Quantitative Morphometric Outcomes Following the Melbourne Method of Total Vault Remodeling for Scaphocephaly

Abstract

The Melbourne method of total vault remodeling was developed at The Royal Children's Hospital (Melbourne) to address all phenotypic aspects of scaphocephaly. To quantitatively evaluate this technique, a retrospective analysis was performed on 33 consecutive patients who underwent the Melbourne procedure between October 2004 and June 2007. To monitor outcomes, three-dimensional digital surface photography was used, obtaining 4 anthropometric measurements (cranial length, cranial width, head circumference, auricular head height) preoperatively and postoperatively. To assess the effect on continuing cranial vault development, cranial volume was calculated with computed tomography. Anthropometric measurements were obtained in 27 patients (81.8%), with a mean postoperative follow-up of 8.9 months. Cranial index (width/length) demonstrated an 11.1% improvement. The mean head circumference in the scaphocephaly group preoperatively remained larger than the normative population postoperatively, although the magnitude of difference was decreased, whereas the mean auricular head height demonstrated a 10.5% increase postoperatively, remaining higher than the normative population. Cranial volume was calculated in 30 patients (91%), with a mean postoperative follow-up of 7.9 months. This demonstrated that the mean intracranial volume was significantly higher in the scaphocephaly group preoperatively, and this difference was maintained postoperatively. These results support our belief that the Melbourne procedure is a technique that may be used to correct all phenotypic aspects of scaphocephaly, with no apparent evidence for a detrimental effect on cranial growth.

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

“…The initial postoperative CI of 75 or the 2-to 4-year postoperative CI of 73 was a good result, as compared with others. 2,4,6,12,15,18,22,23,[29][30][31][32]36,39,40,46,51 The decrease in CI that we observed over time is comparable to the limited available data on long-term outcome. 2,16 Adding a widening bridge complies with Fearon and colleagues' suggestion to overcorrect width to compensate for later growth restriction in that direction.…”

“…A postoperative decrease in HC to a level still larger than that in the normal population has been reported. 15,51 In the present study, HC was overcorrected since it increased from larger than normal before surgery to even larger after surgery. In the 2-3 years after surgery, HC decreased and stabilized around 0.88 SD.…”

“…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.…”

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

“…They also report that all patients showed a decreasing velocity of head growth relative to the normal population, with percentiles for head circumference decreasing between their first and second procedures. The clinical significance of this finding is questionable, as the phenomena of postsurgical decline in relative head circumference in SC is well recognized and widespread; 12,44,47 it is therefore probably unlikely to have a specific etiological role in the development of raised ICP.…”

“…2,5,19,29,31,47 Calvarial remodeling, by contrast, as a more extensive procedure allows a comprehensive correction of the deformity, which usually returns the cephalic index to the normal population mean. 15,26,40,44 We do not believe that raised ICP can simply be attributed to a poor morphological outcome in a minority of cases in an otherwise successful procedure. In data we have presented elsewhere, we found that the preoperative and immediate postoperative head circumference and cephalic index of patients who developed an abnormal ICP were indistinguishable from other patients treated by the same technique.…”