Improved cephalic index following early cranial vault remodeling in patients with isolated nonsyndromic sagittal synostosis

Abstract

OBJECTIVE Isolated nonsyndromic sagittal synostosis (SS) is the most common form of craniosynostosis in children, accounting for approximately 60% of all craniosynostoses. The typical cranial measurement used to define and follow SS is the cephalic index (CI). Several surgical techniques have been suggested, but agreement on type and timing of surgery is lacking. This study aimed to evaluate the authors’ institutional experience of surgically treating SS using a modified subtotal cranial vault remodeling technique in a population-based cohort. Special attention was directed toward the effect of patient age at time of surgery on long-term CI outcome. METHODS A retrospective analysis was conducted on all patients with isolated nonsyndromic SS who were surgically treated from 2003 to 2011. Data from electronic medical records were gathered. Eighty-two patients with SS were identified, 77 fulfilled inclusion criteria, and 72 had sufficient follow-up data and were included. CI during follow-up after surgery was investigated with ANOVA and a linear mixed model. RESULTS In total, 72 patients were analyzed, consisting of 16 females (22%) and 56 males (78%). The mean ± SD age at surgery was 4.1 ± 3.1 months. Blood transfusions were received by 81% of patients (26% intraoperatively, 64% postoperatively, 9% both). The mean ± SD time in the pediatric ICU was 1.1 ± 0.25 days, and the mean ± SD total hospital length of stay was 4.6 ± 2.0 days. No patient required reoperation. The mean ± SD CI increased from 69 ± 3 to 87 ± 5 for patients who underwent surgery before 45 days of age. Surgery resulted in a larger increase in CI for patients who underwent surgery at a younger age compared with older patients (p < 0.05, Tukey’s HSD test). In the comparison of patients who underwent surgery before 45 days of age with patients who underwent surgery at 45–90, 90–180, and more than 180 days of age, the linear mixed model estimated a long-term loss of CI of 3.0, 5.5, and 7.4 points, respectively. CONCLUSIONS The modified subtotal cranial vault remodeling technique used in this study significantly improved CI in patients with SS. The best results were achieved when surgery was performed early in life.

Sagittal Craniosynostosis: Treatment and Outcomes According to Age at Intervention

“…A total of 49 manuscripts with 3316 patients were included in this study. Articles were categorized based on the average age at intervention; 0 to 6, older than 6 to 12, and older than 12 months 3,7–53 . Fifteen of the manuscripts included more than 1 age group, thus they are mentioned in different cohorts 10,11,13,23,30–32,40,43,45,49,50,52,54 .…”

“…Fifteen of the manuscripts included more than 1 age group, thus they are mentioned in different cohorts 10,11,13,23,30–32,40,43,45,49,50,52,54 . From the 49 articles, 36 (n=2141) included patients 0 to 6 months old, 15 (n=669) discussed patients older than 6 to 12 months old, and 9 (n=506) evaluated patients older than 12 months old 3,7–53 . Follow-up ranged from 12 to 144 months 3,7–53 .…”

“…From the 49 articles, 36 (n=2141) included patients 0 to 6 months old, 15 (n=669) discussed patients older than 6 to 12 months old, and 9 (n=506) evaluated patients older than 12 months old 3,7–53 . Follow-up ranged from 12 to 144 months 3,7–53 . Over 8 different types of open surgical techniques were identified and up to 5 different minimally invasive procedures were described 10,11,13,23,30–32,40,43,45,49,50,52,54 …”

“…Minimally invasive procedures were exclusively seen in the youngest cohort (0–6 mo) 3,7–53 . Four studies compared different surgical approaches (open versus minimally invasive) within the same age group (0–6 mo) 30,32,41,54 .…”

“…Thirty-six manuscripts (n=2141) described surgical correction of sagittal craniosynostosis in the 0- to 6-month-old age group 3,7–11,13,14,17,18,20,23–25,28–32,35–45,48–50,52,54 . Both open and minimally invasive techniques were reported 43,50 .…”