Articoli di riviste: "Suturectomy"

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Frazier, Brenda C., Mark P. Mooney, H. Wolfgang Losken, Tim Barbano, Amr Moursi, Michael I. Siegel e Joan T. Richtsmeier. "Comparison of Craniofacial Phenotype in Craniosynostotic Rabbits Treated with Anti–Tgf-β2 at Suturectomy Site". Cleft Palate-Craniofacial Journal 45, n. 6 (novembre 2008): 571–82. http://dx.doi.org/10.1597/07-095.1.

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Objective: Overexpression of transforming growth factor-beta 2 has been associated with craniosynostosis and resynostosis following surgery. We examined the effects of localized transforming growth factor-beta 2 inhibition on craniofacial phenotype in rabbits with craniosynostosis. Design: Twenty-five New Zealand white rabbits with bilateral coronal craniosynostosis were divided into three treatment groups: (1) suturectomy control (n = 8); (2) suturectomy with nonspecific, control immunoglobulin G antibody (n = 6); and (3) suturectomy with anti–transforming growth factor-beta 2 antibody (n = 11). At 10 days of age, a coronal suturectomy was performed on all rabbits. The sites in groups 2 and 3 were immediately filled with a slow-resorbing collagen gel mixed with either immunoglobulin G or anti–transforming growth factor-beta 2 antibody. Computed tomography scans of each rabbit were acquired at ages 10, 25, and 84 days. Craniofacial landmarks were collected from three-dimensional computed tomography reconstructions, and growth and form were compared among the three groups. Results: Rabbits treated with anti–transforming growth factor-beta 2 antibody differed in form at 84 days of age compared with suturectomy control rabbits, specifically in the snout and posterior neurocranium. Growth in some areas of the skull was greater in rabbits from the anti–transforming growth factor-beta 2 group than in suturectomy control rabbits, but not significantly greater than in IgG control rabbits. Conclusions: We find support for the hypothesis that transforming growth factor-beta 2 inhibition alters adult form, but these changes do not appear to be localized to the suturectomy region. Slight differences in form and growth between the two control groups suggest that the presence of the collagen vehicle itself may affect skull growth.

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Sood, Sandeep, Arlene Rozzelle, Blerina Shaqiri, Natasha Sood e Steven D. Ham. "Effect of molding helmet on head shape in nonsurgically treated sagittal craniosynostosis". Journal of Neurosurgery: Pediatrics 7, n. 6 (giugno 2011): 627–32. http://dx.doi.org/10.3171/2011.4.peds116.

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Object Sagittal craniosynostosis is traditionally considered to be a surgical condition. Poor results of simple suturectomy follow from early reclosure of the suture. A wider craniectomy or use of interposing materials has not improved the outcome. However, endoscopic suturectomy supplemented with postoperative use of a molding helmet has shown good results. Because suturectomy reunites within 8–12 weeks of surgery, the authors questioned if the improved outcome was primarily related to use of the helmet. Methods In 4 patients whose families opted for calvarial reconstruction when the infant was 4–6 months old, instead of endoscopic suturectomy, a molding helmet was used to minimize compensatory changes in the interim. Patients underwent 3D CT scanning to confirm craniosynostosis. Follow-up visits were made at intervals of 4 weeks for adjustment of the helmet, head circumference measurements, clinical photographs, and cranial index measurement. Results There was significant improvement in the head shape within 6 weeks of use of the molding helmet. The cranial index score improved from a mean (± SD) of 67% ± 3% to 75% ± 2%. Conclusions These cases demonstrate that molding helmets improve head shape even without a suturectomy in patients with sagittal craniosynostosis, challenging the traditional view.

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Mooney, Mark P., Annie M. Burrows, Timothy D. Smith, H. Wolfgang Losken, Lynne A. Opperman, Jason Dechant, Amy M. Kreithen et al. "Correction of Coronal Suture Synostosis Using Suture and Dura Mater Allografts in Rabbits with Familial Craniosynostosis". Cleft Palate-Craniofacial Journal 38, n. 3 (maggio 2001): 206–25. http://dx.doi.org/10.1597/1545-1569_2001_038_0206_cocssu_2.0.co_2.

