Sagittal synostosis: results of surgical treatment in 210 patients

Álvarez-Garijo, José A.; Cavadas, Pedro C.; Vila, Manuel Mesa; Álvarez-Llanas, Alejandro

doi:10.1007/s003810000353

Cited by 47 publications

(48 citation statements)

References 12 publications

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“…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.…”

Section: Discussionsupporting

confidence: 85%

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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Section: Discussionsupporting

confidence: 85%

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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“…Morphological outcome studies indicate that variants of open vertex strip craniectomy often result in a residual scaphocephalic deformity, with a cephalic index ranging from 70 to 74, frequently below the population norm. 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.…”

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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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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“…The Sshape skin incision allowed for sufficient operative fields. The plasticity of the infant cranial vault is an important factor in this surgical technique 2) . The authors previously suggested that infantile calvarial normalization using a non-fixed procedure is…”

Section: Resultsmentioning

confidence: 99%

“…Scaphocephaly, which is the most common type of craniosynostosis, accounts for approximately 40 to 60% of the isolated suture synostosis, and occurs in 1 in 5,000 children at birth 2,5,8,18,26,27) . Numerous techniques have been used to correct scaphocephaly in infants including bilateral strip craniectomy, wide-strip craniectomy, the π procedure, total vertex craniectomy, endoscopic craniectomy and cranial vault remodeling with parietal flap cranioplasties 3,4,6,7,10,11,[13][14][15]17,18,20,22,23,[25][26][27][28][29][30] .…”

Section: Introductionmentioning

confidence: 99%

Immediate Spontaneous Shape Correction Using Expantile Zigzag Craniectomy in Infantile Scaphocephaly -Is There an Improvement in the Developmental Quotient Following Surgery?-

Kim

2011

J Korean Neurosurg Soc

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Sagittal synostosis: results of surgical treatment in 210 patients

Cited by 47 publications

References 12 publications

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

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

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

Immediate Spontaneous Shape Correction Using Expantile Zigzag Craniectomy in Infantile Scaphocephaly -Is There an Improvement in the Developmental Quotient Following Surgery?-

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