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Results of cranial vault reshaping
M Z Sabry1, I L Wornom, J D Ward
1Division of Plastic and Reconstructive Surgery, Medical College of Virginia, Richmond 23298, USA.
Insights
Cranial vault reshaping is a safe surgical procedure for correcting skull deformities in children. While it can achieve normal head shape for sagittal craniosynostosis, severe anomalies may result in persistent mild deformities.
Area of Science:
- Pediatric surgery
- Craniofacial surgery
- Neurosurgery
Background:
- Cranial vault reshaping is a surgical technique used to correct skull and upper facial deformities.
- This retrospective study reviewed outcomes in 10 children treated between 1993 and 1996.
Observation:
- The study included children with sagittal craniosynostosis, pansynostosis (cloverleaf skull), and turricephaly secondary to hydrocephalus.
- Ages at surgery ranged from 6 to 62 months (mean 25 months).
- Titanium plates and screws were used, with two removals due to palpability.
Findings:
- No operative mortality occurred. Mean blood loss was 422 ml, with all patients requiring transfusion.
- Two major complications arose from increased intracranial pressure, but patients recovered fully without neurological deficits.
- Successful correction to normal head shape was achieved in sagittal craniosynostosis cases. Cloverleaf skull and turricephaly showed improvement but retained mild residual deformities.
Implications:
- Cranial vault reshaping is a safe and effective treatment for specific pediatric skull deformities.
- Late correction of sagittal craniosynostosis can yield excellent long-term aesthetic results.
- While significant improvement is possible for severe craniofacial anomalies, residual deformities may persist, particularly in syndromic cases.
Abstract:
This study was designed to assess the outcome of cranial vault reshaping for correction of deformity of the skull and the upper face. A retrospective review of all children who underwent cranial vault reshaping by a single team of surgeons between 1993 and 1996 was performed. There were 10 children in the series. The age at surgery ranged from 6 to 62 months (mean age, 25 months). Five children in the series had untreated sagittal craniosynostosis with scaphocephaly, two had pansynostosis resulting in cloverleaf skull deformity, and three had turricephaly after shunt treatment of hydrocephalus. There was no operative mortality. Blood loss ranged from 250 to 1,500 ml (mean, 422 ml). All patients needed transfusion. There were two major complications resulting from increased intracranial pressure, but both patients recovered completely with no neurological sequelae. Titanium plates and screws were used in all patients, but were removed in two when they became palpable. The 5 children with sagittal craniosynostosis had a normal head shape. The 2 children with cloverleaf skull have improved head shape with persistent increased bitemporal width and round faces. The 3 children with turricephaly after shunting have marked improvement with mild persistent deformity. This study shows that cranial vault reshaping is safe and can lead to a long-term normal head shape in children with late correction of sagittal craniosynostosis. Children with more severe anomalies, particularly syndromic patients, can be improved but will have persistent mild deformity.