Promoting ossification of calvarial defects in craniosynostosis surgery by demineralized bone plate and bone dust in different age groups

Savolainen, M.; Ritvanen, Antti; Hukki, Jyri; Vuola, Pia; Telkkä, J.; Leikola, Junnu

doi:10.1016/j.bjps.2016.09.012

Cited by 7 publications

(5 citation statements)

References 26 publications

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“…Recently some studies have used quantitative methods to assess bone defects in craniosynostosis. 2,24 Given that it is an easy technique to develop with current image visualization software, we think that all studies of craniosynostosis surgery outcomes may benefit from including this type of assessment as part of the analysis of the results.…”

Section: Radiological Assessment Of Bone Defectsmentioning

confidence: 99%

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

Thenier-Villa

Sanromán-Álvarez

Miranda-Lloret

et al. 2018

Journal of Neurosurgery: Pediatrics

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OBJECTIVEOne of the principles of the surgical treatment of craniosynostosis includes the release of fused bone plates to prevent recurrence. Such bone defects require a reossification process after surgery to prevent a cosmetic problem or brain vulnerability to damage. The objective of this study is to describe and analyze the radiological and clinical evolution of bone defects after craniosynostosis.METHODSFrom January 2005 to May 2016, 248 infants underwent surgical correction of craniosynostosis at HUiP La Fe Valencia; the authors analyzed data from 216 of these cases that met the inclusion criteria for this study. Various surgical techniques were used according to the age of the patient and severity of the case, including endoscopic-assisted suturectomy, open suturectomy, fronto-orbital advancement, and cranial vault remodeling. Clinical follow-up and radiological quantitative measurements in 2 periods—12–24 months and 2 years after surgery—were analyzed; 94 patients had a postoperative CT scan and were included in the radiological analysis.RESULTSAt the end of the follow-up period, 92 of 216 patients (42.59%) showed complete closure of the bone defect, 112 patients (51.85%) had minor bone defects, and 12 patients (5.56%) had significant bone defects that required surgical intervention. In the multivariate analysis, age at first surgery was not significantly associated with incomplete reossification (p = 0.15), nor was surgical site infection (p = 0.75). Multivariate analysis identified area of cranial defect greater than 5 cm2 in the first CT scan as predictive of incomplete reossification (p = 0.04). The mean area of cranial defect in the first CT scan (12–24 months after surgery) was 3.69 cm2 in patients treated with open surgery and 7.13 cm2 in those treated with endoscopic-assisted procedures; in the multivariate analysis, type of procedure was not related to incomplete reossification (p = 0.46). The positive predictive value of palpation as evaluation of bone cranial defects was 50% for significant defects and 71% for minor defects.CONCLUSIONSThe incidence of cranial defects due to incomplete reossification requiring cranioplasty was 5.56% in our series. Defects greater than 5 cm2 in the first postoperative CT scan showed a positive association with incomplete reossification. Patients treated with endoscope-assisted procedures had larger defects in the initial follow-up, but the final incidence of cranial defects was not significantly different in the endoscope-assisted surgery group from that in the open surgery group.

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Section: Radiological Assessment Of Bone Defectsmentioning

confidence: 99%

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

Thenier-Villa

Sanromán-Álvarez

Miranda-Lloret

et al. 2018

Journal of Neurosurgery: Pediatrics

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“…The study by Savolainen et al 14 focused on the efficacy of demineralized bone matrix (DBM) in preventing bone defects across 18 patients. In each patient, 1-2 bone defects were treated with DBM, whereas others were left untreated for comparison.…”

Section: Discussionmentioning

confidence: 99%

Reossification of Bone Defects After Surgical Correction of Nonsyndromic Craniosynostosis: A Review and An Original Study

Berton,

Arrighi,

Barthélémy

et al. 2024

Neurosurgery

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BACKGROUND AND OBJECTIVES: Surgical correction of nonsyndromic craniosynostosis (NSC) aims to restore cranial shape. Reossification of bone defects is paramount for the best aesthetic prognosis. However, the literature on the quantitative evaluation of bone defects after NSC surgery is scarce. This study aimed to quantify and analyze the surface area of bone defects after NSC surgery and establish a threshold value for predicting persistent defects. METHODS: We conducted a systematic review and a prospective study of 28 children undergoing surgical treatment for NSC. We analyzed 426 defects on the first computed tomography scan (1 year postoperative) and 132 defects on the second computed tomography scan (4.6 years postoperative). Statistical analysis was performed using Spearman's rank correlation coefficient, Mann–Whitney–Wilcoxon rank-sum test, and Youden's J statistic. RESULTS: Our systematic review identified three studies reporting on bone defects' surface area and reossification rate. In our study, we found no statistically significant differences in the number or size of defects between sex or type of NSC. The threshold value for the surface area of bone defects above which there was a higher probability of persistent defects was 0.19 cm2 (Youden point), with an 89.47 % probability of persistence. Defects with a surface area below 0.19 cm2 had a considerably lower probability, only 15.07%, of persistence over time. CONCLUSION: Our study provides valuable quantitative data for managing bone defects after NSC surgery. Defects with a surface area above 0.19 cm2 should be monitored with radiological imaging because of the risk of persistence. Our findings highlight the importance of developing robust and reproducible methods for the quantitative analysis of bone defects after NSC surgery.

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“…In children with facial-craniosynostosis functional complications might force anticipation of the time of craniofacial advancement [4][5][6][7][8].…”

Section: Discussionmentioning

confidence: 99%

Use of an Oral Device in the Stabilization of Facial Advancement after Early Removal of the Osteodistraction Device for Postoperative Sequelae

et al. 2020

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The aim of this study is to present an oral device that improves splanchnocranium stability after osteodistraction in children treated for correction of craniofacial malformations. When removal of the distraction device before the end of the treatment is necessary, the reposition of a new fixation system might not be possible. In these cases, regrown bone is immature, and relapse of malformation occurs frequently. We have been treating these cases by the application of an oral device named Maxillary Advancement Contention (MAC). MAC is used in every patient when any complication interrupts the protocol of osteodistraction before the end of the stabilization time. The device is placed immediately after the removal of the distraction device and left in place for at least three months. We used MAC in six children surgically treated for correction of craniosynostosis with facial or craniofacial advancement. To establish the relapse of malformation we analyzed relations Sella-Nasion-Orbitale (SNOr) and Sella-Nasion-A point (SNA) angles before application of the MAC and after one year. The analysis of stability was excellent in every patient. This device might help, with a minimally invasive procedure, to maintain the obtained advancement allowing stabilization of the regrown bone.

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Promoting ossification of calvarial defects in craniosynostosis surgery by demineralized bone plate and bone dust in different age groups

Cited by 7 publications

References 26 publications

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

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

Reossification of Bone Defects After Surgical Correction of Nonsyndromic Craniosynostosis: A Review and An Original Study

Use of an Oral Device in the Stabilization of Facial Advancement after Early Removal of the Osteodistraction Device for Postoperative Sequelae

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