostosis repair

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