A single-center experience with symptomatic postoperative calvarial growth restriction after extended strip craniectomy for sagittal craniosynostosis

2010 ◽  
Vol 5 (1) ◽  
pp. 131-135 ◽  
Author(s):  
Matthew A. Adamo ◽  
Ian F. Pollack
Keyword(s):  
Intracranial Pressure ◽  
Growth Restriction ◽  
Increased Intracranial Pressure ◽  
Sagittal Synostosis ◽  
Sagittal Craniosynostosis ◽  
Single Center Experience ◽  
Number Of Patients ◽  
Single Suture ◽  
Strip Craniectomy

Object Sagittal synostosis accounts for the most common form of craniosynostosis, occurring with an incidence of 1 in 2000–5000 live births. In most cases of single-suture, nonsyndromic sagittal synostosis, a single operation is all that is required to achieve a reasonable cosmetic result. However, there are a number of patients who may experience symptomatic postoperative calvarial growth restriction secondary to fibrosis of newly formed bone and pericranium that replace the surgically removed sagittal suture, or due to fusion of other previously open sutures leading to increased intracranial pressure, necessitating a second operation. Methods A retrospective review was conducted of all cases involving infants who had undergone an extended sagittal strip craniectomy with bilateral parietal wedge osteotomies at our institution between 1990 and 2006 for single-suture, nonsyndromic sagittal craniosynostosis. The frequency with which subsequent operations were required for cranial growth restriction was then defined. Results There were a total of 164 patients with single-suture nonsyndromic sagittal synostosis. Follow-up data were available for 143 of these patients. The average age at time of initial operation was 5.25 months, and the mean duration of follow-up was 43.85 months. There were 2 patients (1.5%) who required a second operation for symptomatic postoperative calvarial growth restriction. Conclusions Recurrence of synostosis with resultant increased intracranial pressure in cases of single-suture, nonsyndromic sagittal craniosynostosis is an uncommon event, but does occur sporadically and unpredictably. Therefore, we recommend routine neurosurgical follow up for at least 5 years, with regular ophthalmological examinations to assess for papilledema.

scholarly journals Optimal duration of postoperative helmet therapy following endoscopic strip craniectomy for sagittal craniosynostosis

2018 ◽  
Vol 22 (6) ◽  
pp. 610-615 ◽  
Author(s):  
Rajiv R. Iyer ◽  
Xiaobu Ye ◽  
Qiuyu Jin ◽  
Yao Lu ◽  
Luckmini Liyanage ◽  
...  
Keyword(s):  
Peak Level ◽  
Multivariate Regression Analysis ◽  
Final Outcome ◽  
Sagittal Synostosis ◽  
Sagittal Craniosynostosis ◽  
Time Period ◽  
Helmet Therapy ◽  
Age At Surgery ◽  
Strip Craniectomy

OBJECTIVEMany infants with sagittal craniosynostosis undergo effective surgical correction with endoscopic strip craniectomy (ESC) and postoperative helmet therapy (PHT). While PHT is essential to achieving optimal cosmesis following ESC, there has been little comprehensive analysis of the ideal PHT duration needed to attain this goal.METHODSThe authors retrospectively reviewed the charts of infants undergoing ESC and PHT for sagittal synostosis at our institution between 2008 and 2015. Data collected included age at surgery, follow-up duration, and PHT duration. Cephalic index (CI) was evaluated preoperatively (CIpre), at its peak level (CImax), at termination of helmet therapy (CIoff), and at last follow-up (CIfinal). A multivariate regression analysis was performed to determine factors influencing CIfinal.RESULTSThirty-one patients (27 male, 4 female) were treated in the studied time period. The median age at surgery was 2.7 months (range 1.6 to 3.2) and the median duration of PHT was 10.4 months (range 8.4 to 14.4). The mean CImax was 0.83 (SD 0.01), which was attained an average of 8.4 months (SD 1.2) following PHT initiation. At last follow-up, there was an average retraction of CIfinal among all patients to 0.78 (SD 0.01). Longer helmet duration after achieving CImax did not correlate with higher CIfinal values. While CImax was a significant predictor of CIfinal, neither age at surgery nor CIpre were found to be predictive of final outcome.CONCLUSIONSPatients undergoing ESC and PHT for sagittal synostosis reach a peak CI around 7 to 9 months after surgery. PHT beyond CImax does not improve final anthropometric outcomes. CIfinal is significantly dependent on CImax, but not on age, nor CIpre. These results imply that helmet removal at CImax may be appropriate for ESC patients, while helmeting beyond the peak does not change final outcome.

