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Decreased skull growth in positional plagiocephaly patients undergoing helmet therapy
Maximilian Lindemann1, Donjetë Januzi1, Sabine Borowski2
1Department of Neurosurgery, University Hospital Jena, Friedrich Schiller University, Jena, Germany.
Insights
Helmet therapy for plagiocephaly significantly reduced head circumference percentiles in newborns. Further research is needed to understand the clinical relevance of this "percentile escape" in head growth.
Area of Science:
- Pediatric orthopedics
- Cranial deformities
- Developmental pediatrics
Background:
- Helmet therapy (HMT) is a standard treatment for plagiocephaly, aiming to improve head shape, motor function, and quality of life.
- Plagiocephaly, a common condition in infants, involves an asymmetrical flattening of the skull.
Purpose of the Study:
- To evaluate the percentile changes in head circumference among infants undergoing helmet therapy for plagiocephaly.
- To assess the phenomenon of 'percentile escape' in head circumference during HMT.
Main Methods:
- A cohort of 272 infants with plagiocephaly was analyzed, with 238 included in the final analysis.
- 3D head scans were used to track head circumference changes before, during, and after HMT.
- The LMS method, referencing the German Health Interview and Examination Survey for Children and Adolescents (KiGGS study), was employed to calculate head circumference percentiles.
Main Results:
- The median head circumference percentile significantly decreased from 50.00 before HMT to 25.00 after treatment (p < 0.001).
- Only 59 out of 238 patients demonstrated percentile adherence during therapy.
- The average difference in head circumference was 21.51 mm, with considerable variation observed.
Conclusions:
- Helmet therapy for plagiocephaly is associated with a significant reduction in head circumference percentiles.
- While no clinical signs of increased intracranial pressure were noted, further long-term studies with larger cohorts are essential to determine the clinical significance of this percentile escape.
Introduction:
Helmet treatment is a worldwide acknowledged method to improve motor function, quality of life and aesthetics in patients with plagiocephaly.
Research Question:
The objective of this study is to assess percentile escape in head circumference in newborns receiving helmet therapy (HMT) for plagiocephaly.
Material And Methods:
All patients underwent HMT over 124.32 days on average (SD = 72.56), with 3D scans (Rodin4D neo) taken of their heads before, during and after the treatment. Eight participants were excluded due to insufficient data. Ten patients were excluded for either craniosynostosis or discontinuation of helmet therapy."German Health Interview and Examination Survey for Children and Adolescents" (KiGGS study) served as reference for the assessment of head circumference growth. Percentiles were calculated using the LMS-method.
Results:
Out of 272 patients (94 females, 178 males), 238 had suitable parameters for the LMS-method. The average age at the onset of therapy was 5.99 (SD = 2.23) months, concluding at 10.06 months (SD = 3.01). The median percentile before HMT was 50.00 (SD = 39.5), which decreased significantly to 25.00 (SD = 33.84) after HMT (p < 0.001). Only 59 patients showed percentile adherence during the treatment. The mean difference in head circumference was 21.51 mm (SD = 14.81), ranging from -44.4 mm to 69.1 mm. Clinical examination revealed that the patients exhibit developmental progress consistent with respective ages.
Discussion And Conclusion:
Significant decrease in head circumferential growth was observed following HMT. Even though patients did not show clinical signs of raised ICP, to ascertain the clinical relevance of this percentile escape, conducting longer follow-ups involving a larger cohort of patients is crucial.
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