Cranial Vault Distraction in Nonsyndromic Sagittal Synostosis

OBJECTIVE Isolated nonsyndromic sagittal synostosis (SS) is the most common form of craniosynostosis in children, accounting for approximately 60% of all craniosynostoses. The typical cranial measurement used to define and follow SS is the cephalic index (CI). Several surgical techniques have been suggested, but agreement on type and timing of surgery is lacking. This study aimed to evaluate the authors’ institutional experience of surgically treating SS using a modified subtotal cranial vault remodeling technique in a population-based cohort. Special attention was directed toward the effect of patient age at time of surgery on long-term CI outcome. METHODS A retrospective analysis was conducted on all patients with isolated nonsyndromic SS who were surgically treated from 2003 to 2011. Data from electronic medical records were gathered. Eighty-two patients with SS were identified, 77 fulfilled inclusion criteria, and 72 had sufficient follow-up data and were included. CI during follow-up after surgery was investigated with ANOVA and a linear mixed model. RESULTS In total, 72 patients were analyzed, consisting of 16 females (22%) and 56 males (78%). The mean ± SD age at surgery was 4.1 ± 3.1 months. Blood transfusions were received by 81% of patients (26% intraoperatively, 64% postoperatively, 9% both). The mean ± SD time in the pediatric ICU was 1.1 ± 0.25 days, and the mean ± SD total hospital length of stay was 4.6 ± 2.0 days. No patient required reoperation. The mean ± SD CI increased from 69 ± 3 to 87 ± 5 for patients who underwent surgery before 45 days of age. Surgery resulted in a larger increase in CI for patients who underwent surgery at a younger age compared with older patients (p < 0.05, Tukey’s HSD test). In the comparison of patients who underwent surgery before 45 days of age with patients who underwent surgery at 45–90, 90–180, and more than 180 days of age, the linear mixed model estimated a long-term loss of CI of 3.0, 5.5, and 7.4 points, respectively. CONCLUSIONS The modified subtotal cranial vault remodeling technique used in this study significantly improved CI in patients with SS. The best results were achieved when surgery was performed early in life.

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Long-Term Neurocognitive Outcomes of Spring-Assisted Surgery versus Cranial Vault Remodeling for Sagittal Synostosis

Plastic & Reconstructive Surgery ◽

10.1097/prs.0000000000007640 ◽

2021 ◽

Vol 147 (3) ◽

pp. 661-671

Author(s):

Michael Alperovich ◽

Christopher M. Runyan ◽

Kyle S. Gabrick ◽

Robin T. Wu ◽

Chelsea Morgan ◽

...

Keyword(s):

Cranial Vault ◽

Sagittal Synostosis ◽

Neurocognitive Outcomes ◽

Cranial Vault Remodeling

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Delayed Chronic Subdural Hematoma after Total Cranial Vault Reconstruction for Sagittal Synostosis

Pediatric Neurosurgery ◽

10.1159/000487809 ◽

2018 ◽

Vol 53 (3) ◽

pp. 200-204

Author(s):

Christopher R. Pasarikovski ◽

Taylor J. Abel ◽

Chris R. Forrest ◽

Peter B. Dirks ◽

George M. Ibrahim

Keyword(s):

Subdural Hematoma ◽

Chronic Subdural Hematoma ◽

Cranial Vault ◽

Sagittal Synostosis

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Anterior Ischemic Optic Neuropathy Complicating Cranial Vault Reconstruction for Sagittal Synostosis in a Child

Journal of Craniofacial Surgery ◽

10.1097/01.scs.0000164331.73805.66 ◽

2005 ◽

Vol 16 (4) ◽

pp. 559-562 ◽

Cited By ~ 9

Author(s):

Jonathan Lee ◽

Mark W Crawford ◽

James Drake ◽

J Raymond Buncic ◽

Christopher Forrest

Keyword(s):

Optic Neuropathy ◽

Cranial Vault ◽

Anterior Ischemic Optic Neuropathy ◽

Ischemic Optic Neuropathy ◽

Sagittal Synostosis

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Secondary Cranial Vault Remodeling for Restenosis after Primary Sagittal Synostosis Repair

Pediatric Neurosurgery ◽

10.1159/000380768 ◽

2015 ◽

Vol 50 (2) ◽

pp. 104-108 ◽

Cited By ~ 3

Author(s):

