The Effects of Whole-Vault Cranioplasty versus Strip Craniectomy on Long-Term Neuropsychological Outcomes in Sagittal Craniosynostosis

Hashim, Peter W.; Patel, Anup; Yang, Jenny; Travieso, Roberto; Terner, Jordan; Losee, Joseph E.; Pollack, Ian F.; Jane, John A.; Kanev, Paul M.; Mayes, Linda C.; Duncan, Charles C.; Bridgett, David J.; Persing, John A.

doi:10.1097/prs.0000000000000420

Cited by 164 publications

(102 citation statements)

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“…In a multicenter study, Hashim et al found that patients who underwent whole-vault cranioplasty attained higher intelligence quotient and achievement scores than those treated with strip craniectomy. 8 It is unclear if the conclusions drawn by these authors are truly applicable to our patients. Our technique is notably different in that our patients did not receive suture constriction in the anterior-posterior dimension and instead received postoperative helmeting.…”

Section: Limitationsmentioning

confidence: 71%

One hundred consecutive endoscopic repairs of sagittal craniosynostosis: an evolution in care

Nguyen

Farber

Skolnick

et al. 2017

Journal of Neurosurgery: Pediatrics

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OBJECTIVEEndoscope-assisted repair of sagittal craniosynostosis was adopted at St. Louis Children’s Hospital in 2006. This study examines the first 100 cases and reviews the outcomes and evolution of patient care protocols at our institution.METHODSThe authors performed a retrospective chart review of the first 100 consecutive endoscopic repairs of sagittal craniosynostosis between 2006 and 2014. The data associated with length of hospital stay, blood loss, transfusion rates, operative times, cephalic indices (CIs), complications, and cranial remolding orthosis were reviewed. Measurements were taken from available preoperative and 1-year postoperative 3D reconstructed CT scans.RESULTSThe patients’ mean age at surgery was 3.3 ± 1.1 months. Of the 100 patients, 30 were female and 70 were male. The following perioperative data were noted. The mean operative time (± SD) was 77.1 ± 22.2 minutes, the mean estimated blood loss was 34.0 ± 34.8 ml, and the mean length of stay was 1.1 ± 0.4 days; 9% of patients required transfusions; and the mean pre- and postoperative CI values were 69.1 ± 3.8 and 77.7 ± 4.2, respectively. Conversion to open technique was required in 1 case due to presence of a large emissary vein that was difficult to control endoscopically. The mean duration of helmet therapy was 8.0 ± 2.9 months. Parietal osteotomies were eventually excluded from the procedure.CONCLUSIONSThe clinical outcomes and improvements in CI seen in our population are similar to those seen at other high-volume centers. Since the inception of endoscope-assisted repair at our institution, the patient care protocol has undergone several significant changes. We have been able to remove less cranium using our “narrow-vertex” suturectomy technique without affecting patient safety or outcome. Patient compliance with helmet therapy and collaborative care with the orthotists remain the most essential aspects of a successful outcome.

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Section: Limitationsmentioning

confidence: 71%

One hundred consecutive endoscopic repairs of sagittal craniosynostosis: an evolution in care

Nguyen

Farber

Skolnick

et al. 2017

Journal of Neurosurgery: Pediatrics

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“…This focus on cosmetic outcomes has diverted attention from the cognitive changes that occur after sagittal synostosis surgery. A multiinstitutional evaluation 9 of the minimally invasive endoscopic strip craniectomy compared with cranial vault repair found the latter to have better long-term cognitive testing outcomes despite the increased morbidity and later age of operation. This brings up several important considerations when treating sagittal craniosynostosis.…”

Section: Discussionmentioning

confidence: 99%

“…7,11 There is an increasing body of evidence to suggest that from a neurocognitive standpoint, outcomes are improved when intervention occurs early (less than 6 months of age) and with either CVR or active expansion after suturectomy. 9 However, a large procedure at a younger age poses considerable risks, including prolonged operative time, increased blood loss, and longer hospital stays.…”

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confidence: 99%

Spring-mediated sagittal craniosynostosis treatment at the Children’s Hospital of Philadelphia: technical notes and literature review

