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

Thenier-Villa, José Luis; Sanromán-Álvarez, Pablo; Miranda-Lloret, Pablo; Ramírez, María Estela Plaza

doi:10.3171/2018.2.peds17717

Cited by 22 publications

(19 citation statements)

References 27 publications

(24 reference statements)

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“…With regards to the craniotomies, all comparisons present a complete closure by 9 months post-operative (12 months of age). This appears to match well with reported in vivo literature (e.g., Thenier-Villa et al, 2018 ). An important consideration when varying surgical techniques in which calvarial healing may prolong, which has been found to vary between different age groups and surgical methods ( Hassanein et al, 2011 ; Thenier-Villa et al, 2018 ).…”

Section: Discussionsupporting

confidence: 92%

“…Two methods of bone formation were undertaken here: Scenario I: applies a bone formation across the sutures/craniotomies as described in Marghoub et al (2019) and here termed "gradual bone formation" (Figure 1D). Here, the suture and craniotomy elements within a specified radius from the adjacent bone were selected, at a rate of 0.1 mm for the sutures and 0.8 mm for the craniotomies for every month of volume growth (Mitchell et al, 2011;Thenier-Villa et al, 2018;Riahinezhad et al, 2019). To monitor for the level of strain in the selected elements, all elements with a hydrostatic strain (i.e., summation of all principal strains divided by three) within 0-50% were used.…”

Section: Boundary Conditions and Modeling Of The Growthmentioning

confidence: 99%

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Using Sensitivity Analysis to Develop a Validated Computational Model of Post-operative Calvarial Growth in Sagittal Craniosynostosis

Cross

Khonsari

Galiay

et al. 2021

Front. Cell Dev. Biol.

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Craniosynostosis is the premature fusion of one or more sutures across the calvaria, resulting in morphological and health complications that require invasive corrective surgery. Finite element (FE) method is a powerful tool that can aid with preoperative planning and post-operative predictions of craniosynostosis outcomes. However, input factors can influence the prediction of skull growth and the pressure on the growing brain using this approach. Therefore, the aim of this study was to carry out a series of sensitivity studies to understand the effect of various input parameters on predicting the skull morphology of a sagittal synostosis patient post-operatively. Preoperative CT images of a 4-month old patient were used to develop a 3D model of the skull, in which calvarial bones, sutures, cerebrospinal fluid (CSF), and brain were segmented. Calvarial reconstructive surgery was virtually modeled and two intracranial content scenarios labeled “CSF present” and “CSF absent,” were then developed. FE method was used to predict the calvarial morphology up to 76 months of age with intracranial volume-bone contact parameters being established across the models. Sensitivity tests with regards to the choice of material properties, methods of simulating bone formation and the rate of bone formation across the sutures were undertaken. Results were compared to the in vivo data from the same patient. Sensitivity tests to the choice of various material properties highlighted that the defined elastic modulus for the craniotomies appears to have the greatest influence on the predicted overall skull morphology. The bone formation modeling approach across the sutures/craniotomies had a considerable impact on the level of contact pressure across the brain with minimum impact on the overall predicated morphology of the skull. Including the effect of CSF (based on the approach adopted here) displayed only a slight reduction in brain pressure outcomes. The sensitivity tests performed in this study set the foundation for future comparative studies using FE method to compare outcomes of different reconstruction techniques for the management of craniosynostosis.

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Section: Discussionsupporting

confidence: 92%

Section: Boundary Conditions and Modeling Of The Growthmentioning

confidence: 99%

Using Sensitivity Analysis to Develop a Validated Computational Model of Post-operative Calvarial Growth in Sagittal Craniosynostosis

Cross

Khonsari

Galiay

et al. 2021

Front. Cell Dev. Biol.

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“…Our prevalence of bony defects is higher than those previously reported. Three children (9.4%) underwent surgery for a skull defect, which is higher than the rate reported by Thenier-Villa et al 36 The reoperation FIG. 3.…”

Section: Discussionmentioning

confidence: 61%

“…They found larger postoperative defect and younger age to be risk factors. 36 Age has inconsistently been reported as a risk factor for bone loss. 10,27,31,36 We observed 27 children (84%) with at least a 0.5-cm 2 calvarial defect and 14 (44%) with a combined area of loss > 4 cm 2 .…”

Section: Discussionmentioning

confidence: 99%

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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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