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Delayed cranial vault reconstruction for sagittal synostosis in older children: an algorithm for tailoring the
Jeffrey Weinzweig1, Stephen B Baker, Linton A Whitaker
1Department of Surgery, Brown University School of Medicine, Rhode Island Hospital, Providence, USA.
Insights
This study presents a tailored surgical algorithm for older children with delayed sagittal synostosis reconstruction. The approach effectively manages scaphocephalic deformities, achieving excellent aesthetic outcomes in all cases.
Area of Science:
- Craniofacial Surgery
- Pediatric Neurosurgery
- Plastic Surgery
Background:
- Sagittal synostosis, a premature fusion of the sagittal suture, can lead to scaphocephalic deformity.
- Delayed presentation beyond infancy alters the characteristic deformity, complicating surgical management.
- Increased intracranial pressure can occur in older children with untreated sagittal synostosis.
Purpose of the Study:
- To present a management algorithm for sagittal synostosis in older children with delayed cranial vault reconstruction.
- To tailor surgical approaches based on the specific craniofacial deformity.
- To evaluate the outcomes of different surgical techniques in this patient population.
Main Methods:
- Review of 16 patients with sagittal synostosis presenting after 12 months of age.
- Surgical management included single-stage total vault reconstruction, two-stage total vault reconstruction, or anterior two-thirds vault reconstruction.
- Procedures were selected based on the extent of scaphocephalic deformity, including frontal bossing and occipital protrusion.
Main Results:
- All 16 patients underwent successful cranial vault reconstruction with excellent aesthetic results.
- Four patients presented with symptoms of increased intracranial pressure.
- Surgical approach selection was guided by the specific deformity, with fronto-orbital expansion for frontal bossing and posterior vault expansion for occipital protrusion.
Conclusions:
- A tailored surgical algorithm effectively manages delayed sagittal synostosis in older children.
- Careful preoperative evaluation of deformity extent is crucial for selecting the appropriate reconstruction technique.
- The presented algorithm ensures excellent aesthetic outcomes in complex pediatric craniofacial cases.
Abstract:
An algorithm for the management of sagittal synostosis in older children who underwent delayed cranial vault reconstruction is presented. This algorithm tailors the surgical approach to the specific craniofacial deformity present in each case. The scaphocephalic deformity characteristic of sagittal synostosis varies significantly when presentation is delayed beyond the first year of life, the time during which reconstruction is usually performed. Sixteen patients with sagittal synostosis who presented after 12 months of age, and were a mean of 3.2 years of age at the time of cranial vault reconstruction, were reviewed. Four patients demonstrated preoperative symptoms and objective findings indicative of increased intracranial pressure, including frequent headaches and emesis, papilledema, or digital markings on computed tomographic scan. Each of the 16 patients underwent either (1) single-stage total vault reconstruction with or without concomitant fronto-orbital expansion; (2) two-stage total vault reconstruction with anterior two-thirds vault expansion followed by transverse occipital expansion and recession a mean of 8.7 months later; or (3) anterior two-thirds vault reconstruction with or without fronto-orbital expansion. In each case, the extent of the scaphocephalic deformity determined the procedure used. The presence of severe frontal bossing associated with transverse restriction of the orbitotemporal region was an indication for fronto-orbital expansion in addition to vault reconstruction, whereas significant occipital protrusion was an indication for transverse posterior vault expansion and recession in addition to anterior two-thirds vault reconstruction. Excellent aesthetic results were obtained in all cases regardless of the type of reconstruction performed. However, it is essential that the extent of the deformity be carefully evaluated preoperatively to permit selection of the appropriate technique for reconstruction.