Referral pattern and surgical outcome of sagittal synostosis

Chatterjee, Justin S.; Mahmoud, Mahtab; Karthikeyan, S.; Duncan, Christian A.; Dover, M.S.; Nishikawa, Hiroshi

doi:10.1016/j.bjps.2007.10.042

Cited by 23 publications

(22 citation statements)

References 17 publications

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“…28,36,37 The findings of this study support this view. Infants who had an MSC at 6 months of age or younger enjoyed a significantly greater increase in CI than those that were older than 6 months at surgery (Fig.…”

Section: Discussionsupporting

confidence: 90%

“…As a result of the difference in presenting CI in the MSC groups, as well as previously published evidence that age at operation may influence morphological outcomes in MSC, the results of the 2 groups (MSCi and MSCii) were considered separately and in combination. 28,36,37 Cephalic Index All surgical groups demonstrated a clinically appreciable and statistically significant improvement in CI after surgery (Table 1; Fig. 1).…”

Section: Patientsmentioning

confidence: 86%

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Long-Term Morphological Outcomes in Nonsyndromic Sagittal Craniosynostosis

Thomas

Johnson

Byren

et al. 2015

Journal of Craniofacial Surgery

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Correction of scaphocephaly is one of the principle goals of surgery in sagittal craniosynostosis. Reported relapse in head shape after surgery and continued head growth into late adolescence underscores the need for long-term outcomes to be considered when comparing between different surgical approaches in this condition; yet there are relatively few reports of results to 5 years and beyond in the literature. Therefore, a retrospective review was performed of the anthropometric data of 224 patients with sagittal craniosynostosis who underwent primary surgery between 1994 and 2012. During this period, patients underwent either a modified strip craniectomy (MSC) or calvarial remodeling (CR) procedure. Sixty-two patients were treated by MSC and followed up for a mean of 44 months. One hundred sixty-two patients had CR, with follow-up for a mean of 45 months. Overall, 90 patients were seen up to 5 years, and 47 patients to 9 years or more after surgery. The cephalic index (CI) of MSC-treated patients improved from a mean of 67.0 to 72.7, with 31% achieving a CI greater than 75 at one year. Calvarial remodeling was significantly more effective at correcting the scaphocephalic deformity. Patients treated with CR improved from a mean CI of 66.7 to 76.1. Sixty-two percent of the patients achieved a CI greater than 75. In both groups, outcomes were stable throughout follow-up with no significant relapse up to 14 years after surgery.

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Section: Discussionsupporting

confidence: 90%

Section: Patientsmentioning

confidence: 86%

Long-Term Morphological Outcomes in Nonsyndromic Sagittal Craniosynostosis

Thomas

Johnson

Byren

et al. 2015

Journal of Craniofacial Surgery

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“…Surgical complications can include infection, encephalocele, hydrocephalus, dura mater compromise, hematoma, cerebrospinal fluid leaks, and post-operative resynostosis. Risk of each of these complications increases with multiple surgeries, which are often necessary in severe cases (9-15). …”

Section: Introductionmentioning

confidence: 99%

Molecular Analysis of Coronal Perisutural Tissues in a Craniosynostotic Rabbit Model Using Polymerase Chain Reaction Suppression Subtractive Hybridization

Cray

Gallo

Durham

et al. 2011

Plastic and Reconstructive Surgery

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Background In the United States the incidence of craniosynostosis (premature fusion of the sutures of the cranial vault) is 1 in 2,000-3,000 live births. The condition can cause increased intracranial pressure, severely altered head shape, and mental retardation. We have previously described a colony of rabbits with heritable coronal suture synostosis. This model has been instrumental in describing the post-surgical craniofacial growth associated with craniosynostosis. The molecular analysis of this model has been limited by the lack of molecular tools for use in rabbits. In order to understand the pathogenesis of craniosynostosis, we compared gene expression in perisutural tissues between wild-type (WT) and craniosynostotic (CS) rabbits using polymerase chain reaction-suppression subtractive hybridization (PCR SSH). Methods PCR SSH was performed on RNA derived from pooled samples of calvariae from 10-day old WT (n=3) and CS (n=3) rabbits to obtain cDNA clones that are either enriched in WT tissues (underexpressed in CS tissue) or enriched in CS tissues (overexpressed in CS compared to WT). Results Differential expression was identified for approximately 140 recovered cDNA clones upregulated in CS tissues and 130 recovered clones for WT tissues. Of these, four genes were confirmed by quantitative reverse-transcriptase (RT)-PCR as being overexpressed in CS sutural tissue: β-globin, osteopontin (SPP1), SPARC, and cathepsin K (CTSK). Two genes were confirmed to be underexpressed in the CS samples: COL3A1 and RNF12. Conclusions The differential expression of these gene products in our naturally occurring CS model appears to be the result of differences in the normal bone formation/resorption pathway.

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“…30,32,56 Most patients present in infancy or early childhood with a scaphocephalic head shape and associated calvarial abnormalities. 10 Historically this morphological deformity alone has been a sufficient indication for corrective transcranial surgery. Furthermore, it is now recognized that raised intracranial pressure (ICP) occurs in this group of patients, with an estimated preoperative incidence between 4.5% and 24%.…”

mentioning

confidence: 99%

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

Wall¹,

Thomas²,

Johnson³

et al. 2014

PED

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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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Referral pattern and surgical outcome of sagittal synostosis

Cited by 23 publications

References 17 publications

Long-Term Morphological Outcomes in Nonsyndromic Sagittal Craniosynostosis

Long-Term Morphological Outcomes in Nonsyndromic Sagittal Craniosynostosis

Molecular Analysis of Coronal Perisutural Tissues in a Craniosynostotic Rabbit Model Using Polymerase Chain Reaction Suppression Subtractive Hybridization

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

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