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

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.

Endoscopic treatment of combined metopic-sagittal craniosynostosis

2020 ◽  
Vol 26 (2) ◽  
pp. 113-121
Author(s):  
Ema Zubovic ◽  
Gary B. Skolnick ◽  
Sybill D. Naidoo ◽  
Mark Bellanger ◽  
Matthew D. Smyth ◽  
...  
Keyword(s):  
Endoscopic Treatment ◽  
Ct Scans ◽  
Sagittal Synostosis ◽  
Sagittal Craniosynostosis ◽  
Cranial Index ◽  
Helmet Therapy ◽  
The Mean ◽  
Normal Controls ◽  
Cranial Vault Remodeling

OBJECTIVECombined metopic-sagittal craniosynostosis is traditionally treated with open cranial vault remodeling and fronto-orbital advancement, sometimes in multiple operations. Endoscopic treatment of this multisuture synostosis presents a complex challenge for the surgeon and orthotist.METHODSThe authors retrospectively analyzed the preoperative and 1-year postoperative CT scans of 3 patients with combined metopic-sagittal synostosis, all of whom were treated with simultaneous endoscope-assisted craniectomy of the metopic and sagittal sutures followed by helmet therapy. Established anthropometric measurements were applied to assess pre- and postoperative morphology, including cranial index and interfrontal divergence angle (IFDA). Patients’ measurements were compared to those obtained in 18 normal controls.RESULTSTwo boys and one girl underwent endoscope-assisted craniectomy at a mean age of 81 days. The mean preoperative cranial index was 0.70 (vs control mean of 0.82, p = 0.009), corrected postoperatively to a mean of 0.82 (vs control mean of 0.80, p = 0.606). The mean preoperative IFDA was 110.4° (vs control mean of 152.6°, p = 0.017), corrected postoperatively to a mean of 139.1° (vs control mean of 140.3°, p = 0.348). The mean blood loss was 100 mL and the mean length of stay was 1.7 days. No patient underwent reoperation. The mean clinical follow-up was 3.4 years.CONCLUSIONSEndoscope-assisted craniectomy with helmet therapy is a viable single-stage treatment option for combined metopic-sagittal synostosis, providing correction of the stigmata of trigonoscaphocephaly, with normalization of the cranial index and IFDA.

scholarly journals Spring-mediated sagittal craniosynostosis treatment at the Children’s Hospital of Philadelphia: technical notes and literature review

2015 ◽  
Vol 38 (5) ◽  
pp. E7 ◽  
Author(s):  
Leopold Arko ◽  
Jordan W. Swanson ◽  
Tamara M. Fierst ◽  
Rosemary E. Henn ◽  
Daniel Chang ◽  
...  
Keyword(s):  
Literature Review ◽  
Blood Loss ◽  
Sagittal Synostosis ◽  
Data Set ◽  
Ultrasonic Scalpel ◽  
Children's Hospital ◽  
Sagittal Craniosynostosis ◽  
Institutional Data ◽  
Cranial Index ◽  
Children’S Hospital

OBJECT Sagittal craniosynostosis has been treated using both cranial remodeling techniques and modification of the sagittal strip craniectomy. A more recent technique is to implant springs in conjunction with a suturectomy to transversely expand the parietal bones to accommodate the growing brain. In this paper the authors describe and evaluate several modifications to the spring-mediated cranioplasty (SMC) technique, most notably use of an ultrasonic scalpel to limit dural dissection and maximize opening of the stenosed suture by placement of multiple spring devices. In addition, the literature is reviewed comparing SMC to other surgical treatments of sagittal synostosis. METHODS The authors retrospectively reviewed patients who presented to the Children’s Hospital of Philadelphia with a diagnosis of sagittal synostosis from August 2011 to November 2014. A pooled data set was created to compare our institutional data to previously published work. A comprehensive literature review was performed of all previous studies describing the SMC technique, as well as other techniques for sagittal synostosis correction. RESULTS Twenty-two patients underwent SMC at our institution during the study period. Patients were 4.2 months of age on average, had a mean blood loss of 56.3 ml, and average intensive care unit and total hospital stays of 29.5 hours and 2.2 days, respectively. The cranial index was corrected to an average of 73.7 (SD 5.2) for patients who received long-term radiological follow-up. When comparing the authors’ institutional data to pooled SMC data, blood loss and length of stay were both significantly less (p = 0.005 and p < 0.001, respectively), but the preoperative cranial index was significantly larger (p = 0.01). A review of the SMC technique compared with other techniques to actively expand the skull of patients with sagittal synostosis demonstrated that SMC can be performed at a significantly earlier age compared with cranial vault reconstruction (CVR). CONCLUSIONS The authors found that their institutional modifications of the SMC technique were safe and effective in correcting the cranial index. In addition, this technique can be performed at a younger age than CVRs. SMC, therefore, has the potential to maximize the cognitive benefits of early intervention, with lower morbidity than the traditional CVR.

