Long-Term Morphological Outcomes in Nonsyndromic Sagittal Craniosynostosis

Abstract

Correction of scaphocephaly is one of the principle goals of surgery in sagittal craniosynostosis. Reported relapse in head shape after surgery and continued head growth into late adolescence underscores the need for long-term outcomes to be considered when comparing between different surgical approaches in this condition; yet there are relatively few reports of results to 5 years and beyond in the literature. Therefore, a retrospective review was performed of the anthropometric data of 224 patients with sagittal craniosynostosis who underwent primary surgery between 1994 and 2012. During this period, patients underwent either a modified strip craniectomy (MSC) or calvarial remodeling (CR) procedure. Sixty-two patients were treated by MSC and followed up for a mean of 44 months. One hundred sixty-two patients had CR, with follow-up for a mean of 45 months. Overall, 90 patients were seen up to 5 years, and 47 patients to 9 years or more after surgery. The cephalic index (CI) of MSC-treated patients improved from a mean of 67.0 to 72.7, with 31% achieving a CI greater than 75 at one year. Calvarial remodeling was significantly more effective at correcting the scaphocephalic deformity. Patients treated with CR improved from a mean CI of 66.7 to 76.1. Sixty-two percent of the patients achieved a CI greater than 75. In both groups, outcomes were stable throughout follow-up with no significant relapse up to 14 years after surgery.

The Management of Nonsyndromic, Isolated Sagittal Synostosis

“…52 Until a measurement index, that is safe and both specific and sensitive, is defined and accepted across the world, cranial index remains the most appropriate measurement tool for assessing the anthropological and morphological changes following surgery for sagittal synostosis. 6,51 In this review, the 4 studies 6,24,27,38 noted a net improvement in the cranial indices following surgery, although this was not significant in 1 study. 38 Two studies used CT scans as a means to measure the CI, 24,27 and the other 2 measured the CI clinically.…”

“…Of the 26 articles that were identified using cranial index as an endpoint, only 7 articles achieved the 75% threshold. These consisted of 4 studies comparing 2 different surgical procedures 6,24,27,38 and of 3 studies describing the outcome of 1 technique. 9,29,35 However, the PICO process suggests that there has to be a comparison population in the study.…”

“…38 Two studies used CT scans as a means to measure the CI, 24,27 and the other 2 measured the CI clinically. 6,38 Measuring the bony dimensions on a CT scan may be precise, but it does not take into account the soft tissue envelope. This is measured with a calliper, thus possibly reflecting a more accurate assessment of the head shape.…”

“…3 The management of sagittal synostosis (SS) is surgical, the 2 main aims being to normalize the aesthetic appearance of the skull, and to relieve any constriction of the brain, thus providing a cranium of appropriate geometry and volume to allow for the normal development and growth of the child's brain. 5,6 As our understanding of the disease process has evolved, and with the advent of surgical innovations, the operative approaches for managing patients with SS have considerably changed, ranging from the initial suturectomy as described by Lannelongue in 1890 and Lane in 1892 to the more extensive calvarial vault remodeling and variants thereof. More recently, the use of spring-assisted surgery and endoscopic-assisted craniectomies, with and without helmets as postoperative adjuncts, has been described.…”

An Overview of Modelling Craniosynostosis Using the Finite Element Method

“…There are a number of reconstruction techniques for different forms of craniosynostosis. These techniques have generally evolved over years in each craniofacial centre due to their experience, while ensuring the best surgical outcome for the child [e.g., McCarthy et al, 1995;Clayman et al, 2007;Thomas et al, 2015]. Nonetheless, when comparing different centres' techniques for treatment of a single form of craniosynotosis, there could be huge variations between them [e.g., Hopper et al, 2002;Taylor and Maugans, 2011;Simpson et al, 2017].…”