Complete Correction of Severe Scaphocephaly: The Melbourne Method of Total Vault Remodeling

Greensmith, Andrew; Holmes, Anthony D.; Lo, Patrick; Maxiner, Wirginia; Heggie, Andrew A; Meara, John G.

doi:10.1097/01.prs.0000304592.56498.d6

Cited by 87 publications

(71 citation statements)

References 29 publications

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“…The initial postoperative CI of 75 or the 2-to 4-year postoperative CI of 73 was a good result, as compared with others. 2,4,6,12,15,18,22,23,[29][30][31][32]36,39,40,46,51 The decrease in CI that we observed over time is comparable to the limited available data on long-term outcome. 2,16 Adding a widening bridge complies with Fearon and colleagues' suggestion to overcorrect width to compensate for later growth restriction in that direction.…”

Section: Discussionsupporting

confidence: 70%

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Frontobiparietal remodeling with or without a widening bridge for sagittal synostosis: comparison of 2 cohorts for aesthetic and functional outcome

Veelen¹,

Mihajlović²,

Dammers³

et al. 2015

PED

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OBJECT Various techniques to correct sagittal synostosis have been described. The authors of this study assess the results of 2 techniques for late complete cranial remodeling and test the hypothesis that adding a widening bridge would improve outcome. METHODS In this retrospective study, the authors evaluated patients with nonsyndromic sagittal synostosis—those who underwent frontobiparietal remodeling (FBR) and those who underwent modified FBR (MFBR) involving the introduction of a bony bridge to increase the width of the skull. Outcomes for both groups are described in terms of the aesthetic results assessed on photographs and any changes in the cranial index (CI) and head circumference over time, the presence of papilledema, and complaints of headache. The effect of the surgical technique on CI and head circumference over time was assessed using linear regression analysis, with adjustment for preoperative CI and head circumference. RESULTS Sixty-nine patients with isolated sagittal synostosis were included in this study: 35 underwent MFBR and 34 underwent the original technique of FBR. The mean follow-up period was 7 years. In the 1st year after surgery, mean CI improved by 9% in the FBR group and by 12% in the MFBR group. One year after surgery, CI in the MFBR group was on average 4.7% higher than that in the FBR group (p < 0.001). During follow-up, CI decreased in both groups; however, at all time points CI was significantly higher in the MFBR group than in the FBR group. The impact of surgical technique on CI was less important than the impact of preoperative CI (R2= 0.26 vs 0.54), and this applied at all time points during follow-up. Head circumference declined during follow-up in both groups. It was influenced by preoperative head circumference, but not by surgical technique. Aesthetic outcome, prevalence of headache (42%), and papilledema (7%) were comparable in both groups. CONCLUSIONS Adding a widening bridge to late complete remodeling significantly improved CI and helped to prevent CI from decreasing in the long term. This addition did not affect the head circumference growth curve. Despite a mean head circumference remaining at +1 SD, patients continued to develop papilledema postoperatively (7%).

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Section: Discussionsupporting

confidence: 70%

“…3,5,[9][10][11][12]15,17,[20][21][22][23][26][27][28][29][30][31][33][34][35][36]38,40,[43][44][45][46][47][48][49][50][51] The field continues to evolve and aims to reduce the impact of surgery. Minimally invasive approaches constitute the majority of recently detailed techniques.…”

mentioning

confidence: 99%

Frontobiparietal remodeling with or without a widening bridge for sagittal synostosis: comparison of 2 cohorts for aesthetic and functional outcome

Veelen¹,

Mihajlović²,

Dammers³

et al. 2015

PED

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“…Various methods exist for addressing the various synostoses, including bifrontal orbital remodelling for metopic and coronal synostosis (Fig. 4) to total vault remodelling [7] or spring-assisted cranioplasty for sagittal synostosis [8].…”