Arko

Swanson

Fierst

et al. 2015

FOC

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OBJECT Sagittal craniosynostosis has been treated using both cranial remodeling techniques and modification of the sagittal strip craniectomy. A more recent technique is to implant springs in conjunction with a suturectomy to transversely expand the parietal bones to accommodate the growing brain. In this paper the authors describe and evaluate several modifications to the spring-mediated cranioplasty (SMC) technique, most notably use of an ultrasonic scalpel to limit dural dissection and maximize opening of the stenosed suture by placement of multiple spring devices. In addition, the literature is reviewed comparing SMC to other surgical treatments of sagittal synostosis. METHODS The authors retrospectively reviewed patients who presented to the Children’s Hospital of Philadelphia with a diagnosis of sagittal synostosis from August 2011 to November 2014. A pooled data set was created to compare our institutional data to previously published work. A comprehensive literature review was performed of all previous studies describing the SMC technique, as well as other techniques for sagittal synostosis correction. RESULTS Twenty-two patients underwent SMC at our institution during the study period. Patients were 4.2 months of age on average, had a mean blood loss of 56.3 ml, and average intensive care unit and total hospital stays of 29.5 hours and 2.2 days, respectively. The cranial index was corrected to an average of 73.7 (SD 5.2) for patients who received long-term radiological follow-up. When comparing the authors’ institutional data to pooled SMC data, blood loss and length of stay were both significantly less (p = 0.005 and p < 0.001, respectively), but the preoperative cranial index was significantly larger (p = 0.01). A review of the SMC technique compared with other techniques to actively expand the skull of patients with sagittal synostosis demonstrated that SMC can be performed at a significantly earlier age compared with cranial vault reconstruction (CVR). CONCLUSIONS The authors found that their institutional modifications of the SMC technique were safe and effective in correcting the cranial index. In addition, this technique can be performed at a younger age than CVRs. SMC, therefore, has the potential to maximize the cognitive benefits of early intervention, with lower morbidity than the traditional CVR.

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“…However, age at surgery is potentially confounded with numerous other variables that might be associated with development, such as family SES, initial severity, surgical approach used, and duration. For example, surgeries at younger ages may well provide optimal benefits in terms of earlier suture release, 20,39 but less mature brains may be more susceptible to the neurotoxicity associated with anesthesia exposure. 38 In our own work, we have found little association between surgery age and neurodevelopmental outcomes measured both in infancy 45 and at school age 12 when controlling for potential confounding variables such as maternal IQ, SES, and involved suture.…”

Section: Discussionmentioning

confidence: 99%

Language, learning, and memory in children with and without single-suture craniosynostosis

Kapp-Simon

Wallace²,

Collett

et al. 2016

PED

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OBJECTIVE The language and memory functions of children with and without single-suture craniosynostosis (SSC) were compared at school age (mean 7.45 years, standard deviation [SD] 0.54 years). The children in this cohort were originally recruited in infancy and prior to cranial surgery for those with SSC. METHODS Individual evaluations of 179 school-aged children with SSC and 183 controls were conducted (70% of the original cohort) using standardized measures of language, learning, and memory. Parents participated in an interview about specialized education interventions and school progress. Parents and teachers completed questionnaires about language development. RESULTS Children with SSC (cases) obtained lower scores than controls on all measures. The adjusted differences in language, learning, and memory scores were modest, with SD ranging from 0.0 to −0.4 (p values ranged from 0.001 to 0.99). Censored normal regression was used to account for intervention services received prior to the school-age evaluation; this increased case-control differences (SD range 0.1 to −0.5, p value range 0.001 to 0.50). Mean scores for cases in each SSC diagnostic group were lower than those for controls, with the greatest differences observed among children with unilateral coronal craniosynostosis. CONCLUSIONS Children with SSC continue to show poorer performance than controls on language, learning, and memory tasks at early elementary school age, even when controlling for known confounders, although mean differences are small. Multidisciplinary care, including direct psychological assessment, for children with SSC should extend through school age with a specific focus on language and conceptual learning, as these are areas of potential risk. Future research is needed to investigate language, memory, and learning for this population during the middle to high school years.

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The Effects of Whole-Vault Cranioplasty versus Strip Craniectomy on Long-Term Neuropsychological Outcomes in Sagittal Craniosynostosis

Abstract: Therapeutic, II.

Cited by 164 publications

References 50 publications

One hundred consecutive endoscopic repairs of sagittal craniosynostosis: an evolution in care

One hundred consecutive endoscopic repairs of sagittal craniosynostosis: an evolution in care

Spring-mediated sagittal craniosynostosis treatment at the Children’s Hospital of Philadelphia: technical notes and literature review

Language, learning, and memory in children with and without single-suture craniosynostosis

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