Effect of molding helmet on head shape in nonsurgically treated sagittal craniosynostosis

Sood, Sandeep; Rozzelle, Arlene; Shaqiri, B.; Sood, Natasha; Ham, Steven D.

doi:10.3171/2011.4.peds116

Cited by 33 publications

(20 citation statements)

References 11 publications

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“…To date there is limited data on treating patients with a helmet only, and standard treatment is surgical intervention. 20 Patients whose intraoperative midvault expansion after placement of 2 springs was inadequate, as judged by the senior craniofacial surgeon, underwent the placement of a third spring. While it may be possible to associate improved comorbidity outcomes with the relatively low amount of required correction in the CHOP patients, it is important to clarify that, unlike in more drastic surgeries such as CVR, recovery time is not directly dependent on the degree of correction needed for the SMC procedure.…”

Section: Discussionmentioning

confidence: 99%

“…Sood and colleagues reported the successful normalization of dolichocephaly in 4 patients treated with cranial molding helmets prior to cranial vault reconstruction at 6 months of age. 20 Therefore, we normally advise initiating helmet orthosis treatment shortly after the initial consultation and continuing until the time of the surgical procedure. Since introducing this modification we have noted less deterioration in head shape in patients at the time of surgery.…”

Section: Preoperative Helmetingmentioning

confidence: 99%

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Spring-mediated sagittal craniosynostosis treatment at the Children’s Hospital of Philadelphia: technical notes and literature review

Arko

Swanson

Fierst

et al. 2015

FOC

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OBJECT Sagittal craniosynostosis has been treated using both cranial remodeling techniques and modification of the sagittal strip craniectomy. A more recent technique is to implant springs in conjunction with a suturectomy to transversely expand the parietal bones to accommodate the growing brain. In this paper the authors describe and evaluate several modifications to the spring-mediated cranioplasty (SMC) technique, most notably use of an ultrasonic scalpel to limit dural dissection and maximize opening of the stenosed suture by placement of multiple spring devices. In addition, the literature is reviewed comparing SMC to other surgical treatments of sagittal synostosis. METHODS The authors retrospectively reviewed patients who presented to the Children’s Hospital of Philadelphia with a diagnosis of sagittal synostosis from August 2011 to November 2014. A pooled data set was created to compare our institutional data to previously published work. A comprehensive literature review was performed of all previous studies describing the SMC technique, as well as other techniques for sagittal synostosis correction. RESULTS Twenty-two patients underwent SMC at our institution during the study period. Patients were 4.2 months of age on average, had a mean blood loss of 56.3 ml, and average intensive care unit and total hospital stays of 29.5 hours and 2.2 days, respectively. The cranial index was corrected to an average of 73.7 (SD 5.2) for patients who received long-term radiological follow-up. When comparing the authors’ institutional data to pooled SMC data, blood loss and length of stay were both significantly less (p = 0.005 and p < 0.001, respectively), but the preoperative cranial index was significantly larger (p = 0.01). A review of the SMC technique compared with other techniques to actively expand the skull of patients with sagittal synostosis demonstrated that SMC can be performed at a significantly earlier age compared with cranial vault reconstruction (CVR). CONCLUSIONS The authors found that their institutional modifications of the SMC technique were safe and effective in correcting the cranial index. In addition, this technique can be performed at a younger age than CVRs. SMC, therefore, has the potential to maximize the cognitive benefits of early intervention, with lower morbidity than the traditional CVR.

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Section: Discussionmentioning

confidence: 99%

Section: Preoperative Helmetingmentioning

confidence: 99%

Spring-mediated sagittal craniosynostosis treatment at the Children’s Hospital of Philadelphia: technical notes and literature review

Arko

Swanson

Fierst

et al. 2015

FOC

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“…We have noted qualitative improvements in our scaphocephalic patients treated with molding helmets: increased CI, widening and flattening of the occipital protrusion, decreased forehead bossing, and increase in the posterior vertex height. 6 Molding helmets may not produce the best outcome in every case, but if the use of molding helmets does not have adverse effects then the use of preoperative helmets may help avoid surgery in select patients or allow for less radical surgical techniques for correction in other patients. This is a prospective, nonrandomized study comprising a small group of patients; nevertheless, this study brings to attention the fact that molding helmets are not associated with an increase in ICP even when used in patients with untreated sagittal craniosynostosis.…”

