Clinical Outcome of the Modified Pi-Plasty Procedure for Sagittal Synostosis

Abstract

The aim of the study was to evaluate the modified pi-plasty procedure for the treatment of sagittal synostosis, assessing the issues of safety, complications, morphological outcome, and degree of parental satisfaction. A retrospective evaluation of 110 patients with nonsyndromal single suture sagittal synostosis operated on with the modified pi-plasty procedure was undertaken. Cephalometric radiographs were obtained preoperatively and postoperatively at ages 3 and 5 years in three standardized projections. The Cephalic Index and the Axial Width Ratio were determined and used as objective outcome measures. An evaluation of the radiographic digital markings was carried out using a Beaten Copper Score. A parental questionnaire was used to obtain a subjective esthetical outcome assessment. The patient population consisted of 76% boys and 24% girls with a 20% incidence of a positive familial history of craniosynostosis. The mean age at surgery was 7.73 months. Morbidity from the procedure was minimal and there were no mortalities. The Cephalic Index changed from a mean preoperative value of 65% to a postoperative mean value of 72% (P = 0.00004). The mean Axial Width Ratio changed from a preoperative 80% to 72% at the 3-year evaluation (P = 0.00029). The Beaten Copper score changed from a mean preoperative value of 2.35 to 5.42 postoperatively at 3 years (P = 0.00001). The response rate to the questionnaire was 86%, and there were significant postoperative improvements in all studied aspects of the skull shape. The modified pi-plasty is a safe technique, and it induces significant objective changes in skull morphology toward normality. It also yields a high degree of parental satisfaction with regard to aesthetic outcome, as evaluated by a written questionnaire.

Cephalic index correlates poorly with intracranial volume in non-syndromic scaphocephalic patients

“…Children with a normal head shape have an average CI of 75 to 80 [3,26], and scaphocephalic children typically have an average CI of 60 to 67 [4,7,9,16,25]. Our present results fall well within these ranges preoperatively (66.56), but the mean postoperative CI (70.…”

Reduction cranioplasty for macrocephaly with long-standing hydrocephalus and non-fused fontanelle in Chiari malformation type I

“…Gentle twisting of wires in the region of the Bregma is done, and the antero-posterior (AP) diameter is shortened [12][13][14]. The original technique was modified to advance the bilateral coronal-parietal flap to the midline, rather than removing it, in order to cover the wide bone defect at the anterior fontanelle with the additional bone harvested from the paired sagittal ostectomy.…”

Cranial vault remodeling for sagittal craniosynostosis in older children

“…[4][5][6][7][8]11,13,15,18 There are proponents of early interventions with open or endoscopically assisted strip craniectomies. These procedures are performed in isolation or with molding of the skull with postoperative helmeting or placement of springs to actively distract the suture site.…”

“…8,18 Others have advocated open remodeling of the cranial vault either through an anterior or posterior approach, while still others have advocated total calvarial remodeling either in a single or multiple staged procedures. [4][5][6][7]11,13,15,17 Although many case series have been reported in the literature, optimal treatment has yet to be fully defined.…”

“…Debate exists regarding the relative benefits of each. [4][5][6][7][8]11,13,15,18 Regardless of the technique employed, most surgeons advocate for operative intervention within the 1st year of life. As scaphocephaly is usually apparent at birth, this is often accomplished.…”