Cranial vault remodeling for sagittal craniosynostosis in older children

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>Sagittal craniosynostosis is the most common form of craniosynostosis and is commonly treated within the first year of life. Optimal treatment of patients older than 1 year of age is not well characterized. The authors reviewed cases of sagittal craniosynostosis involving patients who were treated surgically at their institution when they were older than 1 year in order to determine the rate of intracranial hypertension (ICH), potential to develop nonhealing cranial defects, and the need for various surgical procedures to treat the more mature phenotype.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>A retrospective chart review was conducted of all cases in the Children's Hospital of Pittsburgh Neurosurgery Database involving patients who underwent cranial vault remodeling for scaphocephaly after 1 year of age between October 2000 and December 2010.</jats:p></jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>Ten patients were identified who met the inclusion criteria. Five patients underwent anterior two-thirds cranial vault remodeling procedures, 3 patients underwent posterior vault remodeling, and 2 patients underwent 2-staged total vault remodeling. All patients had improved head shapes, and mean cephalic indices improved from 65.4 to 69.1 (p = 0.05). Six patients exhibited signs of ICH. No patients with more than 3 months of follow-up exhibited palpable calvarial defects.</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>Patients with sagittal synostosis treated after 1 year of age demonstrate increased rates of ICH, warranting diligent evaluations and surveillance to detect it; rarely develop clinically significant cranial defects if appropriate bone grafting is performed at the time of surgery; and achieve acceptable improvements in head shape.</jats:p></jats:sec>

Incomplete Reossification After Craniosynostosis Surgery

“…23,24 Follow-up varied from 6 to 264 months after surgery and was done either by palpation, 20,25 using radiology 16,26 or both. 21,27 (Table 1) In several studies, the type of follow-up was unclear. 5,17,24,28 Higher age of the patient at surgery is associated with incomplete reossification, 7,16,20,24,[29][30][31][32][33][34] but only a few studies have systematically examined and suggested its relation.…”

“…7,8,25,27,41,51,17 In the case of late referral, it is essential for the surgical team to know whether it can rely on spontaneous reossification. In fact, many centers do not leave reossification to chance and fill the bony gaps with some sort of material.…”

Repetitive Traumatic Brain Injury and Development of Chronic Traumatic Encephalopathy: A Potential Role for Biomarkers in Diagnosis, Prognosis, and Treatment?

“…Despite the lack of specific diagnostic criteria required for pre-mortem clinical diagnosis, patients afflicted with CTE diagnosed post-mortem are often described as suffering behavioral, cognitive, and emotional changes or impairments prior to death (Gavett et al, 2011b; Omalu et al, 2011b; Saulle and Greenwald, 2012). Notably, symptom development occurs following a prolonged latency in most cases, although exceptions do exist (Gavett et al, 2011a; Omalu et al, 2011b). The tendency for a latent period creates a clear distinction between initial symptoms associated with traumatic brain injury (TBI) and the persistent, long-term degeneration, much like other neurodegenerative diseases such as Alzheimer’s disease (AD).…”

“…Chronic traumatic encephalopathy has been diagnosed in a broad spectrum of individuals with a history of head trauma, although the number of and severity of impacts is often unclear, ranging from athletes playing American football, soccer, hockey, boxers, and wrestlers to soldiers who have received battlefield injuries (Omalu et al, 2005, 2006, 2010a,b,c, 2011b; McKee et al, 2009; Baugh et al, 2012; Goldstein et al, 2012; Lakhan and Kirchgessner, 2012). Due to the variety of individuals afflicted by CTE, emerging evidence indicates that CTE is likely more common than previously thought (Stern et al, 2011; Baugh et al, 2012).…”

Delayed Chronic Subdural Hematoma after Total Cranial Vault Reconstruction for Sagittal Synostosis

“…Several surgical techniques exist for the correction of sagittal synostosis; however, there are no current standardized management guidelines [2,3]. When diagnosed and treated after the first year of life, the surgical management of sagittal synostosis typically necessitates total cranial vault reconstruction [4][5][6][7]. The safety of total cranial vault reshaping has improved greatly over the past 3 decades, and common complications include infection, subgaleal hematoma, dural tear, wound breakdown, electrolyte abnormalities, hydrocephalus, and postoperative coagulopathy [8][9][10].…”