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Objective: Resynostosis following surgical correction of craniosynostosis is a common clinical correlate. Recent studies suggest that the dura mater is necessary to maintain suture patency. It has also been hypothesized that dura mater from synostotic individuals may provide aberrant biochemical signals to the osteogenic fronts of the calvaria, which result in premature suture fusion and subsequent resynostosis following surgery. This study was designed to test this hypothesis by surgically manipulating the coronal suture and dura mater in rabbits with familial craniosynostosis to prevent postsurgical resynostosis. Design: Craniofacial growth and histomorphometric data were collected from 129 rabbits: 72 normal controls and 57 rabbits with bilateral coronal suture synostosis (15 unoperated on controls; 13 surgical controls; 9 dura mater transplant only; 10 suture transplant only; and 10 suture and dura mater transplant). At 10 days of age, all rabbits had radiopaque amalgam markers placed on either side of the coronal, frontonasal, and anterior lambdoidal sutures. At 25 days of age, 42 synostosed rabbits had a 3 to 5-mm wide coronal suturectomy. Coronal sutures and/or underlying dura mater allografts were harvested from same-aged, wild-type, isohistogenic control rabbits and transplanted onto the dura mater of synostosed host rabbits. Serial radiographs were taken at 10, 25, 42, and 84 days of age, and the suturectomy sites were harvested at 84 days of age in 44 rabbits and serially sectioned for histomorphometric examination. Results: Results revealed that cranial vault growth was significantly (p < .05) improved following surgical release of the fused coronal suture compared with synostosed rabbits who were not operated on but was still significantly different (p < .05) from that of normal control rabbits. By 84 days of age, significant (p < .05) differences were noted in calvarial suture marker separation, cranial vault shape indices, and cranial base angles between rabbits with and without dura mater allografts, probably as a result of resynostosis of the suturectomy site or suture-only allografts. Qualitative histological examination revealed that at 84 days of age rabbits with suture and dura allografts had patent coronal sutures, suture-only allografts had fused coronal sutures with extensive endosteal hyperostosis, dura mater–only allografts had some new bone in the suturectomy site that resembled rudimentary osteogenic fronts, and suturectomy controls had extensive endosteal bone formation and resynostosis of the suturectomy site. Significantly (p < .05) more bone was found in the suturectomy sites of rabbits without dura mater allografts compared with rabbits with dura mater allografts. Conclusions: Results support the initial hypothesis that normal dura mater allografts will maintain suture or suturectomy site patency and allow unrestricted craniofacial growth. However, it is still unclear whether the dura mater from normal rabbits was providing biochemical signals to the transplanted sutures or suturectomy sites or simply acting as a barrier to prevent abnormal biochemical signals from the dura mater of synostosed rabbits from reaching the calvaria. The clinical and therapeutic implications of these procedures are discussed.

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McDowell, Michael M., Robert Kellogg, Jesse A. Goldstein e Taylor J. Abel. "Endoscope-assisted right coronal suturectomy". Neurosurgical Focus: Video 4, n. 2 (aprile 2021): V11. http://dx.doi.org/10.3171/2021.1.focvid20130.

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Endoscopic suturectomy combined with supplementary techniques such as spring-assisted expansion and cranial molding helmets for the correction of craniosynostosis is growing in popularity due to the reduced scar burdened, decreased morbidity, and reduced overall cost. The authors present their technique for the correction of isolated coronal craniosynostosis. The use of dedicated endoscopic tools and lit endoscopes permits enhanced visualization and technical ability, particularly at the distal portions of the suturectomy, and may reduce operative time and cerebrospinal fluid leak risk. The video can be found here: https://vimeo.com/515401366.

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Tombeng, Marthinson Andrew, e I. Wayan Niryana. "Open suturectomy management in craniosynostosis of bilateral coronal and metopic suture". Neurologico Spinale Medico Chirurgico 4, n. 1 (31 marzo 2021): 15–18. http://dx.doi.org/10.36444/nsmc.v4i1.145.

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Craniosynostosis is a cranial deformation that is characterized by the premature fusion of one or more of the cranial sutures. Synostosis of multiple suture is a rare case and can be treated with open suturectomy procedure which is one of the surgical management by removing the fused suture with the purpose to allow the constricted area to expand with the growing brain. We present a case of a 2-month-old male infant with abnormal head shape since birth with a non-contrast 3D computed tomography (CT) scan of the head confirmed closure of the bilateral coronal and metopic suture. Open suturectomy was performed with no post operative complications. Open suturectomy technique can be performed in the management of multisutural craniosynostosis as indicated. The diagnosis of which suture are affected, the timing of surgery, and the prevention of surgical complication such as excessive blood loss are the important factors need to be considered.

