Timing of cranial vault remodeling in nonsyndromic craniosynostosis: a single-institution 30-year experience

Utria, Alan F.; Lopez, Joseph; Cho, Regina S.; Mundinger, Gerhard S.; Jallo, George I.; Ahn, Edward S.; Kolk, Craig Vander; Dorafshar, Amir H.

doi:10.3171/2016.5.peds1663

Cited by 26 publications

(24 citation statements)

References 30 publications

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“…Our median preoperative cephalic index is lower than that reported in many other series, reflecting the severity of disease addressed in this series as well as the relatively advanced median age (3.7 months), while our postoperative cephalic index is well within the range of that achieved in other series. 3,9,27,34,36,37,41 However, while cephalic index is a useful 2D objective data point, we believe it does not reflect the entirety of potential aesthetic issues observed in these children, such as frontal bossing and occipital tapering, that reflect the complex 3D nature of this deformity. The development of metrics that better capture the 3D nature of craniosynostosis and additional studies aimed at specifically capturing and quantifying aesthetic outcomes will hopefully allow for more rigorous comparison of different surgical techniques in the future.…”

Section: Discussionmentioning

confidence: 92%

Endoscopic surgery for nonsyndromic craniosynostosis: a 16-year single-center experience

Ore

Dilip

Brandel

et al. 2018

Journal of Neurosurgery: Pediatrics

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OBJECTIVEIn this paper the authors review their 16-year single-institution consecutive patient experience in the endoscopic treatment of nonsyndromic craniosynostosis with an emphasis on careful review of any associated treatment-related complications and methods of complication avoidance, including preoperative planning, intraoperative management, and postoperative care and follow-up.METHODSA retrospective chart review was conducted on all patients undergoing endoscopic, minimally invasive surgery for nonsyndromic craniosynostosis at Rady Children’s Hospital from 2000 to 2015. All patients were operated on by a single neurosurgeon in collaboration with two plastic and reconstructive surgeons as part of the institution’s craniofacial team.RESULTSTwo hundred thirty-five patients underwent minimally invasive endoscopic surgery for nonsyndromic craniosynostosis from 2000 to 2015. The median age at surgery was 3.8 months. The median operative and anesthesia times were 55 and 105 minutes, respectively. The median estimated blood loss (EBL) was 25 ml (median percentage EBL 4.2%). There were no identified episodes of air embolism or operative deaths. One patient suffered an intraoperative sagittal sinus injury, 2 patients underwent intraoperative conversion of planned endoscopic to open procedures, 1 patient experienced a dural tear, and 1 patient had an immediate reexploration for a developing subgaleal hematoma. Two hundred twenty-five patients (96%) were admitted directly to the standard surgical ward where the median length of stay was 1 day. Eight patients were admitted to the intensive care unit (ICU) postoperatively, 7 of whom had preexisting medical conditions that the team had identified preoperatively as necessitating a planned ICU admission. The 30-day readmission rate was 1.7% (4 patients), only 1 of whom had a diagnosis (surgical site infection) related to their initial admission. Average length of follow-up was 2.8 years (range < 1 year to 13.4 years). Six children (< 3%) had subsequent open procedures for perceived suboptimal aesthetic results, 4 of whom (> 66%) had either coronal or metopic craniosynostosis. No patient in this series either presented with or subsequently developed signs or symptoms of intracranial hypertension.CONCLUSIONSIn this large single-center consecutive patient series in the endoscopic treatment of nonsyndromic craniosynostosis, significant complications were avoided, allowing for postoperative care for the vast majority of infants on a standard surgical ward. No deaths, catastrophic postoperative morbidity, or evidence of the development of symptomatic intracranial hypertension was observed.

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Section: Discussionmentioning

confidence: 92%

Endoscopic surgery for nonsyndromic craniosynostosis: a 16-year single-center experience

Ore

Dilip

Brandel

et al. 2018

Journal of Neurosurgery: Pediatrics

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“…According to previous reports, the incidence of repeat surgery widely varied from 0% to 39% (Table 4). 19,20,[22][23][24][25][26][27] However, the previous reports included short-term follow-up of patients, and the average follow-up period was 4.4-13.2 years, which is much shorter than that in this study. It is difficult to conclude the incidence of repeat surgery for craniosynostosis according to such short-term follow-up studies.…”

Section: Repeat Surgerymentioning

confidence: 59%

“…Based on previous reports, the patients who underwent initial surgery before 6 months of age were more likely to undergo repeat surgery compared with those aged 6 months or older (18-62% vs. 11-12%, respectively). 19,24) Actually, Utria et al (2015) recommended that the initial surgery should be performed between 6 and 9 months of age in syndromic patients. 23) These findings are consistent with our results.…”

