Immediate correction of sagittal synostosis

1978 ◽  
Vol 49 (5) ◽  
pp. 705-710 ◽  
Author(s):  
John A. Jane ◽  
Milton T. Edgerton ◽  
J. William Futrell ◽  
Tae Sung Park
Keyword(s):  
Bone Union ◽  
Cosmetic Result ◽  
Sagittal Synostosis ◽  
Content Type ◽  
Fine Print

✓ A technique for correction of sagittal synostosis with achievement of an immediately pleasing cosmetic result is presented. Even with replacement of bone and no attempt to inhibit bone union, premature reclosure does not occur. Moss' theory of dural tensions is discussed to explain the effect.

Total calvarial reconstruction for sagittal synostosis in older infants and children

1993 ◽  
Vol 78 (2) ◽  
pp. 199-204 ◽  
Author(s):  
Roger J. Hudgins ◽  
Fernando D. Burstein ◽  
William R. Boydston
Keyword(s):  
Blood Loss ◽  
Craniofacial Surgery ◽  
Acute Blood Loss ◽  
Skull Defect ◽  
Sagittal Suture ◽  
Sagittal Synostosis ◽  
Content Type ◽  
Biparietal Diameter ◽  
Postoperative Hyponatremia ◽  
Fine Print

✓ Premature closure of the sagittal suture is the most common form of craniosynostosis, but this condition occasionally goes unrecognized until the child is too old to undergo procedures that depend upon continued calvarial growth for success. As the entire calvaria is affected and thus misshapen by sagittal synostosis, late correction involves total calvarial reconstruction. The extensive nature of this undertaking has precluded its utilization despite the presence of significant deformities. Adapting the techniques and experience gained from craniofacial surgery, the authors performed total calvarial reconstruction on nine children with sagittal synostosis and subsequent scaphocephaly diagnosed after the age of 1 year. In each case the goals of shortening the anteroposterior length, widening the biparietal diameter, and reducing frontal and occipital deformities were met. Morbidity consisted of acute blood loss, postoperative hyponatremia, and in one case a residual skull defect. The rationale for this procedure and the techniques utilized are discussed.

Subtotal neonatal calvariectomy

1979 ◽  
Vol 51 (5) ◽  
pp. 691-696 ◽  
Author(s):  
Laurence W. Mabbutt ◽  
Vincent G. Kokich ◽  
Benjamin C. Moffett ◽  
John D. Loeser
Keyword(s):  
Postoperative Period ◽  
Surgical Margin ◽  
Regenerative Process ◽  
Bone Union ◽  
Histological Techniques ◽  
Content Type ◽  
Rate Of Development ◽  
Definite Pattern ◽  
Fine Print

✓ A subtotal calvariectomy was performed on rabbits between 10 and 14 days of age. The animals were allowed to grow and were then sacrificed serially so that the sutural and skeletal redevelopment could be analyzed through a combination of gross, radiographic, and histological techniques. The results indicate that calvarial regeneration is a progressive process with a definite pattern and rate of development. During the regenerative process, bone was deposited both at the surgical margin and as islands within the surgical defect. The eventual approximation of these areas of ossification produced multiple fibrous articulations. The majority of these articulations were obliterated by bone union, except for the midsagittal, coronal, and metopic sutures, which were re-established in their appropriate anatomical positions. The maintenance of dural integrity during the surgical phase and the regeneration and establishment of pericranial continuity during the postoperative period were believed to be important in the re-establishment of normal sutural and skeletal architecture.

Cloverleaf skull syndrome

1975 ◽  
Vol 43 (1) ◽  
pp. 86-91 ◽  
Author(s):  
Paul J. Muller ◽  
Harold J. Hoffman
Keyword(s):  
Surgical Management ◽  
Institutional Care ◽  
Cosmetic Result ◽  
Cerebral Function ◽  
Content Type ◽  
Cloverleaf Skull ◽  
Fine Print

✓ The authors report a case of cloverleaf skull syndrome (Kleeblattschädel) and describe how early surgical management of this condition appears to offer hope for a reasonable cosmetic result, as well as improvement in cerebral function to the point where children with this syndrome may avoid institutional care.

Reduction of transfusion rates in the surgical correction of sagittal synostosis

2002 ◽  
Vol 97 (3) ◽  
pp. 503-509 ◽  
Author(s):  
Stephen Hentschel ◽  
Paul Steinbok ◽  
D. Douglas Cochrane ◽  
John Kestle
Keyword(s):  
Blood Transfusion ◽  
Univariate Analysis ◽  
Hemoglobin Level ◽  
Skin Closure ◽  
Transfusion Rate ◽  
Sagittal Synostosis ◽  
Content Type ◽  
End Point ◽  
Extent Of Surgery ◽  
Fine Print