A comparison of endoscopic strip craniectomy and pi craniectomy for treatment of sagittal craniosynostosis

2019 ◽  
Vol 23 (6) ◽  
pp. 708-714
Author(s):  
Suresh N. Magge ◽  
Arthur R. Bartolozzi ◽  
Neil D. Almeida ◽  
Deki Tsering ◽  
John S. Myseros ◽  
...  
Keyword(s):  
Statistical Significance ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Sagittal Craniosynostosis ◽  
Cranial Index ◽  
Helmet Therapy ◽  
Operative Strategies ◽  
Single Suture ◽  
Strip Craniectomy

OBJECTIVESagittal craniosynostosis is managed with a wide variety of operative strategies. The current investigation compares the clinical outcomes of two widely performed techniques: pi craniectomy and minimally invasive endoscopic strip craniectomy (ESC) followed by helmet therapy.METHODSThis IRB-approved retrospective study examined patients diagnosed with nonsyndromic, single-suture sagittal craniosynostosis treated with either pi craniectomy or ESC. Included patients had a minimum postoperative follow-up of 5 months.RESULTSFifty-one patients met the inclusion criteria (pi 21 patients, ESC 30 patients). Compared to patients who underwent ESC, the pi patients were older at the time of surgery (mean age 5.06 vs 3.11 months). The mean follow-up time was 23.2 months for ESC patients and 31.4 months for pi patients. Initial cranial index (CI) was similar between the groups, but postoperatively the ESC patients experienced a 12.3% mean increase in CI (from 0.685 to 0.767) compared to a 5.34% increase for the pi patients (from 0.684 to 0.719), and this difference was statistically significant (p < 0.001). Median hospital length of stay (1 vs 2 days) and operative duration (69.5 vs 93.3 minutes) were significantly less for ESC (p < 0.001 for both). The ESC patients showed a trend toward better results when surgery was done at younger ages. Craniectomy width in ESC cases was positively associated with CI improvement (slope of linear regression = 0.69, p = 0.026).CONCLUSIONSWhile both techniques effectively treated sagittal craniosynostosis, ESC showed superior results compared to pi craniectomy. ESC showed a trend for better outcomes when done at younger ages, although the trend did not reach statistical significance. A wider craniectomy width (up to 2 cm) was associated with better outcomes than smaller craniectomy widths among the ESC 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.

Multiple Suture Synostosis and Increased Intracranial Pressure following Repair of Single Suture, Nonsyndromal Craniosynostosis

1998 ◽  
Vol 35 (2) ◽  
pp. 167-172 ◽  
Author(s):  
Roger J. Hudgins ◽  
Steven R. Cohen ◽  
Fernando D. Burstein ◽  
William R. Boydston
Keyword(s):  
Intracranial Pressure ◽  
Head Circumference ◽  
Cranial Sutures ◽  
Increased Intracranial Pressure ◽  
Common Multiple ◽  
Expansion Procedure ◽  
Delayed Closure ◽  
Single Suture ◽  
Less Common Multiple ◽  
Increased Icp

Objective Increased intracranial pressure, frequently associated with closure of multiple cranial sutures, has been reported to occur in 36% of cases following correction of syndromal craniosynostosis. Although much less common, multiple suture closure may occur following repair of single suture, non-syndromal craniosynostosis and we present cases that concern two such children. Results Two children with nonsyndromal craniosynostosis, one metopic and one left-coronal, underwent fronto-orbital advancement at age 3 months. At age 19 months and at age 5 years, respectively, both patients re-presented with headaches, decrease in head circumference percentile, and acceptable cosmetic outcome. Both had computerized tomographic evidence of multiple closed cranial sutures and increased intracranial pressure (ICP) (determined by monitoring). Both patients improved following a cranial expansion procedure. Conclusion Delayed closure of multiple sutures and resultant increased ICP may occur following correction of nonsyndromal, single suture craniosynos-tosis. This may be more likely when the initial suture is contiguous with the facial sutures. Children should be followed for many years following cranio-synostosis repair with cranial, neurologic, and possibly funduscopic examinations as well as head circumference measurements to detect delayed closure of cranial sutures.

