Spring-Assisted Cranioplasty vs Pi-Plasty for Sagittal Synostosis-A Long Term Follow-Up Study

Windh, Per; Davis, Charles R.; Sanger, Claire; Sahlin, Pelle; Lauritzen, Christian

doi:10.1097/scs.0b013e31815c94c8

Cited by 95 publications

(121 citation statements)

References 6 publications

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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%

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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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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.…”

mentioning

confidence: 99%

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

Rottgers

Lohani

Proctor

2016

PED

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“…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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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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“…For this data set, only the papers providing total number, mean, and standard deviation of the relevant factors were included for statistical analysis. 8,16,22,25,27 The cranial index was collected preoperatively using CT scans to report the ratio of maximal biparietal distance over maximal occipitofrontal distance multiplied by 100. Postoperatively, cephalograms were used to obtain the biparietal distance and occipitofrontal distance of patients who had springs implanted for more than 2 months.…”

Section: Methods Data Collectionmentioning

confidence: 99%

“…15 Since its introduction, spring-mediated treatment of sagittal synostosis has been evaluated at multiple institutions with reasonable results. 3,4,8,16,17,22,25,27 At the Children's Hospital of Philadelphia (CHOP), we use a modification of the spring-mediated cranioplasty (SMC) technique to treat sagittal synostosis without the prolonged use of an external orthosis. In this report we present our recent results of SMC, including our modifications of the technique.…”

mentioning

confidence: 99%

Spring-mediated sagittal craniosynostosis treatment at the Children’s Hospital of Philadelphia: technical notes and literature review

Arko

Swanson

Fierst

et al. 2015

FOC

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OBJECT Sagittal craniosynostosis has been treated using both cranial remodeling techniques and modification of the sagittal strip craniectomy. A more recent technique is to implant springs in conjunction with a suturectomy to transversely expand the parietal bones to accommodate the growing brain. In this paper the authors describe and evaluate several modifications to the spring-mediated cranioplasty (SMC) technique, most notably use of an ultrasonic scalpel to limit dural dissection and maximize opening of the stenosed suture by placement of multiple spring devices. In addition, the literature is reviewed comparing SMC to other surgical treatments of sagittal synostosis. METHODS The authors retrospectively reviewed patients who presented to the Children’s Hospital of Philadelphia with a diagnosis of sagittal synostosis from August 2011 to November 2014. A pooled data set was created to compare our institutional data to previously published work. A comprehensive literature review was performed of all previous studies describing the SMC technique, as well as other techniques for sagittal synostosis correction. RESULTS Twenty-two patients underwent SMC at our institution during the study period. Patients were 4.2 months of age on average, had a mean blood loss of 56.3 ml, and average intensive care unit and total hospital stays of 29.5 hours and 2.2 days, respectively. The cranial index was corrected to an average of 73.7 (SD 5.2) for patients who received long-term radiological follow-up. When comparing the authors’ institutional data to pooled SMC data, blood loss and length of stay were both significantly less (p = 0.005 and p < 0.001, respectively), but the preoperative cranial index was significantly larger (p = 0.01). A review of the SMC technique compared with other techniques to actively expand the skull of patients with sagittal synostosis demonstrated that SMC can be performed at a significantly earlier age compared with cranial vault reconstruction (CVR). CONCLUSIONS The authors found that their institutional modifications of the SMC technique were safe and effective in correcting the cranial index. In addition, this technique can be performed at a younger age than CVRs. SMC, therefore, has the potential to maximize the cognitive benefits of early intervention, with lower morbidity than the traditional CVR.

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Spring-Assisted Cranioplasty vs Pi-Plasty for Sagittal Synostosis-A Long Term Follow-Up Study

Cited by 95 publications

References 6 publications

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

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

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

Spring-mediated sagittal craniosynostosis treatment at the Children’s Hospital of Philadelphia: technical notes and literature review

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