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Sagittal craniosynostosis outcome assessment for two methods and timings of intervention
J Panchal1, J L Marsh, T S Park
1Department of Plastic and Reconstructive Surgery at the Oklahoma University Health Sciences Center, Oklahoma City 73003, USA.
Insights
Subtotal calvarectomy effectively normalizes cranial index in infants with sagittal craniosynostosis. Extended strip craniectomy, even when performed early, does not achieve normal cranial proportions.
Area of Science:
- Neurosurgery
- Pediatric Surgery
- Craniofacial Surgery
Background:
- Sagittal craniosynostosis is a common congenital condition characterized by premature fusion of the sagittal suture.
- This fusion leads to abnormal head shape, specifically affecting cranial width and length proportions.
- Surgical intervention aims to correct these deformities and normalize cranial development.
Purpose of the Study:
- To compare the outcomes of extended strip craniectomy versus subtotal calvarectomy for sagittal craniosynostosis.
- To determine the impact of age at surgery on the effectiveness of these procedures.
- To assess changes in the cranial index (CI) following surgical correction.
Main Methods:
- Retrospective quantitative analysis of 40 infants with sagittal craniosynostosis.
- Patients were categorized by surgical procedure (extended strip craniectomy or subtotal calvarectomy) and age at operation (<= 4 months or > 4 months).
- Cranial index (CI) was measured preoperatively, perioperatively, and 1 year postoperatively using computed tomography (CT) data.
Main Results:
- Subtotal calvarectomy resulted in a significant improvement in CI, reaching age-appropriate normal range values 1 year postoperatively (mean CI improved from 66 to 74).
- Extended strip craniectomy showed significant CI improvement (mean CI improved from 67 to 71), but did not reach normal age-appropriate values.
- The percentage improvement in CI was significantly greater after subtotal calvarectomy compared to extended strip craniectomy (p = 0.003).
Conclusions:
- Subtotal calvarectomy is more effective than extended strip craniectomy in achieving normal cranial width-to-length proportions in infants with sagittal craniosynostosis.
- Extended strip craniectomy, even when performed before 4 months of age, does not adequately normalize cranial index.
- Subtotal calvarectomy appears to be a superior surgical approach for normalizing cranial morphology in sagittal craniosynostosis within the first year of life.
Abstract:
A retrospective quantitative analysis of 40 infants who underwent surgery for sagittal craniosynostosis was conducted to determine whether any difference in outcome, with respect to cranial index (cranial width/cranial length x 100), could be associated with either the age at surgery or the extent of the operation. Children < or = 13 months old at surgery and for whom there were archived computed tomography digital data preoperatively, perioperatively, and 1 year postoperatively were studied. For statistical analysis, the operation was classified as either extended strip craniectomy or subtotal calvarectomy, and the age at operation was either < or = 4 months or > 4 months. Twenty-eight patients underwent extended strip craniectomy at a mean age of 5.1 months. Their mean cranial index preoperatively was 67 versus 71 at 1 year postoperatively (p < 0.0001). Of extended strip craniectomy patients, 15 were operated on at age < or = 4 months (mean = 2.9 months) and 13 at age > 4 months (mean = 7.6 months). Mean cranial indices for age at operation groups did not achieve age-appropriate normal range values 1 year postoperatively for either group, and there was no significant difference between the mean percentages of improvement achieved (p = 0.143). Twelve patients underwent subtotal calvarectomy at a mean age of 5.2 months. Their mean cranial index preoperatively was 66 versus 74 at 1 year postoperatively (p < 0.0001). The mean cranial index in this group reached age-appropriate normal range values 1 year postoperatively. The percentage improvement in cranial index 1 year after subtotal calvarectomy was greater than after extended strip craniectomy (p = 0.003). Extended strip craniectomy for sagittal craniosynostosis does not achieve normal cranial width:length proportions, even when performed before 4 months of age. Subtotal calvarectomy for sagittal craniosynostosis does achieve normal cranial width:length proportions in the majority of the children, at least when performed within the first 13 months of life.