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

Marupudi, Neena I.; Sood, Sandeep; Rozzelle, Arlene; Ham, Steven D.

doi:10.3171/2016.1.peds15569

Cited by 14 publications

(12 citation statements)

References 12 publications

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“…7 Two studies have reported on the nonoperative treatment of craniosynostosis with helmet only. 23,34 A recent study tracked the cranial index during helmet therapy. After the maximum cranial index had been achieved, there was no benefit to further helmet therapy.…”

Section: Discussionmentioning

confidence: 99%

Long-term 3D CT follow-up after endoscopic sagittal craniosynostosis repair

Persad

Aronyk

Beaudoin

et al. 2020

Journal of Neurosurgery: Pediatrics

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OBJECTIVESurgical treatment of sagittal synostosis involves various surgical modalities. Long-term follow-up issues include increased intracranial pressure, secondary sutural fusion, incomplete reossification, and suboptimal cosmetic appearance. The authors’ objective in this study was to review their long-term endoscopic surgical results in children with sagittal synostosis using 3D CT.METHODSThe authors reviewed the long-term results of their first 38 patients who underwent endoscopic sagittal synostosis repair at age 16 weeks or younger. A standard vertex craniectomy with biparietal wedges was done in each case. After surgery, the children were fitted with a helmet, which they wore until 8 months of age. Patients were followed up for 5 years or longer, at which point a 3D CT scan was obtained. The authors examined data on the cranial index, area of bony defect, presence or absence of secondary sutural fusion, neosuture formation, and scalloping of the inner table of the skull.RESULTSThirty-two of 38 children met inclusion criteria. There was a small but significant recession of the cranial index after the completion of helmeting (from 0.772 after completion of helmeting to 0.755 at 5 years). Of 32 children, 14 had a bony defect area > 4 cm2. Three children had secondary sutural fusion (two unilateral coronal, one bicoronal). Ten of 32 patients had partial neosuture formation.CONCLUSIONSThe authors report their experience with 32 of their first 38 children who underwent endoscopic sagittal synostosis repair at 16 weeks of age or younger. With a minimum duration of 5 years, this is the longest clinicoradiological follow-up utilizing 3D CT to date in children with sagittal synostosis treated with endoscopic surgery. The authors report detailed measurements of bony loss, adjacent sutural fusion, and neosuture formation.

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Section: Discussionmentioning

confidence: 99%

Long-term 3D CT follow-up after endoscopic sagittal craniosynostosis repair

Persad

Aronyk

Beaudoin

et al. 2020

Journal of Neurosurgery: Pediatrics

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“…12,15 The worry that using a helmet potentially constricts skull growth has not been proven in the literature. 6,9,18 This study utilized two cranial volume measurements and head circumference to assess helmet constriction; we found no indication that the cranial orthosis limited growth in our study population. We chose to assess cranial constriction due to helmeting in the DPB population, as patients undergoing positioning therapy are well suited to forming a control group.…”

Section: Discussionmentioning

confidence: 78%

“…These results extend previous reports on the safety of orthotic helmets for patients with DPB 12,15,30 and craniosynostosis. 9,14,18 This study benefits from its relatively large sample size and its use of detailed 3D photographs in the data collection process. The current study was powered to detect a fairly small change in volume (35.2 ml) between the two therapy groups.…”

Section: Discussionmentioning

confidence: 99%

Assessing calvarial vault constriction associated with helmet therapy in deformational plagiocephaly

