Endoscope-assisted strip craniectomy and postoperative helmet therapy for treatment of craniosynostosis

Berry-Candelario, John; Ridgway, Emily B.; Grondin, Ronald T.; Rogers, Gary F.; Proctor, Mark R.

doi:10.3171/2011.6.focus1198

Cited by 106 publications

(84 citation statements)

References 18 publications

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“…In broad terms, these approaches appear to result in better morphological outcomes than open vertex strip craniectomy procedures, with cephalic indices within the normal range. 7,10,18,30,37,41 If the correction of the scaphocephalic deformity is an important determinant of the development of raised ICP, then one might expect these techniques to have a similar postoperative incidence to that we report for CR. However, we do not understand the mechanism by which intracranial hypertension arises in SC following surgery.…”

Section: Discussionmentioning

confidence: 78%

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The incidence of raised intracranial pressure in nonsyndromic sagittal craniosynostosis following primary surgery

Thomas

Johnson

Byren

et al. 2015

PED

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OBJECT Raised intracranial pressure (ICP) is recognized to occur in patients with nonsyndromic isolated sagittal craniosynostosis (SC) prior to surgery. However, the incidence of raised ICP following primary surgery is rarely reported and there appears to be a widely held assumption that corrective surgery for SC prevents the later development of intracranial hypertension. This study reports the incidence of postoperative raised ICP in a large cohort of patients with SC treated by 1 of 2 surgical procedures in a single craniofacial unit. METHODS A retrospective review was performed of all patients with SC who underwent either a modified strip craniectomy (MSC) or calvarial remodeling (CR) procedure under the care of the Oxford Craniofacial Unit between 1995 and 2010 and who were followed up for more than 2 years. The influence of patient age at surgery, year of surgery, sex, procedure type, and the presence of raised ICP preoperatively were analyzed. RESULTS Two hundred seventeen children had primary surgery for SC and were followed up for a mean of 86 months. The overall rate of raised ICP following surgery was 6.9%, occurring at a mean of 51 months after the primary surgical procedure. Raised ICP was significantly more common in those patients treated by MSC (13 of 89 patients, 14.6%) than CR (2 of 128 patients, 1.6%). Also, raised ICP was more common in patients under 1 year of age, the majority of whom were treated by MCS. No other factor was found to have a significant effect. CONCLUSIONS Postoperative raised ICP was found in more than 1 in 20 children treated for nonsyndromic SC in this series. It was significantly influenced by the primary surgical procedure and age at primary surgery. Careful long-term follow-up is essential if children who develop raised ICP following surgery are not to be overlooked.

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Section: Discussionmentioning

confidence: 78%

“…7,10,17,18,30,37,41,48,52 The incidence of postoperative intracranial hypertension with these procedures has yet to be reported. In broad terms, these approaches appear to result in better morphological outcomes than open vertex strip craniectomy procedures, with cephalic indices within the normal range.…”

Section: Discussionmentioning

confidence: 99%

The incidence of raised intracranial pressure in nonsyndromic sagittal craniosynostosis following primary surgery

Thomas

Johnson

Byren

et al. 2015

PED

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“…Postoperative helmet therapy, springassisted cranioplasty, or cranial distraction must be used to maintain patency of the released suture and to guide subsequent growth. [2][3][4]18,26 These strategies have been applied to the other cranial sutures with success, and a limited number of experiences with nonsyndromic multisuture synostosis cases have been reported.…”

Section: Discussionmentioning

confidence: 99%

“…[2][3][4]18,26 These procedures are less invasive than traditional open cranioplasty and allow safe interventions at an early age. While widely used in cases of single-suture craniosynostosis, only sporadic reports exist of this technique's use in cases of multisuture synostosis.…”

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confidence: 99%

Outcomes of endoscopic suturectomy with postoperative helmet therapy in bilateral coronal craniosynostosis