Object. As public concern about the risks of blood transfusions increased in the mid-1990s, avoidance of transfusions became a goal of surgery for sagittal synostosis. This study was performed to confirm a hypothesized reduction in transfusion rates in recent years and to identify factors associated with both the need for transfusion and low postoperative levels of hemoglobin. Methods. Sagittal synostosis operations performed in children between 1986 and 1999 were reviewed retrospectively. Patients underwent a minimum of vertex strip craniectomy and parietal craniectomies. There were 118 patients whose median age at surgery was 4.2 months. The primary end point for analysis was defined as either the receipt of a blood transfusion or a postoperative level of hemoglobin less than 70 g/L. Forty-two percent of patients (95% confidence interval [CI] 31–52%) treated before 1996 and 11% of patients (95% CI 0–23%) treated from 1996 onward received blood. The reduction in the blood transfusion rate in later years was, in part, related to the acceptance of a lower postoperative hemoglobin level, often below 70 g/L. A univariate analysis showed that the only patient or surgical factors that correlated with reaching the primary end point in a statistically significant manner were the year of surgery and the extent of surgery. A logistic regression of the age and weight of the child, length of surgery time (from skin opening to skin closure), preoperative hemoglobin level, extent of surgery, and surgeon against the primary end point revealed that the best predictor of the need for a blood transfusion or the presence of a postoperative hemoglobin level lower than 70 g/L was the extent of surgery (β = 1.4, standard error of the β statistic = 0.44). Once the extent of surgery was accounted for in the model, no other covariates significantly improved the model. Techniques implemented to minimize blood loss since 1995 included the following: use of the Colorado needle for scalp incision, selection of the Midas Rex craniotome for cranial cuts, and application of microfibrillar collagen. Postoperative hemoglobin was allowed to decrease to 60 g/L if the child was stable hemodynamically, before blood was administered. There were no cardiovascular, wound healing, or infectious complications, and no surgeries were repeated for cosmetic reasons. Conclusions. Low blood transfusion rates were achieved using simple intraoperative techniques and by accepting a low level of postoperative hemoglobin.

Multiple-revolution spiral osteotomy for cranial reconstruction

2001 ◽  
Vol 94 (4) ◽  
pp. 671-676 ◽  
Author(s):  
Micam W. Tullous ◽  
Matthew N. Henry ◽  
Peter T. H. Wang ◽  
Dennis G. Vollmer ◽  
Andrew E. Auber ◽  
...  
Keyword(s):  
Surgical Procedure ◽  
Cranial Bone ◽  
Sagittal Synostosis ◽  
Content Type ◽  
Cosmetic Results ◽  
Parietal Area ◽  
Early Results ◽  
Cranial Deformity ◽  
Lambdoid Synostosis ◽  
Fine Print

✓ Various combinations of cranial remodeling techniques are used in an attempt to provide optimal cosmetic results and to reduce possible sequelae associated with craniosynostosis. One element of deformity that is difficult to correct directly is an overly flattened area such as that found in the parietal area in sagittal synostosis, unilaterally in lambdoid synostosis, or even in severe positional molding. The authors present a novel application for recontouring cranial bone, namely the multiple-revolution spiral osteotomy. The advantages of this technique include the avoidance of large areas of craniectomy and immediate correction of the cranial deformity. The surgical procedure, illustrative cases, early results, and apparent benefits of this technique are discussed.

Outcome analysis of 85 patients undergoing the pi procedure for correction of sagittal synostosis

1996 ◽  
Vol 85 (1) ◽  
pp. 50-55 ◽  
Author(s):  
Frederick A. Boop ◽  
William M. Chadduck ◽  
Kristopher Shewmake ◽  
Charles Teo
Keyword(s):  
Outcome Analysis ◽  
Sagittal Synostosis ◽  
Content Type ◽  
Time Of Surgery ◽  
Male Preponderance ◽  
Cosmetic Outcomes ◽  
Poor Outcomes ◽  
Strip Craniectomy ◽  
Fine Print

✓ The authors present a retrospective review of their experience with 85 cases using the pi procedure to correct sagittal synostosis. A male preponderance of four to one was recognized in this group. Sixty-five infants underwent computerized tomography scanning of the head prior to surgery; these scans revealed unexpected intracranial pathology in 5% of cases. Surgical complications included three intraoperative dural lacerations. All children received blood transfusions with no complications. Cosmetic outcomes were excellent in 53%, good in 43%, and poor in 4% of cases. One patient required reoperation. All poor outcomes were in infants who were younger than 8 weeks of age at the time of surgery and who underwent a “reverse pi” procedure. Most of the excellent outcomes occurred in infants who were between 3 and 6 months of age at the time of surgery. Although more extensive than strip craniectomy, the pi procedure can be accomplished with minimal morbidity. In the authors' opinion, the pi procedure provides better immediate and long-term cosmetic results than synostectomy alone.

Frontal sinus approach to the orbit

1985 ◽  
Vol 63 (5) ◽  
pp. 811-813 ◽  
Author(s):  
Austin R. T. Colohan ◽  
John A. Jane ◽  
Steven A. Newman ◽  
William W. Maggio
Keyword(s):  
Frontal Sinus ◽  
Anterior Wall ◽  
Bone Flap ◽  
Cosmetic Result ◽  
Content Type ◽  
Supraorbital Approach ◽  
Single Bone ◽  
Burr Holes ◽  
Fine Print

✓ The authors have previously advocated a supraorbital approach to tumors of the orbit. In this paper, they describe a technique in which they take advantage of a large frontal sinus as a means of entering the orbit without the necessity of intracranial exposure, as required by the more conventional supraorbital approach. This is achieved without frontal burr holes, allowing for a superior cosmetic result. The anterior wall of the frontal sinus is removed, and with it the roof of the orbit as a single bone flap. A case in which this technique was used is described.

