Comparison of Intracranial Volume and Cephalic Index After Correction of Sagittal Synostosis With Spring-assisted Surgery or Pi-plasty

Fischer, Sara; Maltese, Giovanni; Tarnow, Peter; Wikberg, Emma; Bernhardt, Peter; Kölby, Lars

doi:10.1097/scs.0000000000002519

Cited by 30 publications

(29 citation statements)

References 22 publications

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“…These variables, as well as the paucity of large datasets, contribute to the wide range of results and contradictory opinions that exist in the craniosynostosis surgical literature. For example, the important metric of intracranial volume (ICV), which CS surgeries are designed to increase, have been reported to be significantly higher (Heller et al 2008), lower (Sgouros et al 1999;Seeberger et al 2016) as well as not different in preoperative synostosis patients compared with controls (Netherway et al 2005;Anderson et al 2007;Tovetj€ arn et al 2014;Fischer et al 2016). Such variable results can be attributed to low sample sizes (only one study had 30 cases in any group -Fischer et al 2016 and some studies had sample sizes as low as five per group), to differences in cohort selection (different types of CS might be lumped together), or to methodology.…”

Section: Current Challenges In Cs Outcome Researchmentioning

confidence: 99%

“…; Fischer et al. ). Such variable results can be attributed to low sample sizes (only one study had 30 cases in any group – Fischer et al.…”

Section: Introductionmentioning

confidence: 97%

“…Such variable results can be attributed to low sample sizes (only one study had 30 cases in any group – Fischer et al. and some studies had sample sizes as low as five per group), to differences in cohort selection (different types of CS might be lumped together), or to methodology. There is also no clear consensus on how to measure the surgical outcome objectively in a longitudinal fashion (Lloyd et al.…”

Section: Introductionmentioning

confidence: 99%

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Cranial growth in isolated sagittal craniosynostosis compared with normal growth in the first 6 months of age

2019

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Sagittal craniosynostosis (SCS), the most common type of premature perinatal cranial suture fusion, results in abnormal head shape that requires extensive surgery to correct. It is important to find objective and repeatable measures of severity and surgical outcome to examine the effect of timing and technique on different SCS surgeries. The purpose of this study was to develop statistical models of infant (0–6 months old) skull growth in both normative and SCS subjects (prior to surgery). Our goal was to apply these models to the assessment of differences between these two groups in overall post‐natal growth patterns and sutural growth rates as a first step to develop methods for predictive models of surgical outcome. We identified 81 patients with isolated, non‐syndromic SCS from Seattle Children's Craniofacial Center patient database who had a preoperative CT exam before the age of 6 months. As a control group, we identified 117 CT exams without any craniofacial abnormalities or bone fractures in the same age group. We first created population‐level templates from the CT images of the SCS and normal groups. All CT images from both groups, as well as the canonical templates of both cohorts, were annotated with anatomical landmarks, which were used in a growth model that predicted the locations of these landmarks at a given age based on each population. Using the template images and the landmark positions predicted by the growth models, we created 3D meshes for each week of age up to 6 months for both populations. To analyze the growth patterns at the suture sites, we annotated both templates with additional semi‐landmarks equally spaced along the metopic, coronal, sagittal and lambdoidal cranial sutures. By transferring these semi‐landmarks to meshes produced from the growth model, we measured the displacement of the bone borders and suture closure rates. We found that the growth at the metopic and coronal sutures were more rapid in the SCS cohort than in the normal cohort. The antero‐posterior displacement of the semi‐landmarks also indicated a more rapid growth in the sagittal plane in the SCS model than in the normal model. Statistical templates and geometric morphometrics are promising tools for understanding the growth patterns in normal and synostotic populations and to produce objective and reproducible measurements of severity and outcome. Our study is the first of its kind to quantify the bone growth for the first 6 months of life in both normal and sagittal synostosis patients.