Rottgers

Lohani

Proctor

2016

PED

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OBJECTIVE Historically, bilateral frontoorbital advancement (FOA) has been the keystone for treatment of turribrachycephaly caused by bilateral coronal synostosis. Early endoscopic suturectomy has become a popular technique for treatment of single-suture synostosis, with acceptable results and minimal perioperative morbidity. Boston Children's Hospital has adopted this method of treating early-presenting cases of bilateral coronal synostosis. METHODS A retrospective review of patients with bilateral coronal craniosynostosis who were treated with endoscopic suturectomy between 2005 and 2012 was completed. Patients were operated on between 1 and 4 months of age. Hospital records were reviewed for perioperative morbidity, length of stay, head circumference and cephalic indices, and the need for further surgery. RESULTS Eighteen patients were identified, 8 males and 10 females, with a mean age at surgery of 2.6 months (range 1–4 months). Nine patients had syndromic craniosynostosis. The mean duration of surgery was 73.3 minutes (range 50–93 minutes). The mean blood loss was 40 ml (range 20–100 ml), and 2 patients needed a blood transfusion. The mean duration of hospital stay was 1.2 days (range 1–2 days). There was 1 major complication in the form of a CSF leak. The mean follow-up was 37 months (range 6–102 months). Eleven percent of nonsyndromic patients required a subsequent FOA; 55.6% of syndromic patients underwent FOA. The head circumference percentiles and cephalic indices improved significantly. CONCLUSIONS Early endoscopic suturectomy successfully treats the majority of patients with bilateral coronal synostosis, and affords a short procedure time, a brief hospital stay, and an expedited recovery. Close follow-up is needed to detect patients who will require a secondary FOA due to progressive suture fusion or resynostosis of the released coronal sutures.

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“…31 There may be some utility in endoscopic procedures when applied earlier, unlike the traditional open surgical approaches. 1,7 To date, frontoorbital remodeling surgery remains the standard of care for metopic and unicoronal craniosynostosis treatment, with techniques varying between centers. Paul Tessier's innovative work in 1967 established surgery as the acceptable treatment for craniosynostosis, and it remains the standard for metopic and unicoronal synostoses.…”

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confidence: 99%

The cranial orbital buttress technique for nonsyndromic unicoronal and metopic craniosynostosis

Seal¹,

Steinbok

Courtemanche³

2015

FOC

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OBJECT Current craniosynostosis procedures can result in complications due to absorbable plates and screws or other specialized expensive hardware. The authors propose the cranial orbital buttress (COB) technique of frontoorbital remodeling for metopic and unicoronal synostoses, wherein no plates or screws are used. They hypothesize that, with this technique, aesthetically acceptable outcomes for unicoronal and metopic synostosis can be achieved. In this article, they present this technique and compare the results with current frontoorbital remodeling practices. METHODS The authors conducted a retrospective chart review of cases in which patients with nonsyndromic unicoronal or metopic synostosis underwent cranio-orbital surgery at their institution from 1985 through 2009. Operative parameters, surgical variations, and complications were analyzed. The COB technique uses a 1-piece switch, hemiforeheads, or multiple pieces for forehead remodeling. The supraorbital bar is reconstructed in patients with metopic synostosis using a double wedge or greenstick fracture technique, and in patients with unicoronal synostosis a hinge procedure based on a 1.5-orbital osteotomy is used. The supraorbital bar is advanced and supported in place by bone graft(s) inserted at the lateral aspect(s) of the orbit(s) to form a buttress, with fixation done using absorbable sutures. RESULTS A total of 79 cases met the criteria for inclusion in the study. Twenty-nine patients had metopic synostosis, 3 had combined metopic and sagittal synostoses, and 47 had unicoronal synostosis. The patients’ mean age at surgery was 11.4 ± 10.1 months and the mean operative time was 183.4 ± 41.0 minutes. The mean length of hospital stay was 3.7 ± 1.2 days. The mean blood loss was 150.0 ± 125.6 ml, and 33% of patients required a blood transfusion (mean volume 206.9 ± 102.3 ml). In metopic synostosis, hemiforeheads were used most often (24/29, 83%), and the supraorbital bar was remodeled using a bilateral intracranial orbital osteotomy followed by a double wedge modification (23/29, 79%) or a greenstick fracture (4/29 14%) for milder cases. Forehead remodeling for unicoronal synostosis was by a forehead switch (39/47, 83%) and the supraorbital bar was remodeled using a 1.5-orbital intracranial orbital osteotomy (34/47, 72%) such that the bar was advanced on the abnormal side and hinged at the midline of the normal orbit. Perioperative complications occurred in 19% of cases and included dural tears (16%), inconsequential subdural hematoma (1.3%), and nasal greenstick fracture (1.3%). The total reoperation rate was 7.6% (cranioplasties for irregular contours, 6.3%; scar revision, 1.3%). CONCLUSIONS The COB remodeling technique is simple and efficient, gives acceptable outcomes, and is less resource intensive than previous techniques reported in the literature.

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Endoscope-assisted strip craniectomy and postoperative helmet therapy for treatment of craniosynostosis

Cited by 106 publications

References 18 publications

The incidence of raised intracranial pressure in nonsyndromic sagittal craniosynostosis following primary surgery

The incidence of raised intracranial pressure in nonsyndromic sagittal craniosynostosis following primary surgery

Outcomes of endoscopic suturectomy with postoperative helmet therapy in bilateral coronal craniosynostosis

The cranial orbital buttress technique for nonsyndromic unicoronal and metopic craniosynostosis

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