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Persistent Cranial Defects After Endoscopic Sagittal Synostosis Surgery
1Division of Plastic Surgery, Stanford University School of Medicine, Stanford, CA.
The Journal of Craniofacial Surgery
|September 27, 2022
Summary
Incomplete cranial ossification after endoscopic sagittal synostectomy occurred in 3.5% of patients. These cranial defects, though managed with bone grafting, were associated with a higher incidence of developmental concerns.
Area of Science:
- Neurosurgery
- Pediatric Surgery
- Craniofacial Surgery
Background:
- Incomplete cranial ossification is a rare but significant complication following calvarial-vault remodeling for sagittal synostosis.
- The incidence of this complication can range widely, from 0.5% to 18% in previous studies.
- Reoperation is often necessary to address these ossification defects.
Purpose of the Study:
- To report the incidence and management of incomplete cranial ossification after endoscopic sagittal synostectomy and barrel stave osteotomies.
- To evaluate the outcomes of reconstructive surgery for these defects.
- To explore potential associations between cranial defects and developmental concerns.
Main Methods:
- Retrospective review of infants with sagittal synostosis treated between 2003 and 2021.
- Inclusion criteria included endoscopic sagittal synostectomy with barrel stave osteotomies and postoperative helmeting, with follow-up until helmet completion.
- Data collected included surgical timing, helmet duration, complications, and outcomes of reconstructive procedures.
Main Results:
- Of 86 eligible patients, 3 (3.5%) developed cranial defects.
- Patients with defects showed no significant differences in age at surgery, helmeting duration, or perioperative complications compared to those without.
- However, 100% of patients with cranial defects exhibited developmental concerns, versus 16.9% without. Reconstructive surgery involved bone grafting, bone matrix, and absorbable plates, with variable success.
Conclusions:
- This study represents the largest series on reoperations for incomplete ossification post-endoscopic sagittal synostectomy with helmet treatment.
- A 3.5% rate of cranial defects was observed, managed successfully with bone grafting and bone matrix.
- Poor ossification may correlate with an increased propensity for developmental concerns in affected children.
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