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Scaphocephaly part II: Secondary coronal synostosis after scaphocephalic surgical correction
Eric Arnaud1, Nathalie Capon-Degardin, Joseph Michienzi
1Necker Craniofacial Unit, French National Referral Center for Faciocraniosynostosis, Paris, France.
Insights
Secondary coronal synostosis (SCS) occurred in about 10% of patients after craniectomies not involving coronal sutures. Long-term follow-up is crucial for all patients, even those with milder scaphocephaly.
Area of Science:
- Neurosurgery
- Pediatric Neurosurgery
- Craniofacial Surgery
Background:
- Sagittal synostosis is a common condition in infants.
- Secondary coronal synostosis (SCS) can arise after initial treatment for sagittal synostosis.
- Understanding the incidence and consequences of SCS is vital for patient management.
Purpose of the Study:
- To analyze the occurrence and functional outcomes of secondary coronal synostosis (SCS) in patients with sagittal synostosis.
- To compare SCS rates across different surgical and non-surgical treatment groups for scaphocephaly.
Main Methods:
- Retrospective analysis of children with scaphocephaly and a minimum 3-year follow-up.
- Categorization into four groups: "H" craniectomy, craniectomies removing coronal sutures, "H" craniectomies with flap transposition, and non-surgical management.
- Assessment of SCS, fingerprinting, and signs of increased intracranial pressure.
Main Results:
- SCS occurred in 10.4% of patients undergoing "H" craniectomy without coronal suture removal.
- No SCS cases were observed in patients with craniectomies that included removal of coronal sutures.
- 1.2% of non-surgical patients with milder scaphocephaly developed SCS, highlighting the need for monitoring.
Conclusions:
- Secondary coronal synostosis (SCS) has an approximate 10% incidence following specific craniectomy procedures for sagittal synostosis.
- A small percentage (1%) of these SCS cases necessitate surgical decompression due to elevated intracranial pressure.
- Long-term surveillance is recommended for all patients, including those with milder scaphocephaly, to detect potential SCS recurrence.
Aim:
Occurrence of secondary coronal synostosis (SCS) and its functional consequences were retrospectively analyzed in sagittal synostosis.
Patients And Methods:
Occurrence of SCS and/or fingerprinting and clinical signs of raised intracranial pressure were investigated in children with scaphocephaly with a minimum follow-up of 3 years. Children were divided in 4 groups according to surgery (group 1: "H" craniectomy [193 patients]; group 2: craniectomies with removal of the coronal sutures [24 children]; group 3:"H" craniectomies and flap transpositions without total removal of the coronal suture [36 patients]; and group 4: 253 nonsurgical patients with scaphocephaly).
Results:
Among group 1, 20 (10.4%) developed SCS (3 mo to 6 y postoperatively). Fingerprinting was generalized in 13 patients, localized in 5, and absent in 2. Headaches were present in 8 patients. Papilledema appeared during follow-up in 2 of them. Intracranial pressure that was first recorded as normal became elevated, and they both required a surgical decompression. In group 2, none developed an SCS. In group 3, 11% developed SCS. In group 4, 1.2% nonsurgical patients with scaphocephaly presented with an SCS. However, group 4 corresponds to less severe morphologic deformation and/or parents refusing surgery.
Conclusions:
Secondary coronal synostosis appears to occur with an approximate 10% incidence after craniectomies not involving the coronal sutures, with 1% requiring surgical decompression. Patients with milder forms of scaphocephaly who were not operated on (1.2%) rarely developed an SCS. Long-term follow-up should be undertaken even in the milder forms for possible recurrence of secondary synostosis.
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