Utility of Preoperative Helmet Molding Therapy in Patients With Isolated Sagittal Craniosynostosis

Abstract

The purpose of this study was to review our institution's experience using helmet molding therapy in children with isolated non-syndromic sagittal craniosynostosis before placement of cranial springs and provide objective measurements of craniometric changes to help determine its role in treatment.Patients who underwent preoperative helmet molding therapy for sagittal craniosynostosis were retrospectively reviewed. Three-dimensional surface tomography scans were used to measure head circumference, cranial width, cranial length, cranial index (CI), and cranial vault asymmetry.Seventeen patients underwent orthotic helmeting therapy before spring mediated cranial vault expansion. Patients spent a median of 48 days (interquartile range [IQR] 32, 57) in preoperative orthotic helmeting therapy. There were increases in both cranial width and length post-helmeting (median: 107.5 mm [IQR 104.8, 110.4] versus 115.6 mm [IQR 114.5, 119.3]; P < 0.001) (median: 152.8 mm [IQR 149.2, 154.9] versus 156.8 mm [IQR 155.0, 161.5]; P < 0.001), respectively. There was a greater increase in cranial width (P ¼ 0.015). Consequently, patients' CI improved after preoperative helmeting (median: 0.702 [IQR 0.693, 0.717] versus 0.739 [0.711, 0.752]; P < 0.001). There was no evidence of growth restriction from helmeting (pre-helmeting Head circumference [HC]: median 96.8 percentile [IQR 90.6, 99.9] versus post-helmeting HC: 98.7 percentile [IQR 94.7, 99.8]; P ¼ 0.109).Preoperative helmeting in patients with non-syndromic isolated sagittal craniosynostosis can be used to improve CI before surgical correction. Significant benefits can be achieved in shorter preoperative helmeting durations than previously reported with no evidence of cranial growth restriction, which supports its feasibility and utility in children undergoing spring mediated cranial vault expansion.

Denominator of Cranial Vault Asymmetry Index: Choosing Between Longer and Shorter Diagonal Lengths

“…We excluded 39 articles that did not list the CVAI denominator (including those without a long/short description, those with only the description “percent difference,” those with only the description “modified CVAI,” and those with the description “unaffected side”). Finally, 20 articles published from 8 institutions were organized 3–10. The institute with the highest number of publications (n=4) was the Department of Prosthetics-Orthotics, University of Texas Southwestern Medical Center, Texas, United States (using LD denominator) 4…”

“…A total of 30 original articles (Supplemental Table 1, Supplemental Digital Content 1, http://links.lww.com/SCS/E869) matched the inclusion criteria 3–32. There were 10 articles with LD denominators and 20 articles with SD denominators.…”

“…Finally, 20 articles published from 8 institutions were organized. [3][4][5][6][7][8][9][10] The institute with the highest number of publications (n = 4) was the Department of Prosthetics-Orthotics, University of Texas Southwestern Medical Center, Texas, United States (using LD denominator). 4 A total of 30 original articles (Supplemental Table 1, Supplemental Digital Content 1, http://links.lww.com/SCS/ E869) matched the inclusion criteria.…”

“…The number of papers by the same facility using the LD denominator was also considered a factor. [3][4][5][6] Several articles published in recent years do not cite Loveday et al 1 in their CVAI formulae; some of these used the LD in the denominator. 37,38 It was considered that the dilemma regarding the CVAI formula may have been further complicated by inconsistent citations.…”

“…CT also allows 3-dimensional visualization of bone, 3,4 with the bone mineral density expressed in HU. 5,6 CT has been used for the objective quantification of bone mineral density. The previous CT study suggested that a functional adaptive response of the mandible to mechanical stress derived from mastication occurred in the muscle as well as the bone in the molar region.…”