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Evaluating Surgical Decision-making in Nonsyndromic Sagittal Craniosynostosis Using a Digital 3D Model
Christopher D Hughes1, Olivia Langa2, Laura Nuzzi2
1Division of Plastic and Craniofacial Surgery, Connecticut Children's, Hartford, Conn.
Plastic and Reconstructive Surgery. Global Open
|May 26, 2021
Summary
Surgeons prioritize head shape severity when deciding to operate for nonsyndromic sagittal synostosis. Parental concerns and developmental delays also influence surgical decisions, particularly in moderate cases.
Area of Science:
- Craniofacial Surgery
- Pediatric Neurosurgery
- Developmental Biology
Background:
- Craniosynostosis surgical correction addresses intracranial pressure and cranial deformity.
- Nonsyndromic sagittal synostosis occurs in approximately 15% of patients with elevated intracranial pressure.
- Surgical decisions involve aesthetics, preventing brain growth restriction, surgeon expertise, and parental expectations.
Purpose of the Study:
- To examine clinical factors influencing surgical decision-making in nonsyndromic sagittal synostosis.
- To assess the impact of head shape severity, parental concern, and developmental delay on surgical intervention.
Main Methods:
- An online survey was distributed to craniofacial and neurosurgeons.
- The survey presented 5 theoretical patients with varying severities of sagittal synostosis.
- Clinical scenarios assessed influences of parental concern and developmental delay on operative decisions.
Main Results:
- Head shape severity was the strongest predictor for surgical intervention (P < 0.001).
- Parental concern and developmental delay independently influenced the decision to operate (P < 0.001).
- Experienced surgeons were more likely to operate across all phenotypes (OR: 2.69, P < 0.004).
Conclusions:
- Surgeons are more inclined to operate on nonsyndromic sagittal craniosynostosis with more severe head deformities.
- Parental concern and developmental delay significantly impact surgical decisions, especially for moderate phenotypes.
- Geographic and subspecialty variations did not significantly affect surgical decision-making.