Use of folded vascularized rib graft in anterior fusion after treatment of thoracic and upper lumbar lesions

2001 ◽  
Vol 94 (2) ◽  
pp. 323-327 ◽  
Author(s):  
Hiroaki Nakamura ◽  
Yoshiki Yamano ◽  
Masahiko Seki ◽  
Sadahiko Konishi
Keyword(s):  
Anterior Approach ◽  
Spinal Metastasis ◽  
Intercostal Nerve ◽  
Bone Union ◽  
Autogenous Bone ◽  
Anterior Fusion ◽  
Content Type ◽  
Grafting Technique ◽  
Vascularized Rib ◽  
Fine Print

✓ For lesions involving the anterior and/or middle column of the spine, an anterior approach is adequate for curetting the lesion and restoring spinal stability. Materials such as autogenous bone grafts, cages with bone chips, some artificial materials, or allografts are used as strut materials. Rib material is usually removed when the anterior approach is conducted for thoracic or thoracolumbar lesions. A rib itself is not rigid enough to support the load, and a bone union is not easily obtained. The purpose of this paper is to describe a method of grafting vascularized rib in folded form to fill the defects left after removal of a spinal lesion. The rib, with the artery and vein at two levels cranial to the involved vertebral body, was isolated from surrounding tissues such as the intercostal nerve, muscles, and pleura. After curetting the lesion, the rib was folded into three or four pieces to a length adequate to fill the defect and inserted as a pedicled vascularized graft. A total of 23 cases, including 14 men and nine women, underwent surgery in which this grafting technique was used. The pathological conditions requiring anterior decompression and fusion were spinal trauma in nine cases, spinal infection in six cases, osteoporotic fracture in seven cases, and spinal metastasis in one case. In all cases a solid bone union was obtained and all infections resolved. With vascularized rib graft folded into three to four pieces, solid bone union can be obtained without use of any other grafted materials even in cases of infection and osteoporosis.

Endoscopic craniectomy for early surgical correction of sagittal craniosynostosis

1998 ◽  
Vol 88 (1) ◽  
pp. 77-81 ◽  
Author(s):  
David F. Jimenez ◽  
Constance M. Barone
Keyword(s):  
Blood Loss ◽  
Operative Time ◽  
Sagittal Synostosis ◽  
Content Type ◽  
Endoscopic Techniques ◽  
Early Correction ◽  
Hospitalization Costs ◽  
The Mean ◽  
Fine Print

Object. The authors sought to minimize scalp incisions, blood loss, and operative time by using endoscopically assisted strip craniectomies and barrel-stave osteotomies to treat infants with sagittal suture synostosis. Methods. Four patients, aged 2, 4, 9, and 12 weeks, who presented with scaphocephaly underwent endoscopic midline craniectomies through small midline scalp incisions. The mean operative time for the procedure was 1.68 hours (range 1.15–2.8 hours); the mean blood loss was 54.2 ml (range 12–150 ml). Three patients did not require blood transfusions and were discharged within 24 hours. Postoperatively, all patients were fitted with custom cranial molding helmets. Follow-up evaluation ranged between 8 and 15 months. All patients had successful correction of their scaphocephaly with no mortalities, morbidities, or complications. Conclusions. The use of endoscopic techniques for early correction of sagittal synostosis is safe; decreases blood loss, operative time, and hospitalization costs; and provides excellent early surgical results.

Variants of sagittal synostosis: strategies for surgical correction

1984 ◽  
Vol 61 (3) ◽  
pp. 557-562 ◽  
Author(s):  
Dennis G. Vollmer ◽  
John A. Jane ◽  
T. S. Park ◽  
John A. Persing
Keyword(s):  
Surgical Approach ◽  
Surgical Techniques ◽  
Clinical Problem ◽  
Surgical Correction ◽  
Recent Experience ◽  
Operative Techniques ◽  
Sagittal Synostosis ◽  
Content Type ◽  
Synthetic Materials ◽  
Fine Print

✓ Sagittal synostosis is discussed with respect to the variations seen with the deformity. The morphological spectrum ranging from marked frontal bossing to prominent occipital bulging is described. Surgical techniques have been specifically designed for these variants. These techniques provide an immediate correction of scaphocephaly, and achieve a reduction of the specific deformity with morbidity comparable to that associated with conventional operations. The lack of large areas of craniectomy and the avoidance of synthetic materials are cited as additional advantages of these techniques. The importance of altering the surgical approach to the specific clinical problem is underscored. Two illustrative cases of sagittal synostosis variants are described, and recent experience with the modified operative techniques in treating these and similar cases is discussed.

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