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Biparietal meander expansion technique for sagittal suture synostosis in patients older than 1 year of age-technical
Y S Kang1,2, V Pennacchietti1, M Schulz1
1Pediatric Neurosurgery, Charité-Universitätsmedizin Berlin, Campus Virchow Klinikum, Augustenburger Platz 1, D-13353, Berlin, Germany.
Insights
The biparietal meander expansion (BME) technique offers a stable, effective surgical correction for sagittal suture synostosis (SSS) in older children. This method improves head shape and patient quality of life with high satisfaction rates.
Area of Science:
- Craniofacial Surgery
- Pediatric Neurosurgery
- Plastic Surgery
Background:
- Sagittal suture synostosis (SSS) is the most common craniosynostosis, often requiring surgical intervention.
- Surgical correction in older children (>1 year) presents unique challenges due to diminished skull growth dynamics.
- Active reconstruction cranioplasty is essential for stability in active children.
Purpose of the Study:
- To describe the biparietal meander expansion (BME) technique for SSS in patients over 1 year of age.
- To evaluate the perioperative course and outcomes of the BME technique.
- To assess the subjective experience of patients and caregivers following surgical correction.
Main Methods:
- The BME technique involves bilateral serpentine craniotomies and fixation of expanded bone tongues with sutures.
- A retrospective review of patients undergoing BME for SSS was conducted.
- Patient-reported outcome measures (PROMs) were collected to evaluate subjective experiences and outcomes.
Main Results:
- BME was performed on 31 patients (median age: 43 months), with no immediate complications or neurological morbidity.
- Post-surgery, 100% of patients reported improved head shape (57%
- better
- 43%
- much better
- ).
- 81% experienced no daily activity limitations, and 90.5% would opt for the treatment again despite hospital stress.
Conclusions:
- The BME technique is a feasible and effective surgical option for older SSS patients.
- It provides immediate stability and achieves a more normal head shape.
- Subjective outcomes reported by patients and caregivers are favorable in this older patient cohort.
Objective:
Sagittal suture synostosis (SSS) is the most common form of craniosynostosis. For older patients, the strategy for surgical correction needs to consider diminished growth dynamics of the skull and an active reconstruction cranioplasty aims to sustain stability for the active child. We describe our technique of biparietal meander expansion (BME) technique for SSS for patients older than 1 year and retrospectively reviewed the perioperative course as well as the subjective experience of patients and caregivers during follow-up.
Methods:
The BME technique incorporates bilateral serpentine craniotomies and fixation of the consecutively expanded bone tongues with crossing sutures for patients with SSS older than 12 months of age at surgery. We reviewed patients undergoing this surgical technique for correction of SSS and collected data about the clinical course and performed a patients reported outcome measure (PROM) for patients or caregivers to evaluate subjective experience and outcome after surgical treatment.
Results:
BME was performed in 31 patients (8 females; median age: 43 months; range 13-388). The mean length of operation was 172.7±43 minutes (range 115-294). Patients experienced no immediate complications or neurological morbidity after surgery. Considering a total of 21 completed PROM questionnaires, the head shape after surgery was evaluated as either "better" (57%) or "much better" (43%) compared to preoperatively. Eighty-one percent of patients or caregivers answered that the patient experiences no limitation in daily activities. Although 42.8% perceived the hospital as strenuous, 90.5% would choose to undergo this treatment again.
Conclusion:
BME is a feasible technique for older SSS patients resulting in immediate stability of the remodelled calvarium with a more normal head shape. The survey among caregivers or patients revealed a favourable subjectively experienced outcome after this type of surgical treatment of SSS in the more complex context of an older patient cohort.
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