Section: Discussionmentioning

confidence: 99%

“…We previously published a cases series demonstrating improved head shape with the use of a molding helmet but without surgical intervention. 6 However, the use of molding helmets without surgery remains controversial due to concerns regarding the putative adverse effects on ICP. This study was done to answer criticisms regarding the potential increase in ICP with the use of molding helmets in patients with untreated sagittal craniosynostosis.…”

mentioning

confidence: 99%

Effect of molding helmets on intracranial pressure and head shape in nonsurgically treated sagittal craniosynostosis patients

Marupudi¹,

Sood²,

Rozzelle³

et al. 2016

PED

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OBJECTIVE Cranial vault expansion is performed in pediatric patients with craniosynostosis to improve head shape. Another argument for performing total cranial vault reconstruction is the potential reduction in the harmful effects of elevated intracranial pressure (ICP) that are associated with craniosynostosis. Alternatively, molding helmets have been shown to improve the cranial index (CI) in patients with sagittal synostosis without surgery. However, it is unknown if the use of molding helmets without surgery contributes to adverse changes in ICP. The effect of molding helmets on ICP and CI in patients with sagittal synostosis was investigated. METHODS A prospective cohort study of 24 pediatric patients with sagittal synostosis who planned to undergo total cranial reconstruction was performed from 2011 to 2014 at the Children's Hospital of Michigan. A preoperative molding helmet was used in 13 patients, and no molding helmet was used in 11 patients. End-tidal carbon dioxide, patient positioning, level of sedation, type of anesthetic, and the monitoring site at the time of intraoperative recording were regulated and standardized to establish the accuracy of the ICP readings. CI and head circumference were monitored for each patient. RESULTS The mean duration of the preoperative use of the molding helmet was 17 weeks (range 7–37 weeks). Under controlled settings, the average intraoperative ICP was 7.2 mm Hg (range 2–18 mm Hg) for patients treated with a preoperative molding helmet and 9.5 mm Hg (range 2–22 mm Hg) for patients with no preoperative molding helmet. ICP was not significantly different between the 2 groups, suggesting that the use of a molding helmet in this population is safe. The average CI at the time of helmet placement was 0.70 (range 0.67–0.73), and this improved to an average of 0.74 (range 0.69–0.79) after using the molding helmet for a mean of 17 weeks. CONCLUSIONS ICPs were not significantly different with the use of a preoperative molding helmet, refuting the prevailing thought that molding helmets would be detrimental in children who have craniosynostosis. The use of molding helmet in this population of patients improves head shape and does not adversely affect ICP.

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“…They believed that in absence of a sagittal suturectomy, the molding helmet redirects the growth to the squamosal suture, allowing the superior and lateral growth of the parietal bone as guided by the helmet. 19 The material used for orthosis should have sufficient stiffness to withstand the force acted upon it by the cranium over a given timeline, and at the same time deliver a consistent counter force to overpower the bones load bearing capacity. It should be biocompatible and non-allergic.…”

mentioning

confidence: 99%

Custom made orthotic device for maintaining skull architecture during the postoperative period in infants undergoing craniosynostosis surgery

Gopal

Ganesh

Nagarjuna

et al. 2015

Journal of Oral Biology and Craniofacial Research

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CraniectomyHead moulage a b s t r a c t Aim: To fabricate a cost effective, indigenous and simple orthotics helmet for postoperative cranial molding in patients with craniosynostosis surgery. Methods: We present a case of 15 month old infant with secondary cranial vault deformity.Cranial vault remodeling surgery involving the posterior skull was planned and executed to increase the posterior gap, so that brain growth would be facilitated towards this empty space. Materials such as thermoplastic sponge, thermoplastic ionomer resin sheet, soft sponge and Velcro straps are used to fabricate a cranial orthotics helmet. Results: We have successfully used the above materials to fabricate the orthotics helmet for post-operative cranial molding. Conclusion: The technique described in this article is simple and cost effective. It can be custom made according to the demands of the surgical technique and the type of synostosis. It favors an individualistic prognosis, and proves worthwhile as every synostosis requires a unique treatment plan. It is an excellent adjuvant to craniosynostosis remodeling surgery.

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Effect of molding helmet on head shape in nonsurgically treated sagittal craniosynostosis

Cited by 33 publications

References 11 publications

Spring-mediated sagittal craniosynostosis treatment at the Children’s Hospital of Philadelphia: technical notes and literature review

Spring-mediated sagittal craniosynostosis treatment at the Children’s Hospital of Philadelphia: technical notes and literature review

Effect of molding helmets on intracranial pressure and head shape in nonsurgically treated sagittal craniosynostosis patients

Custom made orthotic device for maintaining skull architecture during the postoperative period in infants undergoing craniosynostosis surgery

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