Modified Cephalic Index Measured at Superior Levels of the Cranium Revealed Improved Correction With Helmet Therapy for Patients With Sagittal Suture Craniosynostosis

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.

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Performance of minimally invasive sagittal synostectomy with supine patient positioning: technical note

Journal of Neurosurgery Pediatrics ◽

10.3171/2018.5.peds18200 ◽

2018 ◽

Vol 22 (4) ◽

pp. 344-347

Author(s):

Jonathan E. Martin ◽

Thomas Manning ◽

Markus Bookland ◽

Charles Castiglione

Keyword(s):

Minimally Invasive ◽

Prone Position ◽

Patient Positioning ◽

Technical Note ◽

Initial Experience ◽

Cephalic Index ◽

Sagittal Suture ◽

Surgical Time ◽

Head Holder ◽

Anesthetic Risk

OBJECTIVEMinimally invasive (MI) synostectomy with postoperative helmet orthosis is increasingly used in the management of sagittal craniosynostosis. Although the MI technique reduces or eliminates the need for access to the lateral skull surface, the modified prone/sphinx position remains popular. The authors present their initial experience with supine positioning for MI sagittal synostectomy.METHODSThe authors used supine positioning with the head turned laterally on a horseshoe head holder in 5 consecutive patients undergoing MI sagittal synostectomy.RESULTSResection of the sagittal suture from the anterior to posterior fontanel was accomplished in all patients. Surgical time averaged 70 minutes. No patient required transfusion. The posttreatment cephalic index averaged 83%.CONCLUSIONSInitial experience with supine positioning for MI sagittal synostectomy suggests that the technique can be used as an alternative to the modified prone position, with the potential to reduce anesthetic risk in these patients.

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The management of sagittal synostosis using endoscopic suturectomy and postoperative helmet therapy

Journal of Neurosurgery Pediatrics ◽

10.3171/2011.3.peds10418 ◽

2011 ◽

Vol 7 (6) ◽

pp. 620-626 ◽

Cited By ~ 66

Author(s):

Emily B. Ridgway ◽

John Berry-Candelario ◽

Ronald T. Grondin ◽

Gary F. Rogers ◽

Mark R. Proctor

Keyword(s):

Hospital Stay ◽

Head Circumference ◽

Length Of Hospital Stay ◽

Retrospective Chart Review ◽

Sagittal Suture ◽

Sagittal Synostosis ◽

Cranial Index ◽

Helmet Therapy ◽

Genetic Evaluations

Object Suturectomy as a treatment for craniosynostosis was largely replaced in the late twentieth century by more extensive, but predictable, cranial remodeling procedures. Recent technical innovations, such as using the endoscope combined with postoperative orthotic reshaping, have led to a resurgence of interest in suturectomy as a safer, less invasive method. Methods A retrospective chart review was performed for all cases of sagittal synostosis treated with endoscopic sagittal suture strip craniectomy and helmet therapy between 2004 and 2008. Data collected included gestational age, genetic evaluations and syndromic status, age at operation, duration of procedure, need for blood transfusions, length of hospital stay, preoperative and postoperative head circumference percentile and cranial index, duration of helmet use, length of follow-up, complications, and revisions. Results Fifty-six patients with isolated sagittal synostosis were treated using endoscopic suturectomy and completed helmet therapy. Mean age at time of procedure was 3.24 months. Mean operative duration was 45.32 minutes. Mean hospital stay was 1.39 days. There were 2 transfusions and no deaths. The mean length of follow-up was 2.34 years. Helmet therapy was instituted for a mean of 7.47 months. Head circumference percentile increased from 61.42% to 89.27% over 2 years of follow-up. Cranial index increased from a preoperative mean of 0.69 to 0.76 over 2 years of follow-up. Reoperations for synostosis included 1 sagittal suture refusion and 2 cases in which other sutures fused. Conclusions Sagittal synostosis can be safely treated with endoscopic suturectomy and helmet therapy. Improvements in cranial volume and shape are comparable to open procedures and are enduring.

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A comparative growth study of cephalic index and transverse cephalic curvature index among Punjabi children

The Indian Journal of Pediatrics ◽

10.1007/bf02896730 ◽

1970 ◽

Vol 37 (2) ◽

pp. 59-62 ◽

Cited By ~ 1

Author(s):

P. Dash Sharma

Keyword(s):

Cephalic Index ◽

Growth Study ◽

Curvature Index

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Quantitative Assessment of Shape Deformation of Regional Cranial Bone for Evaluation of Surgical Effect in Patients with Craniosynostosis

Applied Sciences ◽

10.3390/app11030990 ◽

2021 ◽

Vol 11 (3) ◽

pp. 990

Author(s):

Min Jin Lee ◽

Helen Hong ◽

Kyu Won Shim

Keyword(s):

Quantitative Assessment ◽

Deformable Registration ◽

Occipital Bone ◽

Cranial Bone ◽

Shape Deformation ◽

Surface Model ◽

Cephalic Index ◽

Skull Shape ◽

Quantification Method ◽

Parietal Bones

Surgery in patients with craniosynostosis is a common treatment to correct the deformed skull shape, and it is necessary to verify the surgical effect of correction on the regional cranial bone. We propose a quantification method for evaluating surgical effects on regional cranial bones by comparing preoperative and postoperative skull shapes. To divide preoperative and postoperative skulls into two frontal bones, two parietal bones, and the occipital bone, and to estimate the shape deformation of regional cranial bones between the preoperative and postoperative skulls, an age-matched mean-normal skull surface model already divided into five bones is deformed into a preoperative skull, and a deformed mean-normal skull surface model is redeformed into a postoperative skull. To quantify the degree of the expansion and reduction of regional cranial bones after surgery, expansion and reduction indices of the five cranial bones are calculated using the deformable registration as deformation information. The proposed quantification method overcomes the quantification difficulty when using the traditional cephalic index(CI) by analyzing regional cranial bones and provides useful information for quantifying the surgical effects of craniosynostosis patients with symmetric and asymmetric deformities.

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Cinematic rendering of a burst sagittal suture caused by an occipito-frontal gunshot wound

Forensic Science Medicine and Pathology ◽

10.1007/s12024-021-00387-9 ◽

2021 ◽

Author(s):

Dominic Gascho ◽

Michael J. Thali ◽

Rosa M. Martinez ◽

Stephan A. Bolliger

Keyword(s):

Gunshot Wound ◽

Three Dimensional ◽

The Novel ◽

Sagittal Suture ◽

Resonance Imaging ◽

Cinematic Rendering ◽

Reconstruction Methods ◽

Dimensional Reconstruction ◽

Magnetic Resonance Imaging Mri ◽

The Brain

AbstractThe computed tomography (CT) scan of a 19-year-old man who died from an occipito-frontal gunshot wound presented an impressive radiating fracture line where the entire sagittal suture burst due to the high intracranial pressure that arose from a near-contact shot from a 9 mm bullet fired from a Glock 17 pistol. Photorealistic depictions of the radiating fracture lines along the cranial bones were created using three-dimensional reconstruction methods, such as the novel cinematic rendering technique that simulates the propagation and interaction of light when it passes through volumetric data. Since the brain had collapsed, depiction of soft tissue was insufficient on CT images. An additional magnetic resonance imaging (MRI) examination was performed, which enabled the diagnostic assessment of cerebral injuries.

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