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Three-dimensional changes in head shape after extended sagittal strip craniectomy with wedge ostectomies and helmet
Pang-Yun Chou1,2, Rami R Hallac1,3, Shitel Patel1
1Department of Plastic Surgery, UT Southwestern.
Journal of Neurosurgery. Pediatrics
|April 1, 2017
Summary
Sagittal strip craniectomy rapidly normalizes head shape, measured by the cephalic index (CI), within 57 days. Three-dimensional analysis reveals significant posterior cranial vault expansion after surgery and helmet therapy.
Area of Science:
- Neurosurgery
- Pediatric Plastic Surgery
- Craniofacial Surgery
Background:
- Outcome studies for sagittal strip craniectomy traditionally use the 2D cephalic index (CI).
- Limited 3D analysis exists for head shape changes post-surgery and helmet therapy.
Purpose of the Study:
- To quantify 2D and 3D head shape changes after sagittal strip craniectomy and helmet therapy.
- To assess the timing of cephalic index normalization.
Main Methods:
- Retrospective review of 21 patients with isolated sagittal synostosis treated between 2012-2015.
- Calculation of CI from 3D images and generation of color/dot maps for regional change analysis.
- Comparison of pre-operative, 1-week post-operative, and end-of-treatment 3D head models.
Main Results:
- Mean CI improved from 71.9 to 81.1, normalizing in a mean of 57.2 days.
- Mean maximum surface distances between pre-op and end-of-treatment 3D models were 24.71 mm.
- Maximum head shape change occurred equally in transverse and vertical dimensions of the posterior vault.
Conclusions:
- Cephalic index normalizes rapidly post-sagittal strip craniectomy, with changes occurring pre- and during helmet therapy.
- 3D analysis demonstrates significant vertical and transverse expansion of the posterior cranial vault.
- Further research is needed to evaluate 3D changes with alternative surgical techniques.