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Long-term outcome in 415 operated cases with single suture scaphocephaly
Sofie Dietvorst1, Lawrence Choi2, Aitor de Gea Rico3,4
1Department of Neurosurgery, Alder Hey Children's Hospital, Liverpool, UK. sofie.dietvorst@alderhey.nhs.uk.
Insights
Passive vault remodeling (PassiveVR) and subtotal/total vault remodeling (SVR/TVR) are effective surgical options for scaphocephaly. PassiveVR, performed earlier, requires reoperation in less than 10% of cases for ICP or shape concerns.
Area of Science:
- Craniofacial surgery
- Pediatric neurosurgery
- Plastic surgery
Background:
- Scaphocephaly, a common single-suture synostosis, presents a distinct cranial deformity.
- Surgical goals include cosmetic correction and prevention of elevated intracranial pressure (ICP).
- Various surgical techniques exist, including endoscopic strip craniectomy (ESC), passive vault remodeling (PassiveVR), and active subtotal/total vault remodeling (SVR/TVR).
Purpose of the Study:
- To evaluate the outcomes of different surgical management strategies for non-syndromic scaphocephaly.
- To compare the efficacy and complication rates of PassiveVR, SVR/TVR, and ESC.
- To assess the need for reoperation and its indications.
Main Methods:
- Retrospective analysis of 415 scaphocephaly patients operated between 2012 and 2023.
- Exclusion of syndromic or multisuture synostosis cases.
- Data collected included age, surgical type, ICP at diagnosis, cephalic index (CI) pre- and postoperatively, reoperation details, and follow-up duration.
Main Results:
- PassiveVR (n=200) and SVR/TVR (n=206) were the most common procedures.
- Reoperation rates were 8.5% for PassiveVR, 1.9% for SVR/TVR, and 12.5% for ESC.
- Postoperative CI was significantly improved compared to preoperative CI across all groups (p < 0.01).
Conclusions:
- PassiveVR and SVR/TVR are the primary surgical treatments for scaphocephaly at this institution.
- PassiveVR is associated with lower reoperation rates and is less invasive than SVR/TVR.
- Long-term follow-up is crucial for ESC to detect potential ICP issues or persistent deformities.
Purpose:
There are multiple options available for the surgical management of non-syndromic scaphocephaly. The goals of surgery are to correct the cranial deformity in order to optimize overall cosmetic appearance and to prevent raised intracranial pressure (ICP). At Alder Hey Children's Hospital NHS Trust, we offer a range of surgical procedures for single-suture scaphocephaly (SSS) from endoscopic strip craniectomy (ESC) with helmet therapy, sagittal suturectomy, and barrel staving - known as passive vault remodeling (PassiveVR), to an active subtotal (SVR) or total vault remodeling (TVR).
Methods:
We conducted a retrospective analysis of all operated scaphocephaly patients at Alder Hey. All consecutive patients from 2012 to 2023 were included. Syndromic or multisuture synostosis cases were excluded. Age, type of surgery, issues of ICP at diagnosis, cephalic index (CI) pre- and postoperative, type and indication for reoperation, and length of follow-up were gathered in the database.
Results:
Four hundred fifteen patients were included; 200 underwent PassiveVR, 206 underwent SVR/TVR, 8 underwent ESC + helmet, and one was treated with springs. The median follow-up period was 46 months. Eighteen patients underwent treatment due to high ICP related to synostosis, with the median age at surgery being 54 months in this group. Reoperations for intracranial hypertension or persistent abnormal shape were done for 17 patients treated initially with PassiveVR (8.5%), for 4 patients initially treated with SVR/TVR (1.9%), and for 1 patient initially treated with ESC + helmet (12.5%). Postoperative CI was significantly higher than preoperative CI in all operated patients (paired t-testing, p < 0.01).
Conclusion:
PassiveVR and SVR/TVR are the most common procedures in our centre to treat scaphocephaly, with PassiveVR being performed earlier in life. In less than 10% of PassiveVR cases, reoperation due to increased ICP or abnormal head shape is required, with the benefit of PassiveVR being less invasive than SVR/TVR. Our experience with ESC is limited at present, but preliminary findings from this study suggest the need for long-term follow-up in order to identify early evidence of raised ICP or persistent deformity in this patient subgroup.