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.

Use of Absorbable Poly (D,L) Lactic Acid Plates in Cranial-Vault Remodeling: Presentation of the First Case and Lessons Learned about Its Use

2005 ◽  
Vol 42 (4) ◽  
pp. 333-339 ◽  
Author(s):  
Humberto L. Acosta ◽  
Eric J. Stelnicki ◽  
Luis Rodriguez ◽  
Lisa A. Slingbaum
Keyword(s):  
Lactic Acid ◽  
Phenotypic Expression ◽  
The United States ◽  
Lessons Learned ◽  
Cranial Vault ◽  
Sagittal Craniosynostosis ◽  
First Case ◽  
Cranial Index ◽  
American Case ◽  
Cranial Vault Remodeling

Objective To present the first clinical use of a new bioabsorbable material, poly (D,L) lactic acid (PDLLA), in pediatric cranial-vault remodeling procedures. This discussion will highlight the benefits and detriments of PDLLA in comparison with currently used absorbable plating systems. Design This was a case study documenting the first North American case in which PDLLA was used to treat craniosynostosis. Materials and Methods Evaluation of pure PDLLA, a copolymer product of the mixture of poly L-lactic acid and its D-isomer, was used in an 8-month-old boy with a severe phenotypic expression of sagittal craniosynostosis. No signs of elevated intracranial pressure were present, and the neurological examination did not show impairments. Total cranial-vault remodeling with the “hung-span” technique was performed. The Resorb X system, containing 2.2-mm screws and 0.6- to 1-mm-thick plates, was used to stabilize the reconstructed cranial vault. Results No surgical complications occurred. The preoperative cranial index measured 62. The scaphocephalic appearance of the skull was eliminated, and the cranial index was normalized to 77. The screws and plates were less palpable than other plating systems. Twelve months postoperatively, none of the plates and screws were identifiable by external palpation. Conclusion Resorb X has been successfully used in the treatment of sagittal craniosynostosis. Its rapid rate of resorption and lower profile make it an advantageous system for pediatric skull reconstruction. This represents the first use of this product in the United States for any pathology.

The Effects of Molding Helmet Therapy on Spring-Mediated Cranial Vault Remodeling for Sagittal Craniosynostosis

2016 ◽  
Vol 27 (6) ◽  
pp. 1398-1403 ◽  
Author(s):  
Jordan W. Swanson ◽  
Jacqueline A. Haas ◽  
Brianne T. Mitchell ◽  
Philip B. Storm ◽  
Scott P. Bartlett ◽  
...  
Keyword(s):  
Cranial Vault ◽  
Sagittal Craniosynostosis ◽  
Helmet Therapy ◽  
Cranial Vault Remodeling

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 Analysis of clinical outcomes for treatment of sagittal craniosynostosis: a comparison of endoscopic suturectomy and cranial vault remodeling

2018 ◽  
Vol 22 (5) ◽  
pp. 467-474 ◽  
Author(s):  
Kathryn V. Isaac ◽  
John G. Meara ◽  
Mark R. Proctor
Keyword(s):  
Clinical Outcomes ◽  
Cranial Vault ◽  
Transfusion Rate ◽  
Class Iii ◽  
Sagittal Craniosynostosis ◽  
Cranial Index ◽  
Z Scores ◽  
Effectiveness Studies ◽  
Cranial Vault Remodeling

OBJECTIVEComparative effectiveness studies are needed for analyzing the clinical outcomes of treatment of sagittal craniosynostosis (SC) with endoscopic suturectomy (ES) or cranial vault remodeling (CVR).METHODSFrom 2004–2015, patients were consecutively reviewed and data recorded for operative details and complications. Cranial growth was measured by head circumference percentile (HCP) and cranial index (CI) Z-score. Aesthetic outcomes were compared using the Whitaker classification.RESULTSA total of 207 patients with nonsyndromic SC were treated with ES (n = 187) or CVR (n = 20). The ES group had a lower median operative duration (45 vs 195 minutes), length of stay (1 vs 3 days), and transfusion rate (2% vs 85%; p < 0.0001). Median age at follow-up was 3.0 years (interquartile range [IQR] 2.5–4.5, ES) and 3.9 years (IQR 2–5, CVR; p = 0.12). In both groups, HCP gradually decreased during a 3-year follow-up (p = 0.282). CI Z-scores were initially more favorable in the ES group (p < 0.05); 3 years following surgical intervention, Z-scores were equal between groups (p = 0.392). One nonsyndromic patient treated with ES (0.5%) demonstrated reossification and required secondary expansion. Most patients were Whitaker class I (99% of ES, 95% of CVR); 5% of CVR patients were class II and 1% of ES patients were class III. Four syndromic patients presented without clear evidence of a syndrome, were treated by ES, and subsequently required secondary expansion for raised intracranial pressure.CONCLUSIONSES is an effective treatment for nonsyndromic SC with comparable head growth, aesthetic outcomes, and less morbidity relative to CVR. In the absence of a syndrome, secondary cranial expansion following ES is rarely required.

