Management of Isolated Sagittal Synostosis in the Absence of Scaphocephaly: A Series of Eight Cases

Morritt, Daniel G.; Yeh, Fang-Jui J.; Wall, S A; Richards, Peter G.; Jayamohan, Jayaratnam; Johnson, David

doi:10.1097/prs.0b013e3181e09533

Cited by 33 publications

(32 citation statements)

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“…Our use of a threshold of more than 15 mm Hg to define an abnormally elevated ICP is consistent with that used by all previous studies that have undertaken overnight intracranial ICP monitoring in craniosynostosis, no matter whether an extradural or subdural device was employed. 6,11,13,28,35,42,43,45,46 The pathological significance of multiple B-type waves is also well recognized in the literature. 11,35,50 Consistent with the patient series of van Veelan et al and Cetas et al, we found that elevated ICP was diagnosed late, at least 2 years after primary surgery, with a mean at just under 4.5 years of follow-up.…”

Section: Discussionmentioning

confidence: 96%

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

Thomas

Johnson

Byren

et al. 2015

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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: 96%

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

Thomas

Johnson

Byren

et al. 2015

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“…The incidence of raised ICP in these patients has not been previously reported in the literature, although a recent study conducted by our unit in 6 nonscaphocephalic SC patients who underwent ICP monitoring showed that 4 (67%) had elevated ICP. 36 This high rate may reflect an underlying increased risk of raised ICP in mild or nonscaphocephalic patients compared with the SC population as a whole. Alternately, it may be a function of the patients' age (mean 46 months), given that Renier et al 41 previously found a correlated increase in ICP with age, up to 6 years of age, in craniosynostosis.…”

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confidence: 99%

The preoperative incidence of raised intracranial pressure in nonsyndromic sagittal craniosynostosis is underestimated in the literature

Wall¹,

Thomas²,

Johnson³

et al. 2014

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Object The presence of raised intracranial pressure (ICP) in untreated nonsyndromic, isolated sagittal craniosynostosis (SC) is an important functional indication for surgery. Methods A retrospective review was performed of all 284 patients presenting with SC to the Oxford Craniofacial Unit between 1995 and 2010. Results Intraparenchymal ICP monitoring was performed in 39 children following a standard unit protocol. Monitoring of ICP was offered for all patients in whom nonoperative management was considered on the basis of minimal deformity or in cases in which parents were reluctant to agree to corrective surgery. These patients presented at an older age than the rest of the cohort (mean age 56 months), with marked scaphocephaly (16/39, 41%), mild scaphocephaly (11, 28%), or no scaphocephalic deformity (12, 31%). Raised ICP was found in 17 (44%) patients, with no significant difference in its incidence among the 3 different deformity types. Raised ICP was not predicted by the presence of symptoms of ICP or developmental delay or by ophthalmological or radiological findings. Conclusions The incidence of raised ICP in SC reported here is greater than that previously published in the literature. The lack of a reliable noninvasive method to identify individuals with elevated ICP in SC mandates consideration of intraparenchymal ICP monitoring in all patients for whom nonoperative management is contemplated.

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“…In contrast, non-scaphocephalic sagittal synostosis is a rare diagnosis. Morritt et al [10] were the first to report non-scaphocephalic sagittal synostosis in 8 (4.1%) of the total 193 patients who had isolated sagittal synostosis. According to the report, there are a number of possible explanations including the following: if fusion of the suture occurred at a later stage after the majority of skull growth had taken place, then, the secondary defect induced by compensatory over-growth of adjacent sutures is likely to be less severe in comparison to the secondary defect arising from fusion that occurred at an earlier stage.…”

Section: Discussionmentioning

confidence: 99%

Congenital Muscular Torticollis Concurrent With Sagittal Synostosis: A Case Report

2014

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Congenital muscular torticollis (CMT) and craniosynostosis are diseases that cause plagiocephaly and craniofacial asymmetry in children. In our literature review, we did not find any report of concurrent manifestation of CMT and craniosynostosis. A 41-month-old boy visited our hospital with left torticollis, right laterocollis, and craniofacial asymmetry as the main findings. During clinical examination, prominent right sternocleidomastoid muscle and limited range of motion of the neck were noted, and right CMT was confirmed by magnetic resonance imaging of the neck. Three-dimensional computed tomography of the skull, which was conducted due to the unusual appearance of the skull with a large head circumference, mild brachycephaly, as well as left plagiocephaly, revealed premature closure of the sagittal suture. Thus, we report the first case that showed concurrence of CMT and sagittal synostosis. We recommend that concurrently manifested craniosynostosis needs to be examined if the subject with CMT displays unusual craniofacial asymmetry to a greater extent than deformational plagiocephaly.

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Management of Isolated Sagittal Synostosis in the Absence of Scaphocephaly: A Series of Eight Cases

Cited by 33 publications

References 10 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

The preoperative incidence of raised intracranial pressure in nonsyndromic sagittal craniosynostosis is underestimated in the literature

Congenital Muscular Torticollis Concurrent With Sagittal Synostosis: A Case Report

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