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Ridgway, Emily B., John Berry-Candelario, Ronald T. Grondin, Gary F. Rogers e Mark R. Proctor. "The management of sagittal synostosis using endoscopic suturectomy and postoperative helmet therapy". Journal of Neurosurgery: Pediatrics 7, n. 6 (giugno 2011): 620–26. http://dx.doi.org/10.3171/2011.3.peds10418.

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Object Suturectomy as a treatment for craniosynostosis was largely replaced in the late twentieth century by more extensive, but predictable, cranial remodeling procedures. Recent technical innovations, such as using the endoscope combined with postoperative orthotic reshaping, have led to a resurgence of interest in suturectomy as a safer, less invasive method. Methods A retrospective chart review was performed for all cases of sagittal synostosis treated with endoscopic sagittal suture strip craniectomy and helmet therapy between 2004 and 2008. Data collected included gestational age, genetic evaluations and syndromic status, age at operation, duration of procedure, need for blood transfusions, length of hospital stay, preoperative and postoperative head circumference percentile and cranial index, duration of helmet use, length of follow-up, complications, and revisions. Results Fifty-six patients with isolated sagittal synostosis were treated using endoscopic suturectomy and completed helmet therapy. Mean age at time of procedure was 3.24 months. Mean operative duration was 45.32 minutes. Mean hospital stay was 1.39 days. There were 2 transfusions and no deaths. The mean length of follow-up was 2.34 years. Helmet therapy was instituted for a mean of 7.47 months. Head circumference percentile increased from 61.42% to 89.27% over 2 years of follow-up. Cranial index increased from a preoperative mean of 0.69 to 0.76 over 2 years of follow-up. Reoperations for synostosis included 1 sagittal suture refusion and 2 cases in which other sutures fused. Conclusions Sagittal synostosis can be safely treated with endoscopic suturectomy and helmet therapy. Improvements in cranial volume and shape are comparable to open procedures and are enduring.

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McGahan, Ben G., Joravar Dhaliwal, Gregory D. Pearson, Ibrahim Khansa e Annie I. Drapeau. "A Case Series of the Use of Piezosurgery Instrument for Minimally Invasive Metopic Suturectomy". Operative Neurosurgery 20, n. 6 (6 febbraio 2021): 529–34. http://dx.doi.org/10.1093/ons/opab006.

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Abstract BACKGROUND Minimal invasive suturectomy is one of the many surgical approaches to treat isolated single suture craniosynostosis. This approach can be technically challenging in metopic craniosynostosis given the narrow corridor and steep angle of the forehead. New instruments such as the Piezosurgery device (Mectron) have the potential to improve the ability to safely perform minimal invasive surgery in metopic craniosynostosis. OBJECTIVE To demonstrate the safety and efficacy of Piezosurgery technology in minimal invasive suturectomy for nonsyndromic metopic suture craniosynostosis and to describe our technique. METHODS A retrospective chart review was performed of all the single metopic suturectomies performed at our single institution from March 2018 to November 2019. Pre-, intra-, and postoperative data were collected to assess the safety of Piezosurgery. RESULTS The cohort consisted of 12 patients with an average of 95.25 d old and an average weight of 6.2 kg. A total of 91.7% were male, and 91.7% were Caucasian. There were no intraoperative or postoperative Piezosurgery device-related complications in the entire cohort. CONCLUSION The use of the Piezosurgery instrument was safe in this cohort of minimal invasive metopic suturectomy. This device has greatly increased the ease of this procedure in our hands.

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Dlouhy, Brian J., Dennis C. Nguyen, Kamlesh B. Patel, Gwendolyn M. Hoben, Gary B. Skolnick, Sybill D. Naidoo, Albert S. Woo e Matthew D. Smyth. "Endoscope-assisted management of sagittal synostosis: wide vertex suturectomy and barrel stave osteotomies versus narrow vertex suturectomy". Journal of Neurosurgery: Pediatrics 18, n. 6 (dicembre 2016): 674–78. http://dx.doi.org/10.3171/2016.6.peds1623.