Section: Repeat Surgerymentioning

confidence: 99%

“…17) Although many surgical procedures have been introduced in the past four decades, 18) there are few reports on long-term postoperative outcomes in craniosynostosis. [19][20][21][22][23][24][25][26][27] Furthermore, there are almost no reports that denote the procedures for optimizing longterm outcomes in syndromic and non-syndromic cases, although outcomes may differ between the two types of the disease. Therefore, in this study, we retrospectively analyzed the long-term outcomes of children with craniosynostosis who were followed for at least 5 years after surgery and attempted to determine the prognosis in syndromic and non-syndromic groups.…”

Section: Introductionmentioning

confidence: 99%

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Long-term Outcomes of Non-syndromic and Syndromic Craniosynostosis: Analysis of Demographic, Morphologic, and Surgical Factors

Akai

Yamashita

Shiro

et al. 2022

Neurol. Med. Chir.(Tokyo)

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In this study, we analyzed the outcomes of patients (followed for 5-38 years, average 17.3 years) with craniosynostosis and evaluated their long-term prognosis. In all, 51 patients who underwent surgery for craniosynostosis between 1982 and 2015, including 12 syndromic and 39 non-syndromic cases, were included. The average age at the initial surgery was significantly lower in the syndromic group than that in the non-syndromic group (9.8 months old vs. 19.9 months, respectively). The surgical procedures did not significantly differ between the two groups, but repeat surgery was significantly more common in the syndromic group than in the non-syndromic group (4 children [30.8%] and 3 children [7.7%], respectively). The children requiring repeat surgery tended to be younger at the initial surgery than those who did not. Those patients who required repeat surgery did not have significantly different surgical procedures initially. The incidence of developmental retardation was 49.0% (43.5% in the non-syndromic group and 66.7% in the syndromic group), and only two children in the non-syndromic group displayed recovery. This study is the first to analyze the prognosis for patients who were followed for at least 5 years after cranioplasty. Repeat surgery was common, especially in syndromic patients. Severity of skull deformity and early initial surgery may be important factors determining the need for repeat surgery. Developmental retardation was also common, and improvement was rare even after surgery.

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“…Each of the 4 time points is compared individually. Each technique has a different operative age; approximately 3 months for LISC and 9 months for OCVR (Utria et al, 2016; Jimenez et al, 2018). The difference between vectors was individually calculated and integrated to understand the total difference between the LISC forehead arc and OCVR forehead arc for each time point.…”

Section: Resultsmentioning

confidence: 99%

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

Pressler

Hallac

Geisler

et al. 2020

The Cleft Palate-Craniofacial Journal

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Aim: Metopic craniosynostosis (MCS), with its trigonocephalic head shape, is often treated with either limited incision strip craniectomy (LISC) followed by helmet orthotic treatment, or open cranial vault reconstruction techniques (OCVR). There is controversy regarding resultant shape outcomes among craniofacial surgeons. Those adverse to LISC claim normal head shape is never attained, while proponents believe there is gradual correction to an equivalent outcome. This study aims to quantitate, over time, the three-dimensional (3D) head shapes in patients who have undergone LISC or OCVR intervention for MCS. Methods: Sixty-three 3D images of 26 patients with MCS were analyzed retrospectively. Head shape analyses were performed at: (1) preoperative, (2) 1-month postoperative, (3) 10 to 14 months postoperative (1 year), and (4) 2 years postoperative. Composite 3D head shapes of patients were compared at each time point. Two-dimensional (2D) standardized cross sections of the forehead were also compared. Results: Composite head shapes for both groups were nested, to allow visual comparison as the child’s forehead grows and expands. The difference between LISC and OCVR 2D cross sections was calculated; 108.26 mm preoperatively, 127.18 mm after 1-month postoperative, 51.05 mm after 10 to 14 months postoperative, and 27.03 mm after 2 years postoperative. Conclusions: This study found excellent head shape outcomes for both the LISC and OCVR techniques at 2 years of age. It also corroborates the slow and progressive improvement in head shape with the LISC technique. This study highlights the advantages of 3D photography for measurement of contour outcomes, utilizing both 2D vector and 3D whole head analytical techniques.

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Timing of cranial vault remodeling in nonsyndromic craniosynostosis: a single-institution 30-year experience

Cited by 26 publications

References 30 publications

Endoscopic surgery for nonsyndromic craniosynostosis: a 16-year single-center experience

Endoscopic surgery for nonsyndromic craniosynostosis: a 16-year single-center experience

Long-term Outcomes of Non-syndromic and Syndromic Craniosynostosis: Analysis of Demographic, Morphologic, and Surgical Factors

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

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