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Long-term outcome after sagittal synostosis operations
A L Albright1, R B Towbin, B L Shultz
1Department of Neurosurgery, Children's Hospital of Pittsburgh, PA 15213, USA.
Insights
Early surgical correction of sagittal synostosis in children leads to acceptable long-term cosmetic outcomes. Most children experienced normal or mildly abnormal head appearance, with few reporting headaches.
Area of Science:
- Neurosurgery
- Pediatric Plastic Surgery
- Craniofacial Surgery
Background:
- Sagittal synostosis is a common premature fusion of the sagittal suture, leading to characteristic head shape deformities.
- Surgical intervention aims to correct the deformity and allow for normal brain growth.
- Long-term outcomes regarding cosmetic appearance and potential complications are crucial for evaluating surgical success.
Purpose of the Study:
- To evaluate the long-term cosmetic and radiological outcomes in children operated for sagittal synostosis.
- To assess the incidence of headaches and other complications post-surgery.
- To determine the effectiveness of different surgical techniques for sagittal synostosis.
Main Methods:
- A retrospective study of 27 children operated for sagittal synostosis 5-10 years prior.
- Evaluation of cosmetic appearance by independent examiners and parents.
- Analysis of skull radiographs for abnormalities and beaten copper markings.
- Measurement of cephalic index and assessment of headache prevalence.
Main Results:
- 93% of children had normal or mildly abnormal appearance, with unacceptable outcomes linked to late surgery or syndromes.
- Skull radiographs were mostly normal or mildly abnormal; beaten copper markings were present in 14/27 cases without headache correlation.
- The mean cephalic index was 70 (normal 81), indicating persistent head shape changes.
- Headaches were reported in 7 children, with 3 experiencing migrainous headaches.
Conclusions:
- Sagittal reconstruction provides acceptable cosmetic results 5-10 years postoperatively for children operated before one year of age without syndromes.
- While most children achieve good cosmetic outcomes, persistent cephalic index abnormalities and occasional headaches warrant consideration.
- The study suggests early intervention is key, but the sample size limits definitive conclusions on long-term follow-up needs.
Abstract:
We evaluated 27 children who had been operated on 5-10 years previously for sagittal synostosis. The mean age at operation was 0.55 years. Twenty-two children were treated by the senior author's technique, 4 by the Pi craniectomy technique and 1 by parasagittal sagittal strip craniectomies. The mean age at follow-up was 9.6 years. The cosmetic appearance of the head was graded independently by 3 examiners. Skull radiographs were graded by 2 examiners according to the appearance and presence of beaten copper markings. The cephalic index was measured. Frequent headaches were reported in 7 of 27 children and were migrainous in 3 of the 7. No child had papilledema. The children's appearance was considered to be normal or mildly abnormally by the parents in every case and by the medical observers in 25 of 27 (93%). The only 2 children with an unacceptable appearance were either operated late (3.3 years) or had a craniofacial syndrome. Skull radiographs revealed a normal or mildly abnormal appearance in 18-19 children, depending on the observer. Beaten copper markings were observed to some extent in 14 of 27 cases and did not correlate with the presence of headaches. The cranial index ranged from 62 to 78 with a mean of 70 (normal 81). Sagittal reconstructions resulted in an acceptable appearance 5-10 years postoperatively in all cases operated on at less than 1 year of age who had no syndrome. The need for long-term follow-up of children after sagittal synostosis operations cannot be determined from this sample size.