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OBJECTIVE Endoscope-assisted methods for treatment of craniosynostosis have reported benefits over open calvarial vault reconstruction. In this paper, the authors evaluated 2 methods for endoscope-assisted correction of sagittal synostosis: wide vertex suturectomy and barrel stave osteotomies (WVS+BSO) and narrow vertex suturectomy (NVS). METHODS The authors evaluated patients with nonsyndromic sagittal synostosis treated with either wide vertex suturectomy (4–6 cm) and barrel stave osteotomies (WVS+BSO) or narrow vertex suturectomy (NVS) (approximately 2 cm) between October 2006 and July 2013. Prospectively collected data included patient age, sex, operative time, estimated blood loss (EBL), postoperative hemoglobin level, number of transfusions, complications, and cephalic index. Fourteen patients in the NVS group were age matched to 14 patients in the WVS+BSO group. Descriptive statistics were calculated, and Student t-tests were used to compare prospectively obtained data from the WVS+BSO group with the NVS group in a series of univariate analyses. RESULTS The mean age at surgery was 3.9 months for WVS+BSO and 3.8 months for NVS. The mean operative time for patients undergoing NVS was 59.0 minutes, significantly less than the 83.4-minute operative time for patients undergoing WVS+BSO (p < 0.05). The differences in mean EBL (NVS: 25.4 ml; WVS+BSO: 27.5 ml), mean postoperative hemoglobin level (NVS: 8.6 g/dl; WVS+BSO: 8.0 g/dl), mean preoperative cephalic index (NVS: 69.9; WVS+BSO: 68.2), and mean cephalic index at 1 year of age (NVS: 78.1; WVS+BSO: 77.2) were not statistically significant. CONCLUSIONS The NVS and WVS+BSO produced nearly identical clinical results, as cephalic index at 1 year of age was similar between the 2 approaches. However, the NVS required fewer procedural steps and significantly less operative time than the WVS+BSO. The NVS group obtained the final cephalic index in a similar amount of time postoperatively as the WVS+BSO group. Complications, transfusion rates, and EBL were not different between the 2 techniques.

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Kyutoku, Shigeo, Masahiro Iwanaga, Toyoko Okamoto, Atsuko Harada e Koichi Ueda. "Wider Suturectomy Before Posterior Distraction for Craniosynostosis". Journal of Craniofacial Surgery 30, n. 1 (2019): 71–73. http://dx.doi.org/10.1097/scs.0000000000004911.

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Harada, Atsuko, Shigeo Kyutoku, Yuki Kimoto, Reina Utsugi, Takahiro Fujinaga, Hideyuki Arita, Kazushige Maeno e Koichi Ueda. "Preliminary Report on Endoscopy-assisted Suturectomy for Craniosynostosis". Japanese Journal of Neurosurgery 29, n. 7 (2020): 498–505. http://dx.doi.org/10.7887/jcns.29.498.

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Bonfield, Christopher M., Lesley M. Foley, Shinjini Kundu, Wendy Fellows-Mayle, T. Kevin Hitchens, Gustavo K. Rohde, Ramesh Grandhi e Mark P. Mooney. "The influence of surgical correction on white matter microstructural integrity in rabbits with familial coronal suture craniosynostosis". Neurosurgical Focus 38, n. 5 (maggio 2015): E3. http://dx.doi.org/10.3171/2015.2.focus14849.