Anna Kuang ◽

Nathan R. Selden

Keyword(s):

Cranial Vault ◽

Sagittal Synostosis ◽

Cranial Vault Remodeling

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Comparison of 2 Sagittal Craniosynostosis Repair Techniques: Spring-Assisted Surgery Versus Endoscope-Assisted Craniectomy With Helmet Molding Therapy

The Cleft Palate-Craniofacial Journal ◽

10.1177/1055665620966521 ◽

2020 ◽

pp. 105566562096652

Author(s):

Gary B. Skolnick ◽

Jenny L. Yu ◽

Kamlesh B. Patel ◽

Lisa R. David ◽

Daniel E. Couture ◽

...

Keyword(s):

Computed Tomography ◽

Cranial Vault ◽

Sagittal Synostosis ◽

Time Points ◽

Sagittal Craniosynostosis ◽

Cranial Index ◽

Helmet Therapy ◽

Measurement Consistency ◽

Detectable Bias ◽

Repair Techniques

Introduction: This study compares anthropometric outcomes of 2 sagittal synostosis repair techniques: spring-assisted surgery and endoscope-assisted craniectomy with molding helmet therapy. Methods: Patients undergoing spring-assisted surgery (n = 27) or endoscope-assisted craniectomy with helmet therapy (n = 40) at separate institutions were retrospectively reviewed. Pre- and 1-year postoperative computed tomography (CT) or laser scans were analyzed for traditional cranial index (CI), adjusted cranial index (aCI), and cranial vault volume (CVV). Nine patient-matched scans were analyzed for measurement consistency. Results: The spring-assisted group was older at both time points ( P < .050) and spring-assisted group CVV was larger preoperatively and postoperatively ( P < .01). However, the change in CVV did not differ between the groups ( P = .210). There was no difference in preoperative CI (helmet vs spring: 70.1 vs 71.2, P = .368) between the groups. Postoperatively, helmet group CI (77.0 vs 74.3, P = .008) was greater. The helmet group also demonstrated a greater increase in CI (6.9 vs 3.1, P < .001). The proportion of patients achieving CI of 75 or greater was not significantly different between the groups (helmet vs spring: CI, 65% vs 52%, P = .370). There was no detectable bias in CI between matched CT and laser scans. Differences were identified between scan types in aCI and CVV measurements; subsequent analyses used corrected CVV and aCI measures for laser scan measures. Conclusions: Both techniques had equivalent proportions of patients achieving normal CI, comparable effects on cranial volume, and similar operative characteristics. The study suggests that there may be greater improvement in CI in the helmet group. However, further research should be performed.

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Disappointing results of spring-assisted cranial vault expansion in patients with Crouzon syndrome presenting with sagittal synostosis

Neurosurgical FOCUS ◽

10.3171/2021.1.focus20739 ◽

2021 ◽

Vol 50 (4) ◽

pp. E12

Author(s):

Alexander T. Wilson ◽

Linda Gaillard ◽

Sarah L. Versnel ◽

Jochem K. H. Spoor ◽

Marie-Lise C. van Veelen ◽

...

Keyword(s):

Intracranial Hypertension ◽

Cranial Vault ◽

Recent Experience ◽

Crouzon Syndrome ◽

Sagittal Suture ◽

Single Center ◽

Aesthetic Outcome ◽

Sagittal Synostosis ◽

Successful Outcomes

The aim of this study was to report on a single center’s experience with spring-assisted cranial vault expansion (SAE) in patients with Crouzon syndrome and sagittal suture synostosis. Strip craniotomy with SAE has resulted in successful outcomes with low complication and revision rates in patients with isolated scaphocephaly. However, recent experience suggests that outcomes in patients with Crouzon syndrome and sagittal synostosis (SS) who undergo SAE are less favorable compared with the outcomes of those who undergo frontobiparietal (FBP) expansion. The authors reviewed both operations performed at a single center and noticed an upward expansion of the skull, which may be related to ventriculomegaly, with concurrent intracranial hypertension and poor aesthetic outcome. All patients diagnosed with Crouzon syndrome and SS who were treated with SAE required a revision FBP operation. Based on this outcome, the authors consider Crouzon syndrome a contraindication for correcting SS with springs.

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