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

2011 ◽  
Vol 7 (6) ◽  
pp. 620-626 ◽  
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.

Normal Head Shape Parameters in the First 2 Years of Life and Effect of Helmet Therapy

2017 ◽  
Vol 48 (06) ◽  
pp. 432-441 ◽  
Author(s):  
Kerstin Kaps ◽  
Darko Tabak ◽  
Uta Bierther ◽  
Martina Wilbrand ◽  
Bernd Neubauer ◽  
...  
Keyword(s):  
Asymmetry Index ◽  
Cranial Vault ◽  
Normative Values ◽  
Healthy Children ◽  
Shape Parameters ◽  
Cranial Index ◽  
Helmet Therapy ◽  
Before And After ◽  
Number Of Individuals ◽  
Normal Head

Objective The treatment of a positional head deformity in infancy is a controversial issue. The aim of this study was to explore the effects of helmet therapy on positional plagiocephaly and brachycephaly. Patients and Methods We determined cranial vault shape parameters in 348 healthy children during the second year of life, combined them with preexisting data from more than 400 subjects younger than 12 months, and related retrospectively the data of 1,531 children obtained before and after treatment with individual molding helmets to these newly generated normative values. Results The number of subjects with cranial vault asymmetry values > 97th percentile decreased by 85.5% from 1,361 before to 197 (p < 0.01) after helmet therapy, while the number of individuals with cranial vault asymmetry index values > 97th percentile declined by 87.7% from 1,353 to 167 (p < 0.01). Similarly, the number of infants with cranial index values > 97th percentile diminished by 66.8% from 885 to 294 (p < 0.01). Conclusions These findings do not finally prove, but they support the idea that helmet treatment is effective and meaningful in preventing permanent head deformities in infants with severe deformation. The normative anthropometric data generated in this study will allow investigating the natural course and effects of various therapies on infant cranial shape objectively.

scholarly journals Effect of molding helmets on intracranial pressure and head shape in nonsurgically treated sagittal craniosynostosis patients

2016 ◽  
Vol 18 (2) ◽  
pp. 207-212 ◽  
Author(s):  
Neena I. Marupudi ◽  
Sandeep Sood ◽  
Arlene Rozzelle ◽  
Steven D. Ham
Keyword(s):  
Intracranial Pressure ◽  
Pediatric Patients ◽  
Patient Positioning ◽  
Cranial Vault ◽  
Monitoring Site ◽  
Head Shape ◽  
Sagittal Synostosis ◽  
Cranial Index ◽  
End Tidal ◽  
Harmful Effects

OBJECTIVE Cranial vault expansion is performed in pediatric patients with craniosynostosis to improve head shape. Another argument for performing total cranial vault reconstruction is the potential reduction in the harmful effects of elevated intracranial pressure (ICP) that are associated with craniosynostosis. Alternatively, molding helmets have been shown to improve the cranial index (CI) in patients with sagittal synostosis without surgery. However, it is unknown if the use of molding helmets without surgery contributes to adverse changes in ICP. The effect of molding helmets on ICP and CI in patients with sagittal synostosis was investigated. METHODS A prospective cohort study of 24 pediatric patients with sagittal synostosis who planned to undergo total cranial reconstruction was performed from 2011 to 2014 at the Children's Hospital of Michigan. A preoperative molding helmet was used in 13 patients, and no molding helmet was used in 11 patients. End-tidal carbon dioxide, patient positioning, level of sedation, type of anesthetic, and the monitoring site at the time of intraoperative recording were regulated and standardized to establish the accuracy of the ICP readings. CI and head circumference were monitored for each patient. RESULTS The mean duration of the preoperative use of the molding helmet was 17 weeks (range 7–37 weeks). Under controlled settings, the average intraoperative ICP was 7.2 mm Hg (range 2–18 mm Hg) for patients treated with a preoperative molding helmet and 9.5 mm Hg (range 2–22 mm Hg) for patients with no preoperative molding helmet. ICP was not significantly different between the 2 groups, suggesting that the use of a molding helmet in this population is safe. The average CI at the time of helmet placement was 0.70 (range 0.67–0.73), and this improved to an average of 0.74 (range 0.69–0.79) after using the molding helmet for a mean of 17 weeks. CONCLUSIONS ICPs were not significantly different with the use of a preoperative molding helmet, refuting the prevailing thought that molding helmets would be detrimental in children who have craniosynostosis. The use of molding helmet in this population of patients improves head shape and does not adversely affect ICP.

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