Incomplete Reossification After Craniosynostosis Surgery

Noordzij, Niels; Brouwer, Roma; Horst, Chantal M.A.M. van der

doi:10.1097/scs.0000000000002319

Cited by 26 publications

(16 citation statements)

References 52 publications

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“… 62 , 63 Patients who are not candidates for minimally invasive options, open cranial vault remodeling is favored before the age of 12 months as re-ossification potential decreases after the age of 1 year and complication rates increase. 64 , 65 Patients presenting with symptoms of elevated intracranial pressure are classified as Tier 3a; intervention should not be postponed.…”

Section: Resultsmentioning

confidence: 99%

A Summary of Recommendations for Plastic Surgeons during the Coronavirus Disease 2019 Outbreak

Schoenbrunner

Sarac

Janis

2020

Plastic and Reconstructive Surgery - Global Open

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Background: The coronavirus disease 2019 outbreak presents unique challenges to the healthcare system. The lack of unified guidelines on what constitutes elective surgery left plastic surgeons without a clear framework to guide their practices. More urgently, the ambiguity in defining elective surgery leaves plastic surgeons without clear guidance as states begin to phase in these procedures. Methods: Recommendations issued by state governing bodies as of April 28, 2020, were reviewed. National society and federal guidelines pertaining to postponement and resumption of elective surgeries affected by the coronavirus disease 2019 outbreak were also reviewed. Recommendations based on the above are collated for plastic surgeons. Results: Thirty-six states and the District of Columbia provide recommendations regarding elective surgery. Cosmetic surgery is considered an elective surgery and should be postponed; this may be among the first elective surgeries to safely resume. Societal guidelines provide disease-specific recommendations for cancer-related surgery and breast reconstruction. Trauma, other cancer-related reconstruction, and hand surgeries are considered nonelective if postponement threatens life or limb or if a patient is highly symptomatic. Postponement and resumption of oncology, trauma, and hand surgery cases depend on disease stage and complexity of reconstruction. Pediatric craniofacial surgery presents unique challenges due to the time-sensitive nature of the interventions. Conclusions: Guidance on elective surgery is vague for plastic surgeons. Government recommendations and societal guidelines provide a framework for plastic surgeons to assess the elective nature of a surgical intervention and safety of resumption; however, a nuanced assessment must be made on local disease transmission, supply availability, and hospital capacity.

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Section: Resultsmentioning

confidence: 99%

A Summary of Recommendations for Plastic Surgeons during the Coronavirus Disease 2019 Outbreak

Schoenbrunner

Sarac

Janis

2020

Plastic and Reconstructive Surgery - Global Open

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“…A recent review reports a variable incidence of 0.5% to 18.2%. 19 The aim of this study is to describe the epidemiological characteristics of incomplete reossification after craniosynostosis surgery, related factors, and reossification rates after craniosynostosis surgery.…”

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confidence: 99%

Incomplete reossification after craniosynostosis surgery—incidence and analysis of risk factors: a clinical-radiological assessment study

Thenier-Villa

Sanromán-Álvarez

Miranda-Lloret

et al. 2018

Journal of Neurosurgery: Pediatrics

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OBJECTIVEOne of the principles of the surgical treatment of craniosynostosis includes the release of fused bone plates to prevent recurrence. Such bone defects require a reossification process after surgery to prevent a cosmetic problem or brain vulnerability to damage. The objective of this study is to describe and analyze the radiological and clinical evolution of bone defects after craniosynostosis.METHODSFrom January 2005 to May 2016, 248 infants underwent surgical correction of craniosynostosis at HUiP La Fe Valencia; the authors analyzed data from 216 of these cases that met the inclusion criteria for this study. Various surgical techniques were used according to the age of the patient and severity of the case, including endoscopic-assisted suturectomy, open suturectomy, fronto-orbital advancement, and cranial vault remodeling. Clinical follow-up and radiological quantitative measurements in 2 periods—12–24 months and 2 years after surgery—were analyzed; 94 patients had a postoperative CT scan and were included in the radiological analysis.RESULTSAt the end of the follow-up period, 92 of 216 patients (42.59%) showed complete closure of the bone defect, 112 patients (51.85%) had minor bone defects, and 12 patients (5.56%) had significant bone defects that required surgical intervention. In the multivariate analysis, age at first surgery was not significantly associated with incomplete reossification (p = 0.15), nor was surgical site infection (p = 0.75). Multivariate analysis identified area of cranial defect greater than 5 cm2 in the first CT scan as predictive of incomplete reossification (p = 0.04). The mean area of cranial defect in the first CT scan (12–24 months after surgery) was 3.69 cm2 in patients treated with open surgery and 7.13 cm2 in those treated with endoscopic-assisted procedures; in the multivariate analysis, type of procedure was not related to incomplete reossification (p = 0.46). The positive predictive value of palpation as evaluation of bone cranial defects was 50% for significant defects and 71% for minor defects.CONCLUSIONSThe incidence of cranial defects due to incomplete reossification requiring cranioplasty was 5.56% in our series. Defects greater than 5 cm2 in the first postoperative CT scan showed a positive association with incomplete reossification. Patients treated with endoscope-assisted procedures had larger defects in the initial follow-up, but the final incidence of cranial defects was not significantly different in the endoscope-assisted surgery group from that in the open surgery group.

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“…In fact, all the surgical correction techniques rely on spontaneous ossification of the surgical bone defects. In spite of a proper preservation of dura mater and periosteum, critical size cranial defects may result in a large proportion of cases, from incomplete or defective spontaneous healing of the bone [79] or other surgical complications (i.e., infection or resorption of the bone flap) especially when multiple repeated surgeries are required, as in the case of re-synostosis [80].…”

Section: Tissue Engineering Strategiesmentioning

confidence: 99%

Personalized Bone Reconstruction and Regeneration in the Treatment of Craniosynostosis

et al. 2021

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Craniosynostosis (CS) is the second most prevalent craniofacial congenital malformation due to the premature fusion of skull sutures. CS care requires surgical treatment of variable complexity, aimed at resolving functional and cosmetic defects resulting from the skull growth constrain. Despite significant innovation in the management of CS, morbidity and mortality still exist. Residual cranial defects represent a potential complication and needdedicated management to drive a targeted bone regeneration while modulating suture ossification. To this aim, existing techniques are rapidly evolving and include the implementation of novel biomaterials, 3D printing and additive manufacturing techniques, and advanced therapies based on tissue engineering. This review aims at providing an exhaustive and up-to-date overview of the strategies in use to correct these congenital defects, focusing on the technological advances in the fields of biomaterials and tissue engineering implemented in pediatric surgical skull reconstruction, i.e., biodegradable bone fixation systems, biomimetic scaffolds, drug delivery systems, and cell-based approaches.

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Incomplete Reossification After Craniosynostosis Surgery

Cited by 26 publications

References 52 publications

A Summary of Recommendations for Plastic Surgeons during the Coronavirus Disease 2019 Outbreak

A Summary of Recommendations for Plastic Surgeons during the Coronavirus Disease 2019 Outbreak

Incomplete reossification after craniosynostosis surgery—incidence and analysis of risk factors: a clinical-radiological assessment study

Personalized Bone Reconstruction and Regeneration in the Treatment of Craniosynostosis

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