Peterson

Patel

Skolnick

et al. 2018

Journal of Neurosurgery: Pediatrics

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OBJECTIVEDeformational plagiocephaly and/or brachycephaly (DPB) is a cranial flattening frequently treated in pediatric craniofacial centers. The standard of care for DPB involves patient positioning or helmet therapy. Orthotic therapy successfully reduces cranial asymmetry, but there is concern over whether the orthotics have the potential to restrict cranial growth. Previous research addressing helmet safety was limited by lack of volume measurements and serial data. The purpose of this study was to directly compare head growth data in patients with DPB between those who underwent helmet therapy and those who received repositioning therapy.METHODSThis retrospective cohort study analyzed pre- and posttherapy 3D photographs of 57 patients with DPB who had helmet therapy and a control group of 57 patients with DPB who underwent repositioning therapy. The authors determined the change in cranial vault volume and cranial circumference between each patient’s photographs using 3D photogrammetry. They also computed a cubic volume calculated by multiplying anterior-posterior diameter, biparietal diameter, and height. Linear regressions were used to quantify effects of age and therapy type on these quantities.RESULTSA comparison of the following variables between the two groups yielded nonsignificant results: age at the beginning (p = 0.861) and end (p = 0.539) of therapy, therapy duration (p = 0.161), and the ratio of males to females (p = 0.689). There was no significant difference between patients who underwent helmeting versus positioning therapy with respect to change in either volume calculation or head circumference z-score (p ≥ 0.545). Pretherapy photograph age was a significant predictor of cranial growth (p ≤ 0.001), but therapy type was not predictive of the change in the study measurements (p ≤ 0.210).CONCLUSIONSThe authors found no evidence that helmet therapy was associated with cranial constriction in the study population of patients with DPB. These results strengthen previous research supporting helmet safety and should allow health care providers and families to choose the appropriate therapy without concern for potential negative effects on cranial growth.

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“…There have not been reports of increased incidence of ICP in children with isolated non-syndromic sagittal craniosynostosis treated with preoperative helmet therapy at the time of surgery. 7,8 This evidence should give surgeons additional confidence that preoperative helmets can be used safely in patients with isolated sagittal craniosynostosis. We predicted that several patient and helmeting protocol factors would have significant effects on the success of helmeting.…”

Section: Discussionmentioning

confidence: 98%

“…Historically, CI has been calculated based on hand measurements. 3,4,[6][7][8]16,27 The use of hand measurements introduces potential bias and measurement error. Using surface topography scans, we can report accurate CI's and diagonal measurements with CVA to better describe the head shape changes following the intervention.…”

Section: Discussionmentioning

confidence: 99%

Utility of Preoperative Helmet Molding Therapy in Patients With Isolated Sagittal Craniosynostosis

Zapatero

Slawinski²,

Kosyk

et al. 2021

Journal of Craniofacial Surgery

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The purpose of this study was to review our institution's experience using helmet molding therapy in children with isolated non-syndromic sagittal craniosynostosis before placement of cranial springs and provide objective measurements of craniometric changes to help determine its role in treatment.Patients who underwent preoperative helmet molding therapy for sagittal craniosynostosis were retrospectively reviewed. Three-dimensional surface tomography scans were used to measure head circumference, cranial width, cranial length, cranial index (CI), and cranial vault asymmetry.Seventeen patients underwent orthotic helmeting therapy before spring mediated cranial vault expansion. Patients spent a median of 48 days (interquartile range [IQR] 32, 57) in preoperative orthotic helmeting therapy. There were increases in both cranial width and length post-helmeting (median: 107.5 mm [IQR 104.8, 110.4] versus 115.6 mm [IQR 114.5, 119.3]; P < 0.001) (median: 152.8 mm [IQR 149.2, 154.9] versus 156.8 mm [IQR 155.0, 161.5]; P < 0.001), respectively. There was a greater increase in cranial width (P ¼ 0.015). Consequently, patients' CI improved after preoperative helmeting (median: 0.702 [IQR 0.693, 0.717] versus 0.739 [0.711, 0.752]; P < 0.001). There was no evidence of growth restriction from helmeting (pre-helmeting Head circumference [HC]: median 96.8 percentile [IQR 90.6, 99.9] versus post-helmeting HC: 98.7 percentile [IQR 94.7, 99.8]; P ¼ 0.109).Preoperative helmeting in patients with non-syndromic isolated sagittal craniosynostosis can be used to improve CI before surgical correction. Significant benefits can be achieved in shorter preoperative helmeting durations than previously reported with no evidence of cranial growth restriction, which supports its feasibility and utility in children undergoing spring mediated cranial vault expansion.

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

Cited by 14 publications

References 12 publications

Long-term 3D CT follow-up after endoscopic sagittal craniosynostosis repair

Long-term 3D CT follow-up after endoscopic sagittal craniosynostosis repair

Assessing calvarial vault constriction associated with helmet therapy in deformational plagiocephaly

Utility of Preoperative Helmet Molding Therapy in Patients With Isolated Sagittal Craniosynostosis

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