Correction of Metopic Craniosynostosis Using Limited Incision Strip Craniectomy Versus Open Fronto-Orbital Reconstruction

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Michal Benkler ◽  
Rami R. Hallac ◽  
Emily L. Geisler ◽  
Alex A. Kane
Keyword(s):  
Orbital Reconstruction ◽  
Strip Craniectomy ◽  
Metopic Craniosynostosis

Quantitative outcomes of endoscopic strip craniectomy for metopic craniosynostosis in children with severe trigonocephaly

2020 ◽  
Author(s):  
Orgest Lajthia ◽  
Gary F. Rogers ◽  
Deki Tsering ◽  
Robert F. Keating ◽  
Suresh N. Magge
Keyword(s):  
Strip Craniectomy ◽  
Metopic Craniosynostosis

142 Current Surgeon Opinions Concerning the Indications for Surgery in Metopic Craniosynostosis

Neurosurgery ◽  
2017 ◽  
Vol 64 (CN_suppl_1) ◽  
pp. 233-234
Author(s):  
Kavelin Rumalla ◽  
Usiakimi Igbaseimokumo
Keyword(s):  
Online Survey ◽  
Pediatric Neurosurgery ◽  
Clinical Vignettes ◽  
Metopic Synostosis ◽  
Conflicting Evidence ◽  
The Future ◽  
Patient Prognosis ◽  
Strip Craniectomy ◽  
Increased Icp ◽  
Metopic Craniosynostosis

Abstract INTRODUCTION Metopic craniosynostosis lacks a defined threshold for surgery. We conducted a short online survey to determine if surgeon opinions reflected the current conflicting evidence in the literature. METHODS The survey was conducted using SurveyMonkey and recipients included members of the International Society for Pediatric Neurosurgery (N = 212). The survey consisted of 2 clinical vignettes of children with metopic craniosynostosis with 5 questions each. The first vignette featured a 1 year old girl presenting with a persistent metopic ridge with otherwise normal development and no signs of raised ICP. The second vignette featured a 1 month old boy with metopic synostosis but otherwise normal exam with soft anterior fontanelle and no raised ICP. The respondents were asked if surgery should be advised, reason for surgery (if advised), type of procedure recommended (if advised), likelihood of increased ICP in the future, and predicted prognosis in 10 years if no surgery performed. RESULTS >We received 75 responses from pediatric neurosurgeons, with the majority (41.4%) having 20 + years in practice. For vignette #1, the majority (94.5%) did not suggest surgery and 67.6% of them were not concerned about increased ICP in the future. However, only 46.5% of respondents against surgery believed the ridge would improve in 10 years, whereas 49.3% thought it would remain unchanged. In vignette #2, 93.0% of surgeons advised surgery and the reasons for advising surgery varied: appearance (60.6%), developmental delay concern (15.2%), and increased ICP (10.6%). Most surgeons suggested an open procedure (71.2%) over endoscopy assisted strip craniectomy (28.8%). The majority rated the likelihood of raised ICP as <10% (37.1%), with the minority suggesting 10–24% (25.7%), 25–50% (15.7%), and 51–100% (4.3%). CONCLUSION While the majority of surgeons agreed upon surgery versus non-surgery in each case, we observed significant variations in opinions regarding reasons for proceeding with surgery, surgical approach, and patient prognosis.

scholarly journals Minimally invasive strip craniectomy for metopic craniosynostosis using a lighted retractor

2021 ◽  
Vol 4 (2) ◽  
pp. V5
Author(s):  
David S. Hersh ◽  
William A. Lambert ◽  
Markus J. Bookland ◽  
Jonathan E. Martin
Keyword(s):  
Minimally Invasive ◽  
Cost Effective ◽  
Transfusion Rate ◽  
Open Approach ◽  
Minimally Invasive Approach ◽  
Invasive Approach ◽  
Open Reconstruction ◽  
Surgical Options ◽  
Strip Craniectomy ◽  
Metopic Craniosynostosis

Surgical options for metopic craniosynostosis include the traditional open approach or a minimally invasive approach that typically involves an endoscopy-assisted strip craniectomy. The minimally invasive approach has been associated with less blood loss and operative time, a lower transfusion rate, and a shorter length of stay. Additionally, it is more cost-effective than open reconstruction, despite the need for a postoperative cranial orthosis and multiple follow-up visits. The authors describe a variation of the minimally invasive approach using a lighted retractor to perform a strip craniectomy of the metopic suture in a 2-month-old patient with metopic craniosynostosis. The video can be found here: https://vimeo.com/511237503.

Pediatric Fronto-Orbital Skull Reconstruction

2021 ◽  
Author(s):  
Andrew M. Ferry ◽  
Rami P. Dibbs ◽  
Shayan M. Sarrami ◽  
Amjed Abu-Ghname ◽  
Han Zhuang Beh ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Facial Trauma ◽  
Limited Data ◽  
Significant Morbidity ◽  
Craniofacial Skeleton ◽  
Optimal Care ◽  
Orbital Reconstruction ◽  
Safety And Efficacy ◽  
The Central Nervous System ◽  
Orbital Region

AbstractCraniofacial surgery in children is a highly challenging discipline that requires extensive knowledge of craniofacial anatomy and pathology. Insults to the fronto-orbital skeleton have the potential to inflict significant morbidity and even mortality in patients due to its proximity to the central nervous system. In addition, significant aesthetic and ophthalmologic disturbances frequently accompany these insults. Craniosynostosis, facial trauma, and craniofacial tumors are all pathologies that frequently affect the fronto-orbital region of the craniofacial skeleton in children. While the mechanisms of these pathologies vary greatly, the underlying principles of reconstruction remain the same. Despite the limited data in certain areas of fronto-orbital reconstruction in children, significant innovations have greatly improved its safety and efficacy. It is imperative that further investigations of fronto-orbital reconstruction are undertaken so that craniofacial surgeons may provide optimal care for these patients.

