Surgical Treatment of Nonsyndromic Craniosynostosis

Abstract

Studies on the treatment of nonsyndromic craniosynostosis demonstrate decreasing morbidity and mortality; however, complication rates still range from 5% to 14%. Here, the authors present their last 10 years' experience treatment of nonsyndromic single suture craniosynostosis. A retrospective review was performed on patients who underwent open surgical treatment of nonsyndromic craniosynostosis over 10 years. Patient characteristics and clinical outcomes were reviewed. Radiological analysis of intracranial volumes was performed using Amira software. The authors' technique for treatment of sagittal synostosis was the Foreshortening and Lateral Expansion of the Cranium Activated by Gravity (FLAG) procedure. The authors identified 106 patients with a median age of 0.8 years. Sagittal synostosis was most common (n = 65, 61%). Seventeen percent underwent distraction of the cranial vault; the remainder underwent traditional remodeling procedures. The average operative time was 131 minutes, blood loss was 296 mL (30 mL/kg), and intraoperative transfusion was 332 mL (34 mL/kg). There were 2 postoperative complications. Six patients required an additional major operation years later, most commonly for increased intracranial pressure. The authors separately analyzed 50 patients with sagittal synostosis treated with the FLAG procedure. There were no postoperative complications, and only 4 patients required reoperation. The average operative time for the FLAG procedure was 97.3 minutes. Intracranial volume increased by 191.45 mL (28.3-427.5 mL) with 28% average relative cranial vault expansion (4.5%-93.2%). Surgical correction of craniosynostosis using the FLAG technique is safe and effective with minimal morbidity and long standing results. Treatment should involve a structured approach, which minimizes operative times and decreases complication rates.

Cranial Vault Distraction in Nonsyndromic Sagittal Synostosis

“…The mean percentage increase was 17%. Although this is less than the figure reported by Klement et al 21 in their study of nonsyndromic craniosynostosis, only 17% of patients described underwent distraction, and other sutures were involved in 39% of cases. Similarly only 4 of the 14 patients included in Sulong et al's 22 study of volumes had sagittal synostosis.…”

Systematic Review of the Clinical and Experimental Research Assessing the Effects of Craniosynostosis on the Brain

“…In turn, this serves as an argument in favor of early surgical intervention to relieve intracranial tension. [6][7][8][9][10][11][12][13] Although surgical approaches have been consolidated as an efficient way to avoid serious consequences in brain development in patients with CS, some reports have identified subtle neurocognitive deficits in patients even after cranial reconstruction secondary to CS during childhood; these reports also described visual-spatial deficits, language impairment, and behavioral problems, reinforcing the argument that the goal of the surgical treatment of this disease is cosmetic. [14][15][16][17][18][19] Moreover, a paucity of studies were published to date that clarified the etiopathogenesis of CS on the brain microstructure and its connectivity, to address the controversy mentioned above.…”

“…In addition, intracranial pression becomes persistently high because of CS, which causes brain injury and neurocognitive problems. In turn, this serves as an argument in favor of early surgical intervention to relieve intracranial tension 6–13…”

Endoscopic Versus Open Total Vault Reconstruction of Sagittal Craniosynostosis

“…Small areas of excess space are created by this re-organizing procedure and the growing brain fills such space. 13 Despite significant advances in surgical technique, fixation methods and anesthesia, total cranial vault reconstruction has a well-documented relatively high rate of blood loss requiring transfusion, prolonged hospital, and intensive care stay. [14][15][16][17] Endoscopic suturectomy, first reported in the literature in 1998, as advances in minimally invasive surgery continues to evolve.…”

“…The reshaped bony segments are stabilized by means of internal fixation. Small areas of excess space are created by this re-organizing procedure and the growing brain fills such space 13 . Despite significant advances in surgical technique, fixation methods and anesthesia, total cranial vault reconstruction has a well-documented relatively high rate of blood loss requiring transfusion, prolonged hospital, and intensive care stay 14–17 …”