Three-dimensional changes in head shape after extended sagittal strip craniectomy with wedge ostectomies and helmet therapy

Abstract

<jats:sec><jats:title>OBJECTIVE</jats:title><jats:p>Outcome studies for sagittal strip craniectomy have largely relied on the 2D measure of the cephalic index (CI) as the primary indicator of head shape. The goal of this study was to measure the 2D and 3D changes in head shape that occur after sagittal strip craniectomy and postoperative helmet therapy.</jats:p></jats:sec><jats:sec><jats:title>METHODS</jats:title><jats:p>The authors performed a retrospective review of patients treated with sagittal strip craniectomy at their institution between January 2012 and October 2015. Inclusion criteria were as follows: 1) isolated sagittal synostosis; 2) age at surgery &lt; 200 days; and 3) helmet management by a single orthotist. The CI was calculated from 3D images. Color maps and dot maps were generated from 3D images to demonstrate the regional differences in the magnitude of change in head shape over time.</jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p>Twenty-one patients met the study inclusion criteria. The mean CI was 71.9 (range 63.0–77.9) preoperatively and 81.1 (range 73.0–89.8) at the end of treatment. The mean time to stabilization of the CI after surgery was 57.2 ± 32.7 days. The mean maximum distances between the surfaces of the preoperative and 1-week postoperative and between the surfaces of the preoperative and end-of-treatment 3D images were 13.0 ± 4.1 mm and 24.71 ± 6.83 mm, respectively. The zone of maximum change was distributed equally in the transverse and vertical dimensions of the posterior vault.</jats:p></jats:sec><jats:sec><jats:title>CONCLUSIONS</jats:title><jats:p>The CI normalizes rapidly after sagittal strip craniectomy (57.2 days), with equal distribution of the change in CI occurring before and during helmet therapy. Three-dimensional analysis revealed significant vertical and transverse expansion of the posterior cranial vault. Further studies are needed to assess the 3D changes that occur after other sagittal strip craniectomy techniques.</jats:p></jats:sec>

Comparison of Head Shape Outcomes in Metopic Synostosis Using Limited Strip Craniectomy and Open Vault Reconstruction Techniques

“…Which intervention a surgeon chooses to treat MCS with is related to the child’s age at presentation, the surgeon’s training and comfort level with a particular technique, opinions regarding efficacy and durability of outcome, and potential morbidities. Although the purpose of this work was not to delve into all of these, there exists significant evidence to suggest that for sagittal craniosynostosis, LISC results in outcomes that are equivalent or superior to open vault procedures (OCVR) in terms of shape outcome, morbidity, and stress on the child (lower operative blood loss, shorter lengths of anesthesia hospital stay, lesser amounts of swelling and scar burden, and lower overall cost) (Jimenez and Barone, 1998; Barone and Jimenez, 1999; Shah et al, 2011; Jimenez and Barone, 2012; Le et al, 2014; Han et al, 2016; Chou et al, 2017; Goyal et al, 2018). In our study, one surgeon performed 8 LISC procedures, another surgeon performed 2, and a third surgeon performed one.…”

“…The template was deformed to each 3D patient scan using 2 mathematical techniques: thin-plate spline algorithm and closest point deformation. Composite head was calculated by obtaining the average of all the deformed templates for each surgical technique using techniques previously described by our group (Chou et al, 2017; Hallac et al, 2019).…”

“…Yet the reduction in the complex shape of the forehead to a single measurement is similar to reducing the shape changes that occur in sagittal synostosis to a single number such as cranial index. Our group has previously studied the rich data provided by modern imaging modalities such as computed tomography (CT) and threedimensional (3D) photography, and how cranial index is not adequately descriptive (Chou et al, 2017).…”

Diagnosis and treatment of positional plagiocephaly

“…Surgical treatment is very effective in cases of plagiocephaly with craniosynostosis, and various surgical methods are available [12,[52][53][54][55]. However, many studies report that, since there are many cases of recurrence and changes in the shape of the skull after surgery, helmet treatment after surgical treatment, such as craniotomy and distraction osteogenesis of the cranium, is beneficial [7,14,17,[55][56][57][58]. Helmet treatment after surgery does not limit cranial growth and shows excellent functional and cosmetic results in remodeling of the skull shape.…”

“…Postoperative helmet treatment can aid in allowing the skull and brain grow normally. The average duration of the treatment is 6-12 months and the treatment is generally continued till the age of 12-18 months [7,14,17,[55][56][57][58].…”