Delayed Synostoses of Uninvolved Sutures After Surgical Treatment of Nonsyndromic Craniosynostosis

Yarbrough, Chester K.; Smyth, Matthew D.; Holekamp, Terrence F.; Ranalli, Nathan J.; Huang, Andrew H.; Patel, Kamlesh B.; Kane, Alex A.; Woo, Albert S.

doi:10.1097/scs.0b013e3182a75102

Cited by 30 publications

(22 citation statements)

References 27 publications

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“…13 Finally, a recent study from our group found similar rates of delayed synostosis of uninvolved sutures between open and endoscopic procedures in non-syndromic patients. 35 …”

Section: Discussionmentioning

confidence: 99%

Characterization of complications associated with open and endoscopic craniosynostosis surgery at a single institution

Han¹,

Nguyen²,

Brück³

et al. 2016

PED

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OBJECT The authors present a retrospective cohort study examining complications in patients undergoing surgery for craniosynostosis using both minimally invasive endoscopic and open approaches. METHODS Over the past 10 years, 295 nonsyndromic patients (140 undergoing endoscopic procedures and 155 undergoing open procedures) and 33 syndromic patients (endoscopic procedures in 10 and open procedures in 23) met the authors’ criteria. Variables analyzed included age at surgery, presence of a preexisting CSF shunt, skin incision method, estimated blood loss, transfusions of packed red blood cells, use of intravenous steroids or tranexamic acid, intraoperative durotomies, procedure length, and length of hospital stay. Complications were classified as either surgically or medically related. RESULTS In the nonsyndromic endoscopic group, the authors experienced 3 (2.1%) surgical and 5 (3.6%) medical complications. In the nonsyndromic open group, there were 2 (1.3%) surgical and 7 (4.5%) medical complications. Intraoperative durotomies occurred in 5 (3.6%) endoscopic and 12 (7.8%) open cases, were repaired primarily, and did not result in reoperations for CSF leakage. Similar complication rates were seen in syndromic cases. There was no death or permanent morbidity. Additionally, endoscopic procedures were associated with significantly decreased estimated blood loss, transfusions, procedure length, and length of hospital stay compared with open procedures. CONCLUSIONS Rates of intraoperative durotomies and surgical and medical complications were comparable between endoscopic and open techniques. This is the largest direct comparison to date between endoscopic and open interventions for synostosis, and the results are in agreement with previous series that endoscopic surgery confers distinct advantages over open surgery in appropriate patient populations.

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“…13 Finally, a recent study from our group found similar rates of delayed synostosis of uninvolved sutures between open and endoscopic procedures in non-syndromic patients. 35 …”

Section: Discussionmentioning

confidence: 99%

Characterization of complications associated with open and endoscopic craniosynostosis surgery at a single institution

Han¹,

Nguyen²,

Brück³

et al. 2016

PED

Self Cite

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“…34,38,39 The incidence of raised ICP following primary surgical correction in single-suture SC ranges widely from 1.5% to 44% 1,2,5,29,34,35,40,41 and adjacent synostoses occur following both ES 17,44 and CVR. 5,9,44 The addition of a syndromic diagnosis further increases the risk of restenosis and raised ICP. 9,43 Based on the present study and current literature, it is not clear whether ES or CVR are equivalent in mitigating the risk of raised ICP or secondary synostoses in the syndromic population.…”

Section: Icp and Need For Secondary Interventionmentioning

confidence: 99%

Analysis of clinical outcomes for treatment of sagittal craniosynostosis: a comparison of endoscopic suturectomy and cranial vault remodeling

Isaac¹,

Meara²,

Proctor

2018

Journal of Neurosurgery: Pediatrics

104

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OBJECTIVEComparative effectiveness studies are needed for analyzing the clinical outcomes of treatment of sagittal craniosynostosis (SC) with endoscopic suturectomy (ES) or cranial vault remodeling (CVR).METHODSFrom 2004–2015, patients were consecutively reviewed and data recorded for operative details and complications. Cranial growth was measured by head circumference percentile (HCP) and cranial index (CI) Z-score. Aesthetic outcomes were compared using the Whitaker classification.RESULTSA total of 207 patients with nonsyndromic SC were treated with ES (n = 187) or CVR (n = 20). The ES group had a lower median operative duration (45 vs 195 minutes), length of stay (1 vs 3 days), and transfusion rate (2% vs 85%; p < 0.0001). Median age at follow-up was 3.0 years (interquartile range [IQR] 2.5–4.5, ES) and 3.9 years (IQR 2–5, CVR; p = 0.12). In both groups, HCP gradually decreased during a 3-year follow-up (p = 0.282). CI Z-scores were initially more favorable in the ES group (p < 0.05); 3 years following surgical intervention, Z-scores were equal between groups (p = 0.392). One nonsyndromic patient treated with ES (0.5%) demonstrated reossification and required secondary expansion. Most patients were Whitaker class I (99% of ES, 95% of CVR); 5% of CVR patients were class II and 1% of ES patients were class III. Four syndromic patients presented without clear evidence of a syndrome, were treated by ES, and subsequently required secondary expansion for raised intracranial pressure.CONCLUSIONSES is an effective treatment for nonsyndromic SC with comparable head growth, aesthetic outcomes, and less morbidity relative to CVR. In the absence of a syndrome, secondary cranial expansion following ES is rarely required.

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“…Since these surgeries are typically performed in the first 6 months of age, it is important to identify the optimal time to intervene for best surgical outcome while having the least detrimental impact to the patient (Yarbrough et al. ; Sivakumar et al. ; Bergquist et al.…”

Section: Introductionmentioning

confidence: 99%

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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Delayed Synostoses of Uninvolved Sutures After Surgical Treatment of Nonsyndromic Craniosynostosis

Cited by 30 publications

References 27 publications

Characterization of complications associated with open and endoscopic craniosynostosis surgery at a single institution

Characterization of complications associated with open and endoscopic craniosynostosis surgery at a single institution

Analysis of clinical outcomes for treatment of sagittal craniosynostosis: a comparison of endoscopic suturectomy and cranial vault remodeling

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

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