scholarly journals Regression of cephalic index following endoscopic repair of sagittal synostosis

2019 ◽  
Vol 23 (1) ◽  
pp. 54-60
Author(s):  
Nicholas A. Pickersgill ◽  
Gary B. Skolnick ◽  
Sybill D. Naidoo ◽  
Matthew D. Smyth ◽  
Kamlesh B. Patel
Keyword(s):  
Time Course ◽  
Strong Positive Correlation ◽  
Cephalic Index ◽  
Sagittal Synostosis ◽  
Endoscopic Repair ◽  
Future Studies ◽  
Helmet Therapy ◽  
Significant Regression ◽  
Strip Craniectomy

OBJECTIVEMetrics used to quantify preoperative severity and postoperative outcomes for patients with sagittal synostosis include cephalic index (CI), the well-known standard, and the recently described adjusted cephalic index (aCI), which accounts for altered euryon location. This study tracks the time course of these measures following endoscopic repair with orthotic helmet therapy. The authors hypothesize that CI and aCI show significant regression following endoscope-assisted repair.METHODSCT scans or 3D photographs of patients with nonsyndromic sagittal synostosis treated before 6 months of age by endoscope-assisted strip craniectomy and postoperative helmet therapy (n = 41) were reviewed retrospectively at three time points (preoperatively, 0–2 months after helmeting, and > 24 months postoperatively). The CI and aCI were measured at each time point.RESULTSMean CI and aCI increased from 71.8 to 78.2 and 62.7 to 72.4, respectively, during helmet treatment (p < 0.001). At final follow-up, mean CI and aCI had regressed significantly from 78.2 to 76.5 and 72.4 to 69.7, respectively (p < 0.001). The CI regressed in 33 of 41 cases (80%) and aCI in 39 of 41 cases (95%). The authors observed a mean loss of 31% of improvement in aCI achieved through treatment. A strong, positive correlation existed between CI and aCI (R = 0.88).CONCLUSIONSRegression following endoscope-assisted strip craniectomy with postoperative helmet therapy commonly occurs in patients with sagittal synostosis. Future studies are required to determine whether duration of helmet therapy or modifications in helmet design affect regression.

Early Development of Infants with Untreated Metopic Craniosynostosis

2005 ◽  
Vol 115 (6) ◽  
pp. 1518-1523 ◽  
Author(s):  
Seth Warschausky ◽  
Jeff Angobaldo ◽  
Donald Kewman ◽  
Steven Buchman ◽  
Karin M. Muraszko ◽  
...  
Keyword(s):  
Early Development ◽  
Metopic Craniosynostosis

En Bloc Resection of Lacrimal Sac Tumors and Simultaneous Orbital Reconstruction

2014 ◽  
Vol 30 (6) ◽  
pp. 459-467 ◽  
Author(s):  
Chrisfouad R. Alabiad ◽  
Donald T. Weed ◽  
Thomas J. Walker ◽  
Richard Vivero ◽  
Georges A. Hobeika ◽  
...  
Keyword(s):  
En Bloc Resection ◽  
Bloc Resection ◽  
Lacrimal Sac ◽  
En Bloc ◽  
Orbital Reconstruction

Endoscopically assisted versus open repair of sagittal craniosynostosis: the St. Louis Children's Hospital experience

2011 ◽  
Vol 8 (2) ◽  
pp. 165-170 ◽  
Author(s):  
Manish N. Shah ◽  
Alex A. Kane ◽  
J. Dayne Petersen ◽  
Albert S. Woo ◽  
Sybill D. Naidoo ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Blood Loss ◽  
Open Surgery ◽  
Operating Time ◽  
Endoscopic Procedure ◽  
Sagittal Craniosynostosis ◽  
Helmet Therapy ◽  
Age At Surgery ◽  
The Mean ◽  
Strip Craniectomy

Object This study investigated the differences in effectiveness and morbidity between endoscopically assisted wide-vertex strip craniectomy with barrel-stave osteotomies and postoperative helmet therapy versus open calvarial vault reconstruction without helmet therapy for sagittal craniosynostosis. Methods Between 2003 and 2010, the authors prospectively observed 89 children less than 12 months old who were surgically treated for a diagnosis of isolated sagittal synostosis. The endoscopic procedure was offered starting in 2006. The data associated with length of stay, blood loss, transfusion rates, operating times, and cephalic indices were reviewed. Results There were 47 endoscopically treated patients with a mean age at surgery of 3.6 months and 42 patients with open-vault reconstruction whose mean age at surgery was 6.8 months. The mean follow-up time was 13 months for endoscopic versus 25 months for open procedures. The mean operating time for the endoscopic procedure was 88 minutes, versus 179 minutes for the open surgery. The mean blood loss was 29 ml for endoscopic versus 218 ml for open procedures. Three endoscopically treated cases (6.4%) underwent transfusion, whereas all patients with open procedures underwent transfusion, with a mean of 1.6 transfusions per patient. The mean length of stay was 1.2 days for endoscopic and 3.9 days for open procedures. Of endoscopically treated patients completing helmet therapy, the mean duration for helmet therapy was 8.7 months. The mean pre- and postoperative cephalic indices for endoscopic procedures were 68% and 76% at 13 months postoperatively, versus 68% and 77% at 25 months postoperatively for open surgery. Conclusions Endoscopically assisted strip craniectomy offers a safe and effective treatment for sagittal craniosynostosis that is comparable in outcome to calvarial vault reconstruction, with no increase in morbidity and a shorter length of stay.

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