Outcome analysis of 85 patients undergoing the pi procedure for correction of sagittal synostosis

Boop, Frederick A.; Chadduck, William M.; Shewmake, Kristopher; Teo, Charles

doi:10.3171/jns.1996.85.1.0050

Cited by 70 publications

(36 citation statements)

References 20 publications

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“…As reported in a series of patients undergoing the pi procedure [13], postoperative fevers were universal and not considered as morbidity. Ten SC patients required postoperative transfusions for low hematocrits as com pared to 6 CVR patients.…”

Section: Postoperative Factorsmentioning

confidence: 86%

Surgical Management of Sagittal Synostosis: A Comparative Analysis of Strip Craniectomy and Calvarial Vault Remodeling

Jg²,

Levy

1997

Pediatr Neurosurg

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Although surgical treatment of sagittal synostosis has become normative, the procedure of choice is still debated. This retrospective analysis, during a 10-year period (1986-1995) at Children’s Hospital Los Angeles, compares the more conservative strip craniectomy (SC) procedure with a more extensive occipital reduction-biparietal widening calvarial vault remodeling (CVR) technique for the management of sagittal synostosis. SC was performed in 72 patients (61%) and CVR in 46 (39%). Patients undergoing CVR were older (mean 5.3 vs. 3.0 months, p< 0.01), the procedure time longer (mean 126 min vs. 72 min, p < 0.01), intraoperative blood loss greater (mean 243 vs. 54 cm³, p < 0.01), and the frequency of intraoperative blood transfusion increased (100 vs. 38%, p < 0.01; mean volume 357 vs. 51 cm³, p < 0.01) compared to patients undergoing SC. No significant intraoperative complications occurred in either group. The total time of hospitalization was similar (mean 4.4 vs. 3.8 days, p = 0.02). No neurological, hematological, or transfusion-related complications or deaths were encountered in either group. Cosmetic outcomes were significantly better in the CVR group with 79% rated as excellent compared to 41% in the SC group (p < 0.01). Fifty-nine percent of the SC patients manifested bony defects at last follow-up visit. Two SC patients required reopera-tion for poor cosmetic outcomes; CVR was successfully employed in both cases. These findings demonstrate that CVR is superior to SC in providing immediate and lasting correction of calvarial deformities secondary to sagittal synostosis. The optimal age at time of surgery is <6 months; however, CVR can be utilized throughout infancy, while SC becomes progressively less effective after 6 months of age. No significant complications were observed in either group, despite the increased operative manipulation and greater incidence of blood transfusion in the CVR patients.

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Section: Postoperative Factorsmentioning

confidence: 86%

Surgical Management of Sagittal Synostosis: A Comparative Analysis of Strip Craniectomy and Calvarial Vault Remodeling

Jg²,

Levy

1997

Pediatr Neurosurg

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“…3,5,[9][10][11][12]15,17,[20][21][22][23][26][27][28][29][30][31][33][34][35][36]38,40,[43][44][45][46][47][48][49][50][51] The field continues to evolve and aims to reduce the impact of surgery. Minimally invasive approaches constitute the majority of recently detailed techniques.…”

mentioning

confidence: 99%

Frontobiparietal remodeling with or without a widening bridge for sagittal synostosis: comparison of 2 cohorts for aesthetic and functional outcome

