Outcome Analysis of Our First 75 Spring-Assisted Surgeries for Scaphocephaly

David, Lisa R.; Plikaitis, Christina M.; Couture, Daniel E.; Glazier, Steven S.; Argenta, Louis C.

doi:10.1097/scs.0b013e3181c3469d

Cited by 114 publications

(133 citation statements)

References 18 publications

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“…In broad terms, these approaches appear to result in better morphological outcomes than open vertex strip craniectomy procedures, with cephalic indices within the normal range. 7,10,18,30,37,41 If the correction of the scaphocephalic deformity is an important determinant of the development of raised ICP, then one might expect these techniques to have a similar postoperative incidence to that we report for CR. However, we do not understand the mechanism by which intracranial hypertension arises in SC following surgery.…”

Section: Discussionmentioning

confidence: 78%

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

Thomas

Johnson

Byren

et al. 2015

PED

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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: 78%

“…7,10,17,18,30,37,41,48,52 The incidence of postoperative intracranial hypertension with these procedures has yet to be reported. In broad terms, these approaches appear to result in better morphological outcomes than open vertex strip craniectomy procedures, with cephalic indices within the normal range.…”

Section: Discussionmentioning

confidence: 99%

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

Thomas

Johnson

Byren

et al. 2015

PED

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“…Postoperative helmet therapy, springassisted cranioplasty, or cranial distraction must be used to maintain patency of the released suture and to guide subsequent growth. [2][3][4]18,26 These strategies have been applied to the other cranial sutures with success, and a limited number of experiences with nonsyndromic multisuture synostosis cases have been reported.…”

Section: Discussionmentioning

confidence: 99%

“…[2][3][4]18,26 These procedures are less invasive than traditional open cranioplasty and allow safe interventions at an early age. While widely used in cases of single-suture craniosynostosis, only sporadic reports exist of this technique's use in cases of multisuture synostosis.…”

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confidence: 99%

Outcomes of endoscopic suturectomy with postoperative helmet therapy in bilateral coronal craniosynostosis

Rottgers

Lohani

Proctor

2016

PED

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OBJECTIVE Historically, bilateral frontoorbital advancement (FOA) has been the keystone for treatment of turribrachycephaly caused by bilateral coronal synostosis. Early endoscopic suturectomy has become a popular technique for treatment of single-suture synostosis, with acceptable results and minimal perioperative morbidity. Boston Children's Hospital has adopted this method of treating early-presenting cases of bilateral coronal synostosis. METHODS A retrospective review of patients with bilateral coronal craniosynostosis who were treated with endoscopic suturectomy between 2005 and 2012 was completed. Patients were operated on between 1 and 4 months of age. Hospital records were reviewed for perioperative morbidity, length of stay, head circumference and cephalic indices, and the need for further surgery. RESULTS Eighteen patients were identified, 8 males and 10 females, with a mean age at surgery of 2.6 months (range 1–4 months). Nine patients had syndromic craniosynostosis. The mean duration of surgery was 73.3 minutes (range 50–93 minutes). The mean blood loss was 40 ml (range 20–100 ml), and 2 patients needed a blood transfusion. The mean duration of hospital stay was 1.2 days (range 1–2 days). There was 1 major complication in the form of a CSF leak. The mean follow-up was 37 months (range 6–102 months). Eleven percent of nonsyndromic patients required a subsequent FOA; 55.6% of syndromic patients underwent FOA. The head circumference percentiles and cephalic indices improved significantly. CONCLUSIONS Early endoscopic suturectomy successfully treats the majority of patients with bilateral coronal synostosis, and affords a short procedure time, a brief hospital stay, and an expedited recovery. Close follow-up is needed to detect patients who will require a secondary FOA due to progressive suture fusion or resynostosis of the released coronal sutures.

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“…3 Good to excellent correction w/ visible irregularity (e.g., a visible prominence from a surgical wire or plate, or a visible bony spicule or defect that does not compromise the overall correction), not requiring reoperation. 4 Good to excellent correction w/ visible or palpable irregularity requiring reoperation (e.g., a surgical plate requiring removal).…”

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confidence: 99%

Transsutural distraction osteogenesis for 285 children with craniosynostosis: a single-institution experience

Park

Yoon

2016

PED

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OBJECT Although distraction osteogenesis (DO) requires a secondary procedure in the surgical correction of craniosynostosis, it is relatively simple, requires less transfusion, results in a shorter intensive care unit stay, and is quite safe. Because of these positive factors, various DO techniques have been developed. However, there is disagreement regarding the superiority of DO. The authors reported on a new DO technique, transsutural DO (TSDO), 6 years ago that was performed in 23 patients over a period of 6 months, and it continues to be used at the present time. In this paper the authors report the results of TSDO performed in 285 patients with craniosynostosis over a period of 6 years at a single institution. METHODS TSDO consists of a simple suturectomy of the pathological suture followed by direct distraction of the suturectomy site only. Types of TSDO conducted included sagittal TSDO in 95 patients, bicoronal in 14, unilateral coronal in 57, lambdoid in 26, metopic in 13, multiple in 19, syndromic in 33, and secondary in 28. The mean age (± SD) of the patients was 19.4 ± 23.0 months, and mean follow-up was 39.5 ± 21.0 months. RESULTS The mean operating time was 115 ± 43 minutes, and mean anesthesia time was 218 ± 56 minutes. The mean transfusion volume of red blood cell components was 48 ± 58 ml, and mean transfusion volume of fresh-frozen plasma was 19 ± 35 ml. Total transfusion volume was significantly less in infants younger than 12 months of age and in children with lower lumbar puncture pressures (p < 0.05). Complications included 1 (0.4%) death from postoperative acute pneumonia after a distractor removal operation and 23 (8%) surgical morbidities comprising 10 revisions (3.5%) and 13 early removals of distracters (4.6%). CONCLUSIONS TSDO is a simple, effective, and safe method to use for treating all types of craniosynostosis. Some morbidity was experienced in this study, but it may be attributed to the learning curve of the technique.

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Outcome Analysis of Our First 75 Spring-Assisted Surgeries for Scaphocephaly

Cited by 114 publications

References 18 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

Outcomes of endoscopic suturectomy with postoperative helmet therapy in bilateral coronal craniosynostosis

Transsutural distraction osteogenesis for 285 children with craniosynostosis: a single-institution experience

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