A systematic review of the latest technologies in Cranial Vault Remodeling and its outcomes for correction of craniosynostosis

The authors report on the case of a 6-week-old boy who presented with infantile spasms. At 2.5 months of age, the patient underwent a right hemispherectomy. Approximately 3 months postoperatively, the patient presented with left coronal craniosynostosis. Subsequent cranial vault remodeling resulted in satisfactory cosmesis. Four years after surgery, the patient remains seizure free without the need for anticonvulsant medications. The authors believe this to be the first reported case of iatrogenic craniosynostosis due to hemispherectomy, and they describe 2 potential mechanisms for its development. This case suggests that, in the surgical treatment of infants with intractable epilepsy, minimization of brain volume loss through disconnection techniques should be considered, among other factors, when determining the best course of action.

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Improved cephalic index following early cranial vault remodeling in patients with isolated nonsyndromic sagittal synostosis

Neurosurgical FOCUS ◽

10.3171/2021.1.focus201017 ◽

2021 ◽

Vol 50 (4) ◽

pp. E7

Author(s):

Arvid Frostell ◽

Maryam Haghighi ◽

Jiri Bartek ◽

Ulrika Sandvik ◽

Bengt Gustavsson ◽

...

Keyword(s):

Mixed Model ◽

Linear Mixed Model ◽

Cranial Vault ◽

Hospital Length Of Stay ◽

Cephalic Index ◽

Sagittal Synostosis ◽

The Mean ◽

Cranial Vault Remodeling

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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Nonsyndromic craniosynostosis in Vietnam: initial surgical outcomes of subspecialty mentorship

Journal of Neurosurgery Pediatrics ◽

10.3171/2021.5.peds20932 ◽

2021 ◽

pp. 1-8

Author(s):

Dang Do Thanh Can ◽

Jacob R. Lepard ◽

Nguyen Minh Anh ◽

Pham Anh Tuan ◽

Tran Diep Tuan ◽

...

Keyword(s):

Scale Up ◽

Unmet Need ◽

Case Series ◽

Surgical Care ◽

Cranial Vault ◽

Female Ratio ◽

Estimated Blood Loss ◽

Common Diagnosis ◽

Cranial Vault Remodeling

OBJECTIVE There is a global deficit of pediatric neurosurgical care, and the epidemiology and overall surgical care for craniosynostosis is not well characterized at the global level. This study serves to highlight the details and early surgical results of a neurosurgical educational partnership and subsequent local scale-up in craniosynostosis correction. METHODS A prospective case series was performed with inclusion of all patients undergoing correction of craniosynostosis by extensive cranial vault remodeling at Children’s Hospital 2, Ho Chi Minh City, Vietnam, between January 1, 2015, and December 31, 2019. RESULTS A total of 76 patients were included in the study. The group was predominantly male, with a male-to-female ratio of 3.3:1. Sagittal synostosis was the most common diagnosis (50%, 38/76), followed by unilateral coronal (11.8%, 9/76), bicoronal (11.8%, 9/76), and metopic (7.9%, 6/76). The most common corrective technique was anterior cranial vault remodeling (30/76, 39.4%) followed by frontoorbital advancement (34.2%, 26/76). The overall mean operative time was 205.8 ± 38.6 minutes, and the estimated blood loss was 176 ± 89.4 mL. Eleven procedures were complicated by intraoperative durotomy (14.5%, 11/76) without any damage of dural venous sinuses or brain tissue. Postoperatively, 4 procedures were complicated by wound infection (5.3%, 4/76), all of which required operative wound debridement. There were no neurological complications or postoperative deaths. One patient required repeat reconstruction due to delayed intracranial hypertension. There was no loss to follow-up. All patients were followed at outpatient clinic, and the mean follow-up period was 32.3 ± 18.8 months postoperatively. CONCLUSIONS Surgical care for pediatric craniosynostosis can be taught and sustained in the setting of collegial educational partnerships with early capability for high surgical volume and safe outcomes. In the setting of the significant deficit in worldwide pediatric neurosurgical care, this study provides an example of the feasibility of such relationships in addressing this unmet need.

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