Veelen¹,

Mihajlović²,

Dammers³

et al. 2015

PED

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OBJECT Various techniques to correct sagittal synostosis have been described. The authors of this study assess the results of 2 techniques for late complete cranial remodeling and test the hypothesis that adding a widening bridge would improve outcome. METHODS In this retrospective study, the authors evaluated patients with nonsyndromic sagittal synostosis—those who underwent frontobiparietal remodeling (FBR) and those who underwent modified FBR (MFBR) involving the introduction of a bony bridge to increase the width of the skull. Outcomes for both groups are described in terms of the aesthetic results assessed on photographs and any changes in the cranial index (CI) and head circumference over time, the presence of papilledema, and complaints of headache. The effect of the surgical technique on CI and head circumference over time was assessed using linear regression analysis, with adjustment for preoperative CI and head circumference. RESULTS Sixty-nine patients with isolated sagittal synostosis were included in this study: 35 underwent MFBR and 34 underwent the original technique of FBR. The mean follow-up period was 7 years. In the 1st year after surgery, mean CI improved by 9% in the FBR group and by 12% in the MFBR group. One year after surgery, CI in the MFBR group was on average 4.7% higher than that in the FBR group (p < 0.001). During follow-up, CI decreased in both groups; however, at all time points CI was significantly higher in the MFBR group than in the FBR group. The impact of surgical technique on CI was less important than the impact of preoperative CI (R2= 0.26 vs 0.54), and this applied at all time points during follow-up. Head circumference declined during follow-up in both groups. It was influenced by preoperative head circumference, but not by surgical technique. Aesthetic outcome, prevalence of headache (42%), and papilledema (7%) were comparable in both groups. CONCLUSIONS Adding a widening bridge to late complete remodeling significantly improved CI and helped to prevent CI from decreasing in the long term. This addition did not affect the head circumference growth curve. Despite a mean head circumference remaining at +1 SD, patients continued to develop papilledema postoperatively (7%).

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“…We have not performed this operation (or strip craniectomies) on patients younger than 3 months, preferring to allow those infants time to grow given the potential for significant blood loss. Postoperative cranial index measurements (82% excellent, 18% good and 0% poor results) compare favorably to those of accepted CVR techniques [11, 20]. Furthermore, these results are immediate, durable and do not require the use of a molding helmet or follow-up surgeries for device removal.…”

Section: Discussionmentioning

confidence: 75%

“…Larger CVR series in the literature report mean blood losses between 100 and 290 ml with transfusion rates between 80 and 100% [11, 20,22,23,24,25,26]. Our procedure resulted in a mean EBL of 300 ml and a transfusion rate of 86% (corresponding to the upper and lower ranges, respectively, for CVR series in the literature).…”

Section: Discussionmentioning

confidence: 98%

“…While operative times between 4 and 8 h have been reported, large studies reviewing the π or occipital reduction-biparietal widening procedures revealed mean surgical times of 1.5 and 2 h, respectively [11, 18, 20, 21]. Our mean surgical time of 3.3 h (range 2.5–5 h) is typical of most CVR procedures and significantly higher than that reported for endoscopic strip craniectomies [18] – reflecting the difference in complexity between these procedures.…”

Section: Discussionmentioning

confidence: 99%

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Correction of Sagittal Craniosynostosis Using a Novel Parietal Bone Fixation Technique: Results over a 10-Year Period

Sikorski¹,

Iteld

McKinnon

et al. 2006

Pediatr Neurosurg

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Isolated sagittal synostosis is a common form of craniosynostosis affecting roughly 1 in 5,000 children at birth. This results in a scaphocephalic head shape with a characteristically elongated anterior-posterior dimension and narrowed biparietal diameter. We present our experience with the correction of scaphocephaly due to sagittal synostosis using cranial vault reconstruction with a novel form of parietal bone fixation in 21 patients over 10 years. The medial fixation results in a hinging effect whereby transverse brain growth at the squamoid suture is enhanced. This results in excellent cosmetic results that are immediate and durable without the need for postoperative molding helmets. Furthermore, the complications associated with this procedure are limited.

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Outcome analysis of 85 patients undergoing the pi procedure for correction of sagittal synostosis

Cited by 70 publications

References 20 publications

Surgical Management of Sagittal Synostosis: A Comparative Analysis of Strip Craniectomy and Calvarial Vault Remodeling

Surgical Management of Sagittal Synostosis: A Comparative Analysis of Strip Craniectomy and Calvarial Vault Remodeling

Frontobiparietal remodeling with or without a widening bridge for sagittal synostosis: comparison of 2 cohorts for aesthetic and functional outcome

Correction of Sagittal Craniosynostosis Using a Novel Parietal Bone Fixation Technique: Results over a 10-Year Period

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