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Total calvarial reconstruction for sagittal synostosis in older infants and children
R J Hudgins1, F D Burstein, W R Boydston
1Department of Pediatric Neurosurgery, Scottish Rite Children's Medical Center, Atlanta, Georgia.
Insights
Total calvarial reconstruction can correct severe scaphocephaly caused by sagittal synostosis in older children. This complex surgery reshapes the skull, addressing deformities when diagnosed late.
Area of Science:
- Craniofacial Surgery
- Pediatric Neurosurgery
- Plastic Surgery
Background:
- Sagittal synostosis, a common craniosynostosis, can lead to scaphocephaly if not treated early.
- Late diagnosis prevents standard surgical correction due to the cessation of calvarial growth.
Purpose of the Study:
- To evaluate the efficacy of total calvarial reconstruction for sagittal synostosis diagnosed after one year of age.
- To address significant skull deformities in older children with scaphocephaly.
Main Methods:
- Adapted craniofacial surgical techniques for total calvarial reconstruction.
- Performed the procedure on nine children with late-diagnosed sagittal synostosis and scaphocephaly.
- Aimed to shorten anteroposterior length, widen biparietal diameter, and reduce deformities.
Main Results:
- Successful correction of skull deformities was achieved in all patients.
- Surgical goals of skull reshaping were met.
- Morbidity included blood loss, hyponatremia, and one instance of a skull defect.
Conclusions:
- Total calvarial reconstruction is a viable option for correcting severe scaphocephaly in older children with sagittal synostosis.
- The procedure effectively addresses significant deformities when diagnosed late.
- Careful surgical planning and execution are crucial for managing potential complications.
Abstract:
Premature closure of the sagittal suture is the most common form of craniosynostosis, but this condition occasionally goes unrecognized until the child is too old to undergo procedures that depend upon continued calvarial growth for success. As the entire calvaria is affected and thus misshapen by sagittal synostosis, late correction involves total calvarial reconstruction. The extensive nature of this undertaking has precluded its utilization despite the presence of significant deformities. Adapting the techniques and experience gained from craniofacial surgery, the authors performed total calvarial reconstruction on nine children with sagittal synostosis and subsequent scaphocephaly diagnosed after the age of 1 year. In each case the goals of shortening the anteroposterior length, widening the biparietal diameter, and reducing frontal and occipital deformities were met. Morbidity consisted of acute blood loss, postoperative hyponatremia, and in one case a residual skull defect. The rationale for this procedure and the techniques utilized are discussed.