Comparative analysis of cranial vault remodeling versus endoscopic suturectomy in the treatment of unilateral lambdoid craniosynostosis

Abstract

<jats:sec><jats:title>OBJECTIVE</jats:title><jats:p>Unilateral lambdoid synostosis is the premature fusion of a lambdoid suture or sutures and represents the least common form of craniosynostosis, occurring in 1 in 40,000 births. Cranial vault remodeling (CVR) and endoscopic suturectomy with helmet therapy (ES) are surgical approaches that are used to allow for normal brain growth and improved craniofacial symmetry. The authors conducted a comparative outcomes analysis of patients with lambdoid synostosis undergoing either CVR or ES.</jats:p></jats:sec><jats:sec><jats:title>METHODS</jats:title><jats:p>The authors conducted a retrospective consecutive cohort study of patients with nonsyndromic lambdoid synostosis who underwent surgical correction identified from a single-institution database of patients with craniosynostosis seen between 2000 and 2018. Cranial growth was measured in head circumference percentile and <jats:italic>z</jats:italic> score.</jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p>Nineteen patients (8 female and 11 male) with isolated unilateral lambdoid synostosis were identified (8 right and 11 left). Six underwent CVR and 13 underwent ES. No statistically significant differences were noted between surgical groups with respect to suture laterality, the patient’s sex, and length of follow-up. Patients treated with ES presented and underwent surgery at a younger age than those treated with CVR (p = 0.0002 and p = 0.0001, respectively). Operating and anesthesia time, estimated blood loss, and ICU and total hospital days were significantly lower in ES (all p &lt; 0.05). No significant differences were observed in pre- and postoperative head circumference percentiles or <jats:italic>z</jats:italic> scores between groups up to 36 months postoperatively. No patients required reoperation as of last follow-up.</jats:p></jats:sec><jats:sec><jats:title>CONCLUSIONS</jats:title><jats:p>Endoscopic management of lambdoid synostosis is safe, efficient, and efficacious in terms of intraoperative and long-term cranial growth outcomes when compared to CVR. The authors recommend this minimally invasive approach as an option for correction of lambdoid synostosis in patients presenting early in their course.</jats:p></jats:sec>

Management of Lambdoid Craniosynostosis: A Comprehensive and Systematic Review

“…Lambdoid synostosis can result in deformities to the posterior fossa. An increased proportion of these patients may concomitantly carry a Chiari malformation, especially if the synostosis is bilateral [114]. An MRI allows identification of this preoperatively, allowing for modification of the treatment approach or management of resultant hydrocephalus.…”

“…MRI also localizes important vascular structures such as the torcula and the transverse venous sinuses and their relation to the suture. The 3 main surgical approaches are open cranial vault reconstruction, endoscopic suturectomy, and spring-assisted distraction osteogenesis [112][113][114][115]. A comparison of these techniques, along with their technical attributes, benefits, and considerations, is summarized in Table 4.…”

“…A burr hole is placed at each location over the suture and enlarged with a Kerrison rongeur. The holes are then connected via the endoscope, and after dura is freely dissected from bone, bone-cutting scissors are used to completely free the parietal bone from the occipital bone [114].…”

“…These depend on the type of operation, namely open cranial vault reconstruction versus endoscopic correction. In a retrospective series of 19 patients surgically treated with isolated lambdoid synostosis, endoscopic correction has a significantly lower rate of operative time, anesthesia time, estimated blood loss, intensive care unit days, and hospital days when compared with open correction [114]. Additionally, surgical site infection, meningitis, dural tear, cerebrospinal fluid leak, and, perhaps most importantly, blood loss are acute complications that should be assessed for.…”

“…Late complications include contour irregularities, failure of reossification, and refusion of suture, all of which may require reoperation. Many studies have shown that endoscopic correction can achieve comparable outcomes to cranial vault reconstruction in lambdoid synostosis [114,118]. It is important to continue to follow these patients longitudinally, as these complications can present years after surgery.…”