Section: Introductionmentioning

confidence: 99%

Neurodevelopmental functioning of infants with untreated single-suture craniosynostosis during early infancy

et al. 2012

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“…Since the first attempts to treat skulls deformed by craniosynostoses, restoration of the stenotic line expandability (pri mary defect) and remodeling the areas of compensatory deformation (secondary defect) have been the main concerns. In the evolutionary history of the treatment of craniosynostoses, we reviewed extensive and morbid craniectomies and suturectomies that possibly involved the interposition of materials or caustic substances in an attempt to inhibit the recurrence of early suture closure 3,4 through distraction osteogenesis using external distractors 5 and skullcap re mo deling 1 . Such remodeling, the preferred practice still to day, follows various types of osteotomies, but all involve craniotomy using dural detachment, back table remodeling of the osteotomized cap, and its return as a graft fixed with varied materials.…”

Section: Introductionmentioning

confidence: 99%

Nautilus: craniotomia dinâmica - nova técnica cirúrgica e resultados preliminares

Cardim¹,

Silva

Salomons

et al. 2013

Rev. Bras. Cir. Plást.

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Nautilus-shaped dynamic craniotomy: a new surgical technique and preliminary resultsNautilus: craniotomia dinâmica -nova técnica cirúrgica e resultados preliminares ABSTRACT Introduction: Considering that craniosynostosis is a suture-related condition, the main challenge for its treatment is the fact that the brain is located in a closed compartment that does not have the required adaptability to accommodate its growth. The goal of treat ment is to restore stenotic suture adaptability and correct the compensatory cranial deformity. This paper proposes the combined use of spiral osteotomy with distraction osteogenesis by the use of distracting springs to remodel craniofacial defects caused by craniosynostosis. Methods: Between July 2010 and July 2012, 10 patients with craniosynostosis were treated: 5 with oxycephaly, 3 with scaphocephaly, 1 with turricephaly, and 1 with trigonocephaly. The treatment consisted of the application of Lauritzen springs to correct the primary craniosynostosis defect in combination with a nautilus-shaped spiral craniotomy at the secondary deformation sites without dural detachment. Results: Resolution of cranial deformity and remission of the clinical signs of intracranial hypertension were observed. None of the patients had complications such as cerebrospinal fluid fistula, local infection, seroma, or hematoma. Conclusions: The combined use of spiral osteotomy with spring-mediated distraction or contraction enables active reshaping of the skull and facilitates accommodation of the brain by the cranial cavity. (clinicaltrials.gov identifier: NCT01672619) Keywords: Craniosynostoses. Osteogenesis, distraction. Craniotomy. RESUMOIntrodução: Considerando-se que as craniossinostoses são afecções basicamente suturais, o fato de o cérebro estar aprisionado em um compartimento fechado, que não possui a complacência necessária para acompanhar seu crescimento, se constitui no desafio principal de seu tratamento. O objetivo do tratamento é restabelecer a complacência da sutura estenótica e corrigir a deformidade craniana compensatória. Este trabalho propõe a associação de osteotomia helicoide à distração osteogênica proporcionada pelo uso das molas distratoras para remodelar defeitos craniofaciais causados por craniossinostoses. Método: Entre julho de 2010 e julho de 2012, foram tratados 10 pacientes portadores de craniossinostoses, sendo 5 oxicefalias, 3 escafocefalias, 1 turricefalia e 1 trigonocefalia. O tratamento consistiu na aplicação de molas de Lauritzen, para corrigir a deformidade primária da craniossinostose, com a associação de craniotomia helicoide em forma de Nautilus nos sítios de deformação secundária do crânio, sem descolamento dural. Resultados: Foi observada resolução da deformidade craniana e remissão dos sinais clínicos de hipertensão intracraniana. Nenhum

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Complete Correction of Severe Scaphocephaly: The Melbourne Method of Total Vault Remodeling

Abstract: The Melbourne technique of total vault remodeling consistently achieves a virtually normal head shape. After analysis of the first 30 cases, the authors recommend this as their technique of choice for severe scaphocephaly when the full constellation of deformities is present.

Cited by 87 publications

References 29 publications

Frontobiparietal remodeling with or without a widening bridge for sagittal synostosis: comparison of 2 cohorts for aesthetic and functional outcome

Frontobiparietal remodeling with or without a widening bridge for sagittal synostosis: comparison of 2 cohorts for aesthetic and functional outcome

Neurodevelopmental functioning of infants with untreated single-suture craniosynostosis during early infancy

Nautilus: craniotomia dinâmica - nova técnica cirúrgica e resultados preliminares

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