Intracranial Pressure in Single-Suture Craniosynostosis

1998 ◽  
Vol 35 (3) ◽  
pp. 194-196 ◽  
Author(s):  
Steven R. Cohen ◽  
John A. Persing
Keyword(s):  
Intracranial Pressure ◽  
Multidisciplinary Team ◽  
Basic Science ◽  
Treatment Plan ◽  
Science Research ◽  
Team Management ◽  
Increased Intracranial Pressure ◽  
Rational Treatment ◽  
Basic Science Research ◽  
Single Suture

In this paper, we review the incidence of increased intracranial pressure in children with single-suture craniosynostosis. The major studies in this area are presented, along with their limitations. A rational treatment plan including multidisciplinary team management is recommended. All patients with proven synostosis should be followed closely, whether or not surgery is chosen. Continued clinical and basic science research are necessary to further clarify the ramifications of asymptomatic elevations of intracranial pressure in these patients.

Reversal of Increased Intracranial Pressure with Removal of a Torcular Epidermoid: Case Report

Neurosurgery ◽  
2001 ◽  
Vol 48 (4) ◽  
pp. 929-932 ◽  
Author(s):  
Cornelius H. Lam ◽  
Robin K. Solomon ◽  
H. Brent Clark ◽  
Sean O. Casey
Keyword(s):  
Intracranial Pressure ◽  
Venous Obstruction ◽  
Increased Intracranial Pressure ◽  
Easy Method ◽  
Computed Tomographic ◽  
Straight Sinus ◽  
Computed Tomographic Venography ◽  
Bony Lesion ◽  
Slow Growing

Abstract OBJECTIVE AND IMPORTANCE Venous obstruction has been postulated as a cause of increased intracranial pressure, but it has been documented rarely. We present a case of obstruction of the torcula by a slow-growing epidermoid. The tumor caused increased intracranial pressure, which was relieved when it was excised. In addition, the torcular epidermoid is associated with a bifid straight sinus. CLINICAL PRESENTATION A 35-year-old man presented with a headache and a lump on the back of the head. Physical examination revealed a firm, bony lesion approximately 4 × 4 cm in size. Lumbar puncture demonstrated an intraspinal pressure of 39 cm H2O. Neuroradiological studies revealed an epidermoid that compressed and almost completely occluded the torcula. INTERVENTION After the tumor was resected, the intraspinal pressure decreased to 19 cm H2O and remained stable 6 months later. CONCLUSION Pure venous obstruction causes increased intracranial pressure. Removal of the obstruction relieves the intracranial hypertension. In addition, computed tomographic venography is a safe and easy method of documenting torcular anatomy, and it was useful in the follow-up of this patient. Computed tomographic venography can demonstrate a double straight sinus, which is a congenital variant that may be associated with the epidermoid.

scholarly journals Sagittal Synostosis with Increased Intracranial Pressure in an 8-year-old Boy

1985 ◽  
Vol 25 (10) ◽  
pp. 850-854 ◽  
Author(s):  
Akira UTOH ◽  
Kikuo SUDA ◽  
Hajime ARAI ◽  
Takeyoshi SHIMOJI ◽  
Minoru MAEDA
Keyword(s):  
Intracranial Pressure ◽  
Increased Intracranial Pressure ◽  
Sagittal Synostosis

scholarly journals Less is more: does the addition of barrel staves improve results in endoscopic strip craniectomy for sagittal craniosynostosis?

