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Published on: June 20, 2018
Outcome analysis of 85 patients undergoing the pi procedure for correction of sagittal synostosis
F A Boop1, W M Chadduck, K Shewmake
1Arkansas Children's Hospital, Little Rock, USA.
Insights
The pi procedure effectively corrects sagittal synostosis in infants, offering excellent cosmetic outcomes. Early surgery (under 8 weeks) with the reverse pi technique is linked to poorer results.
Area of Science:
- Neurosurgery
- Pediatric Surgery
- Craniofacial Surgery
Background:
- Sagittal synostosis is a common craniosynostosis affecting skull development.
- The pi procedure is a surgical technique for correcting sagittal synostosis.
- Understanding outcomes and complications is crucial for surgical decision-making.
Purpose of the Study:
- To review the authors' experience with the pi procedure for sagittal synostosis.
- To evaluate the efficacy and safety of the pi procedure.
- To compare outcomes based on patient age and surgical technique variations.
Main Methods:
- Retrospective review of 85 cases undergoing the pi procedure.
- Analysis of pre-operative computerized tomography scans for intracranial pathology.
- Assessment of surgical complications, cosmetic outcomes, and reoperation rates.
Main Results:
- A 4:1 male preponderance was observed.
- 5% of pre-operative scans revealed unexpected intracranial pathology.
- Excellent cosmetic outcomes were achieved in 53% of cases, with poor outcomes in 4% (linked to early surgery and reverse pi procedure).
- Complications included 3 dural lacerations; all patients tolerated blood transfusions.
Conclusions:
- The pi procedure is a viable option for sagittal synostosis with acceptable morbidity.
- Optimal outcomes are associated with surgery between 3-6 months of age.
- The pi procedure may offer superior cosmetic results compared to synostectomy alone.
Abstract:
The authors present a retrospective review of their experience with 85 cases using the pi procedure to correct sagittal synostosis. A male preponderance of four to one was recognized in this group. Sixty-five infants underwent computerized tomography scanning of the head prior to surgery; these scans revealed unexpected intracranial pathology in 5% of cases. Surgical complications included three intraoperative dural lacerations. All children received blood transfusions with no complications. Cosmetic outcomes were excellent in 53%, good in 43%, and poor in 4% of cases. One patient required reoperation. All poor outcomes were in infants who were younger than 8 weeks of age at the time of surgery and who underwent a "reverse pi" procedure. Most of the excellent outcomes occurred in infants who were between 3 and 6 months of age at the time of surgery. Although more extensive than strip craniectomy, the pi procedure can be accomplished with minimal morbidity. In the authors' opinion, the pi procedure provides better immediate and long-term cosmetic results than synostectomy alone.
