A Treatment Algorithm for Patients Presenting with Sagittal Craniosynostosis after the Age of 1 Year

Ruane, Edward J.; Garland, Catharine B.; Camison, Liliana; Fenton, Regina A.; Nischal, Ken K.; Pollack, Ian F.; Tamber, Mandeep S.; Grunwaldt, Lorelei; Losee, Joseph E.; Goldstein, Jesse A.

doi:10.1097/prs.0000000000003602

Cited by 18 publications

(20 citation statements)

References 22 publications

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“…Other centers have shown that patients with SS who present at older than 1 year often present without significant scaphocephaly, frontal bossing, or occipital protuberance. 37 Patients presenting to our center at younger ages presented with more severe scaphocephaly and increased relative posterior vault volume suggesting occipital protuberance; children presenting at older ages presented with more severe middle vault constriction. 3 When assessing for predictors of long-term morphometric outcomes in SS, we found that preoperative severity was the best predictor across all measurements.…”

Section: Discussionmentioning

confidence: 94%

Morphometric Outcomes of Nonsyndromic Sagittal Synostosis following Open Middle and Posterior Cranial Vault Expansion

Massenburg

Mercan

Shepard

et al. 2022

Plastic &Amp; Reconstructive Surgery

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Background: This study aimed to quantify the change in three-dimensional skull morphometrics for patients with sagittal synostosis at presentation, after surgery, and at 2-year follow-up. Methods: Computed tomography scans from 91 patients with isolated SS were age-, sex-, and race-matched with those from 273 controls. The authors performed vector analysis with linear regressions to model the effect of open middle and posterior cranial vault remodeling on cranial shape and growth. Results: Anterior cranial volume, bossing angle, and frontal shape were not changed by surgery but normalized without surgical intervention by 2 years. Biparietal narrowing and middle cranial volume were corrected after surgery and maintained at 2 years. Occipital protuberance was improved after surgery and normalized at 2 years. Posterior cranial volume was decreased by occipital remodeling and remained slightly lower than control volumes at 2 years, whereas middle vault volume was larger than in controls. Residual deformities that persisted at 2 years were decreased superolateral width at the level of opisthion and increased anterosuperior height (vertex bulge). Linear models suggested older age at surgery resulted in more scaphocephaly and enlarged posterior cranial vault volumes at 2 years but did not affect other volume outcomes. Preoperative severity was the variable most predictive of 2-year morphometrics. Conclusions: Initial severity of sagittal synostosis deformity was the best predictor of 2-year morphometric outcomes. Upper posterior cranial width decreases with time after surgery and an anterior vertex bulge can persist after open surgery, but frontal dysmorphology self-corrects without surgical intervention. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

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Section: Discussionmentioning

confidence: 94%

Morphometric Outcomes of Nonsyndromic Sagittal Synostosis following Open Middle and Posterior Cranial Vault Expansion

Massenburg

Mercan

Shepard

et al. 2022

Plastic &Amp; Reconstructive Surgery

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“…[14][15][16][17][18][19] Thus, this group of patients falls into the subset of "normocephalic" sagittal craniosynostosis as described by Morritt et al and Ruane and colleagues. 4,12 Although an incidental suture fusion in this age group is abnormal, it is unclear whether it has any clinical importance. None of the 11 computed tomographic scans that demonstrated a fused suture showed radiographic findings suggestive of elevated intracranial pressure, and volume analysis on this subset of patients was normal with the exception of the one patient with Rett syndrome.…”

Section: Discussionmentioning

confidence: 99%

Premature Fusion of the Sagittal Suture as an Incidental Radiographic Finding in Young Children

