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Novel Suturectomy Using Absorbable Plates in Early Surgery for Craniosynostosis
Daisuke Sakahara1, Keisuke Imai1, Takeshi Masuoka1
1Department of Plastic and Reconstructive Surgery.
Insights
Early suturectomy with absorbable plates effectively treats severe craniosynostosis in infants. This innovative technique improved cranial shape and avoided secondary surgeries in most patients, offering a less invasive solution.
Area of Science:
- Pediatric Neurosurgery
- Craniofacial Surgery
- Biomaterials in Medicine
Background:
- Craniosynostosis requires early intervention, with suturectomy being a common treatment for infants under three months.
- Severe cases may not benefit from conventional suturectomy, necessitating alternative approaches.
- This study evaluates a novel suturectomy technique using absorbable plates for improved outcomes in young craniosynostosis patients.
Purpose of the Study:
- To assess the efficacy of suturectomy combined with absorbable plates in treating severe craniosynostosis in infants.
- To evaluate the impact of this technique on cranial shape and the need for secondary surgeries.
- To determine the safety and effectiveness of this less invasive approach.
Main Methods:
- The study included craniosynostosis patients under three months with severe intracranial hypertension or deformities (scaphocephaly, plagiocephaly, trigonocephaly).
- Patients underwent suturectomy with absorbable plates covering the bone edges.
- Outcomes were assessed using 3D CT scans, photographs, cephalic index, and distance from the dorsum sellae to the forehead.
Main Results:
- Twenty-one of twenty-five patients were evaluated, with diverse preoperative cranial shapes including brachycephaly, scaphocephaly, and plagiocephaly.
- Eighteen patients showed improved cephalic index and cranial definition after surgery.
- Secondary surgeries were avoided in four syndromic and all twelve nonsyndromic patients, with no major complications reported.
Conclusions:
- Absorbable plates effectively manage bone formation, preventing premature fusion and promoting proper bone growth post-absorption.
- This suturectomy technique with absorbable plates successfully prevented secondary surgeries in syndromic and nonsyndromic craniosynostosis patients.
- The approach is a less invasive and highly effective treatment option for craniosynostosis, particularly in severe cases.
Background:
In craniosynostosis patients under 3 months of age, suturectomy is a valuable early treatment improving their outcomes. However, conventional suturectomy might not be in severe patients. The efficacy of our developed suturectomy using absorbable plates was examined.
Methods:
Our method was indicated for craniosynostosis patients under 3 months old who had severe intracranial hypertension, scaphocephaly, plagiocephaly, or trigonocephaly between September 2011 and March 2018. All patients underwent suturectomy, and the bone edges on both sides of the cuts were covered with absorbable plates. Evaluation was conducted with 3-dimensional computed tomography and photographs, and cephalic index, distance from dorsum sellae to forehead on computed tomography were analyzed.
Results:
Twenty-one of the 25 patients were evaluated. The preoperative cranial shapes were 4 brachycephaly, 6 scaphocephaly, 5 oxycephaly, 2 clover-leaf deformity, and 4 plagiocephaly. There were 9 syndromic and 12 nonsyndromic patients. The mean age at the time of surgery was 52.3 days (7-89), and the mean follow-up period was 3.5 years (1-8).The cephalic index and cranial definition improved in 18 patients. The secondary surgery was not required in four syndromic and none of the 12 nonsyndromic patients. There were no major complications.
Conclusion:
Placement of absorbable plates was able to prevent bone formation during the early postoperative period, and yet also promote bone formation after plate absorption. The authors believe syndromic craniosynostosis patients with severe deformities and nonsyndromic ones with scaphocephaly or plagiocephaly, successfully avoided secondary surgeries. This approach is less invasive for craniosynostosis and is expected to be highly effective.
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