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Section: Current Challenges In Cs Outcome Researchmentioning

confidence: 99%

“…; Fischer et al. ). Such variable results can be attributed to low sample sizes (only one study had 30 cases in any group – Fischer et al.…”

Section: Introductionmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Cranial growth in isolated sagittal craniosynostosis compared with normal growth in the first 6 months of age

2019

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“…Patient demographics, perioperative details, length of hospital stay, and postoperative outcomes were noted from admission to postoperative follow-up at 1 month. Patients operated with temporary springs underwent an additional procedure for spring removal at 6 months [7,8] and were, therefore, followed until 30 days after spring removal. Any events that occurred after discharge (e.g.…”

Section: Patient Case Seriesmentioning

confidence: 99%

In search of a single standardised system for reporting complications in craniofacial surgery: a comparison of three different classifications

Paganini

Bhatti-Søfteland

Fischer

et al. 2019

Journal of Plastic Surgery and Hand Surgery

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Comparing complication rates between centres is difficult due to the lack of unanimous criteria regarding what adverse events should be defined as complications and how these events should be compiled. This study analysed all adverse events in a cohort of craniofacial (CF) operations over a 10-year period and applied three different scales (Clavien-Dindo, Leeds and Oxford) for systematic comparison. A total of 1023 consecutive CF procedures in 641 patients was identified. The Clavien-Dindo scale captured 74 complications in 74 procedures (7.2%), whereas the Leeds and Oxford scales captured 163 complications in 134 procedures (13.1%) and 85 complications in 83 procedures (8.1%), respectively. The Clavien-Dindo scale appeared less suitable for CF surgery, because it is predominantly adapted to severe complications and also regards blood transfusion as a complication. The Leeds scale provided a detailed picture of all complications, as well as minor events, whereas the Oxford scale captured all major complications well but applied less accurate definitions for the minor events. Our findings contribute to the benchmarking of complications between CF centres and suggest that both the Leeds and the Oxford scale appear relevant, depending on the emphasis required for major and minor complications and inter-centre audits, respectively.

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“…One of the concerns regarding all techniques for surgical correction of sagittal synostosis is the potential for post-operative deleterious effects on skull growth and intracranial volume. In fact, several studies have suggested that traditional vault remodeling techniques may reduce intracranial volume [12,[22][23][24]. As restriction of cranial volume appears to be a risk factor for raised intracranial pressure [6,25,26], it seems logical that techniques that increase (or at least stabilize) intracranial volume are preferable to those that do not.…”

Section: Effect On Intracranial Volumementioning

confidence: 99%

Results Following Adoption of a Modified Melbourne Technique of Total Scaphocephaly Correction

Sharma

O’Hara

Borghi

et al. 2018

Journal of Craniofacial Surgery

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The Melbourne technique was described in 2008 as a novel method for complete correction of scaphocephaly. Since 2015, it has become our operation of choice for children with sagittal synostosis who are too old at presentation for minimally invasive techniques. Our modifications were 2-position (initially supine then prone) technique and undertaking a formal fronto-orbital remodeling to correct forehead contour. Retrospective chart review was used to record demographics, blood transfusion frequency and volumes, operating time, length of stay, clinical outcome, and complications. Eleven underwent modified Melbourne procedure between July 2015 and March 2017; 9 of 11 were male. All had a diagnosis of nonsyndromic sagittal synostosis. Mean age at surgery was 29 months. Mean surgical time was 6 hours. All patients required blood transfusion with a mean volume transfused of 29 mL/kg (range 13-83 mL/kg). For those 5 patients where preoperative and postoperative measurements were available, there was an increase in mean cephalic index (CI) from 0.64 to 0.75. All postoperative patients had a CI of over 0.70. Three-dimensional shape analysis indicated head shape change addressing all phenotypic aspects of scaphocephaly. In the 5 patients in which analysis could be undertaken, the mean intracranial volume increased from 1481 cm preoperatively to 1671 cm postoperatively, a mean increase in intracranial volume of 14%. The postoperative intracranial volume was higher than preoperative in all 5 patients. There were 4 minor and no major complications. Modified Melbourne procedure is safe and effective for the treatment of severe scaphocephaly in sagittal synostosis.

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Comparison of Intracranial Volume and Cephalic Index After Correction of Sagittal Synostosis With Spring-assisted Surgery or Pi-plasty

Abstract: There was no significant difference between craniotomy combined with springs in children younger than 6 months and pi-plasty in older children regarding the efficacy of improving ICV and CI. Neither of the techniques fully normalized the head shape.

Cited by 30 publications

References 22 publications

Cranial growth in isolated sagittal craniosynostosis compared with normal growth in the first 6 months of age

Cranial growth in isolated sagittal craniosynostosis compared with normal growth in the first 6 months of age

In search of a single standardised system for reporting complications in craniofacial surgery: a comparison of three different classifications

Results Following Adoption of a Modified Melbourne Technique of Total Scaphocephaly Correction

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