Manrique¹,

Mantilla-Rivas²,

Perez³

et al. 2021

Plastic &Amp; Reconstructive Surgery

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Background: Craniosynostosis typically develops prenatally and creates characteristic changes in craniofacial form. Nevertheless, postnatal forms of craniosynostosis have been described. The purpose of this study was to determine the prevalence of incidentally identified, but temporally premature, cranial suture fusion in normocephalic children. Methods: Computed tomographic scans obtained from children aged 1 to 5 years evaluated in the authors' emergency department between 2005 and 2016 were reviewed for evidence of craniosynostosis. Patients with prior ventriculoperitoneal shunt, brain or cranial abnormality, or known syndromes were excluded. The presence of craniosynostosis and cranial index was assessed by a panel of three craniofacial surgeons and one pediatric neurosurgeon. Demographic information, fusion type, reason for the computed tomographic scan, and medical history were recorded as covariates. Cranial shape and intracranial volume were calculated using a previously validated automated system. Results: Three hundred thirty-one patients met the inclusion criteria. The mean age was 2.4 ± 1.3 years. Eleven patients (3.3 percent) were found to have a complete (n = 9) or partial (n = 2) fusion of the sagittal suture. All patients had a normal cranial index (0.80; range, 0.72 to 0.87) and a grossly normal head shape. Only two fusions (18.2 percent) were documented by the radiologist. Cranial shape analysis performed in five of the 11 patients showed subtle phenotypic changes along the scaphocephaly spectrum in four patients, with a normal shape in the remaining case. Conclusions: Sagittal fusion is present in 3.3 percent of otherwise phenotypically normal children aged 1 to 5 years. The clinical significance of this result is unclear, but routine screening of affected patients is paramount. (Plast.

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“…La prédominance masculine est retrouvée aussi bien dans la littérature [6] Actuellement, l'examen de référence pour la craniosténose est le scanner cérébral (fait dans 15,38% dans notre série), mais dans les pays en cours de développement par faute de moyens et d'accessibilité, la radiographie standard reste largement utilisée (76,92% dans notre étude) et demandée dans 66% des cas dans l'étude de ECH-CHAFAIY [10]. En ce qui concerne l'IRM, dans la littérature, la prévalence sur l'existence d'une anomalie parenchymateuse reste faible à l'IRM [11] ; ces anomalies sont à type de ventriculomégalie essentiellement pour une atteinte de la suture sagittale et au niveau de la région médiane une diminution du volume du corps calleux surtout sur son segment postérieur, et une diminution du volume du cervelet.…”

Section: Discussionunclassified

“…La suspension n'est pas nécessaire pour la chirurgie des craniosténoses. La technique chirurgicale varie selon le type de la craniosténose [6]. La réalisation d'un remodelage complet doit être réservée pour les enfants plus de 4 mois ; avant 4 mois, il faut faire une simple craniotomie bipariétale [19].…”

Section: Discussionunclassified

Epidemiologic and Surgical Approach of Cranyosynostosis: A Case of Madagascar and Review of Literature

Synèse¹,

Francis

Tony³

et al. 2019

JARMHS

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Introduction: Craniosynostosis is a premature closure of one or more sutures of the skull. She reaches 1 child out of 2100. She is responsible for a psychomotor developmental delay. The objective of this study was to define epidemiology, surgical approach and compare with literature. Methods: this was a multicenter retrospective descriptive study performed in hospitalized children operated or not on three neurosurgery centers (CHU-JRA, CENHOSOA and Fianarantsoa), from January 2010 to December 2017. Variables studied: epidemiology, clinical, paraclinical and therapeutic. Results: During the targeted period, 52 children had craniosynostosis (4 cases at CENHSOA, 6 at Fianarantsoa and 42 at CHUA-HJRA). There was a clear male predominance with a sex ratio of 2.4. The average age was 13.11 months. Several types of craniosynostosis were reported, the majority of which were dominated by brachycephaly in 40.38% followed by scaphocephalia (21.15%) and 2 cases of Apert Syndrome. The main symptom was delayed psychomotor development (34.46%). A standard radiography of the skull required in 76.92% and a scanner in 15.38% of the cases. The average age at surgery was 13.04 months. The majority of the surgical techniques practiced were a suturotomy, with blood transfusion and the majority of which at the time of the incision. Conclusion: Craniosynostosis is a pathology that requires neurosurgical management. Several operative techniques exist but the indication depends on the age and the clinico-radiological aspect of the pathology. The main cause of death is related to intraoperative bleeding.

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A Treatment Algorithm for Patients Presenting with Sagittal Craniosynostosis after the Age of 1 Year

Abstract: Therapeutic, IV.

Cited by 18 publications

References 22 publications

Morphometric Outcomes of Nonsyndromic Sagittal Synostosis following Open Middle and Posterior Cranial Vault Expansion

Morphometric Outcomes of Nonsyndromic Sagittal Synostosis following Open Middle and Posterior Cranial Vault Expansion

Premature Fusion of the Sagittal Suture as an Incidental Radiographic Finding in Young Children

Epidemiologic and Surgical Approach of Cranyosynostosis: A Case of Madagascar and Review of Literature

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