2017 ◽  
Vol 20 (1) ◽  
pp. 86-90 ◽  
Author(s):  
Benjamin C. Wood ◽  
Edward S. Ahn ◽  
Joanna Y. Wang ◽  
Albert K. Oh ◽  
Robert F. Keating ◽  
...  
Keyword(s):  
Consecutive Series ◽  
Less Is More ◽  
Sagittal Craniosynostosis ◽  
Group A ◽  
The Mean ◽  
The Difference ◽  
Scan Data ◽  
Group B ◽  
Strip Craniectomy

OBJECTIVEEndoscopic strip craniectomy (ESC) with postoperative helmet orthosis is a well-established treatment option for sagittal craniosynostosis. There are many technical variations to the surgery ranging from simple strip craniectomy to methods that employ multiple cranial osteotomies. The purpose of this study was to determine whether the addition of lateral barrel-stave osteotomies during ESC improved morphological outcomes.METHODSAn IRB-approved retrospective review was conducted on a consecutive series of cases involving ESC for sagittal craniosynostosis at 2 different institutions from March 2008 to August 2014. The patients in Group A underwent ESC and those in Group B had ESC with lateral barrel-stave osteotomies. Demographic and perioperative data were recorded; postoperative morphological outcomes were analyzed using 3D laser scan data acquired from a single orthotic manufacturer who managed patients from both institutions.RESULTSA total of 73 patients were included (34 in Group A and 39 in Group B). Compared with Group B patients, Group A patients had a shorter mean anesthetic time (161.7 vs 195 minutes; p < 0.01) and operative time (71.6 vs 111 minutes; p < 0.01). The mean hospital stay was similar for the 2 groups (1.2 days for Group A vs 1.4 days for Group B; p = 0.1). Adequate postoperative data on morphological outcomes were reported by the orthotic manufacturer for 65 patients (29 in Group A and 36 in Group B). The 2 groups had similar improvement in the cephalic index (CI): Group A, mean change 10.5% (mean preoperative CI 72.6, final 80.4) at a mean follow-up of 13.2 months; Group B, mean change 12.2% (mean preoperative CI 71.0, final 79.6) at a mean follow-up of 19.4 months. The difference was not statistically significant (p = 0.15).CONCLUSIONSBoth ESC alone and ESC with barrel staving produced excellent outcomes. However, the addition of barrel staves did not improve the results and, therefore, may not be warranted in the endoscopic treatment of sagittal craniosynostosis.

Neurological manifestations of pediatric achondroplasia

1981 ◽  
Vol 54 (1) ◽  
pp. 49-57 ◽  
Author(s):  
Hiroshi Yamada ◽  
Shigetoshi Nakamura ◽  
Masataka Tajima ◽  
Naoki Kageyama
Keyword(s):  
Intracranial Pressure ◽  
Growth Curves ◽  
Jugular Foramen ◽  
Foramen Magnum ◽  
Cerebral Veins ◽  
Increased Intracranial Pressure ◽  
Content Type ◽  
Respiratory Problems ◽  
Number Of Patients ◽  
Small Foramen

✓ The neurological and neuroradiological manifestations of pediatric achondroplasia are analyzed on the basis of 10 cases. In addition to the classical symptomatology of an enlarging head, with or without increased intracranial pressure, several patients presented symptoms related to a small foramen magnum. Respiratory problems and quadriparesis were also observed in these patients. Six patients who were treated by foramen magnum decompression showed remarkable improvement. Neuroradiological evaluation revealed a significant number of patients with dilated cortical sulci and basal cisterns, and mild dilatation of the ventricles on computerized tomography (CT) and/or ventriculography. Two patients showed signs of obstruction at the fourth ventricle outlets. Some exhibited anomalous dilatation of cerebral veins and dural sinuses, narrowing of the sinuses at the jugular foramen, and enlarged emissary veins. Ventriculoperitoneal or ventriculoatrial shunts were placed in three patients. In the other children with a large head and dilated ventricles, head growth curves paralleled the normal slope, and there was no significant clinical evidence of increased intracranial pressure or enlarging ventricles on follow-up CT scan.

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