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OBJECT Craniosynostosis is a condition in which one or more of the calvarial sutures fuses prematurely. In addition to the cosmetic ramifications attributable to premature suture fusion, aberrations in neurophysiological parameters are seen, which may result in more significant damage. This work examines the microstructural integrity of white matter, using diffusion tensor imaging (DTI) in a homogeneous strain of rabbits with simple, familial coronal suture synostosis before and after surgical correction. METHODS After diagnosis, rabbits were assigned to different groups: wild-type (WT), rabbits with early-onset complete fusion of the coronal suture (BC), and rabbits that had undergone surgical correction with suturectomy (BC-SU) at 10 days of age. Fixed rabbit heads were imaged at 12, 25, or 42 days of life using a 4.7-T, 40-cm bore Avance scanner with a 7.2-cm radiofrequency coil. For DTI, a 3D spin echo sequence was used with a diffusion gradient (b = 2000 sec/mm2) applied in 6 directions. RESULTS As age increased from 12 to 42 days, the DTI differences between WT and BC groups became more pronounced (p < 0.05, 1-way ANOVA), especially in the corpus callosum, cingulum, and fimbriae. Suturectomy resulted in rabbits with no significant differences compared with WT animals, as assessed by DTI of white matter tracts. Also, it was possible to predict to which group an animal belonged (WT, BC, and BC-SU) with high accuracy based on imaging data alone using a linear support vector machine classifier. The ability to predict to which group the animal belonged improved as the age of the animal increased (71% accurate at 12 days and 100% accurate at 42 days). CONCLUSIONS Craniosynostosis results in characteristic changes of major white matter tracts, with differences becoming more apparent as the age of the rabbits increases. Early suturectomy (at 10 days of life) appears to mitigate these differences.

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Rottgers, S. Alex, Subash Lohani e Mark R. Proctor. "Outcomes of endoscopic suturectomy with postoperative helmet therapy in bilateral coronal craniosynostosis". Journal of Neurosurgery: Pediatrics 18, n. 3 (settembre 2016): 281–86. http://dx.doi.org/10.3171/2016.2.peds15693.

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OBJECTIVE Historically, bilateral frontoorbital advancement (FOA) has been the keystone for treatment of turribrachycephaly caused by bilateral coronal synostosis. Early endoscopic suturectomy has become a popular technique for treatment of single-suture synostosis, with acceptable results and minimal perioperative morbidity. Boston Children's Hospital has adopted this method of treating early-presenting cases of bilateral coronal synostosis. METHODS A retrospective review of patients with bilateral coronal craniosynostosis who were treated with endoscopic suturectomy between 2005 and 2012 was completed. Patients were operated on between 1 and 4 months of age. Hospital records were reviewed for perioperative morbidity, length of stay, head circumference and cephalic indices, and the need for further surgery. RESULTS Eighteen patients were identified, 8 males and 10 females, with a mean age at surgery of 2.6 months (range 1–4 months). Nine patients had syndromic craniosynostosis. The mean duration of surgery was 73.3 minutes (range 50–93 minutes). The mean blood loss was 40 ml (range 20–100 ml), and 2 patients needed a blood transfusion. The mean duration of hospital stay was 1.2 days (range 1–2 days). There was 1 major complication in the form of a CSF leak. The mean follow-up was 37 months (range 6–102 months). Eleven percent of nonsyndromic patients required a subsequent FOA; 55.6% of syndromic patients underwent FOA. The head circumference percentiles and cephalic indices improved significantly. CONCLUSIONS Early endoscopic suturectomy successfully treats the majority of patients with bilateral coronal synostosis, and affords a short procedure time, a brief hospital stay, and an expedited recovery. Close follow-up is needed to detect patients who will require a secondary FOA due to progressive suture fusion or resynostosis of the released coronal sutures.

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Mooney, Mark P., Wendy Fellows-Mayle, H. Wolfgang Losken, Jason Dechant, Annie M. Burrows, Timothy D. Smith, Gregory M. Cooper, Ian Pollack e Michael I. Siegel. "Increased Intracranial Pressure After Coronal Suturectomy in Craniosynostotic Rabbits". Journal of Craniofacial Surgery 10, n. 2 (marzo 1999): 104–10. http://dx.doi.org/10.1097/00001665-199903000-00003.

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Rottgers, S. Alex, Hasan R. Syed, Diana S. Jodeh, Yasser Jeelani, Edward Yang, John G. Meara e Mark R. Proctor. "Craniometric Analysis of Endoscopic Suturectomy for Bilateral Coronal Craniosynostosis". Plastic and Reconstructive Surgery 143, n. 1 (gennaio 2019): 183–96. http://dx.doi.org/10.1097/prs.0000000000005118.

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Putz, DA, TD Smith, AM Burrows, GM Cooper, J. Dechant, HW Losken, MI Siegel e MP Mooney. "Cranial base changes following coronal suturectomy in craniosynostotic rabbits". Orthodontics & Craniofacial Research 5, n. 2 (maggio 2002): 90–103. http://dx.doi.org/10.1034/j.1600-0544.2002.01178.x.

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Mohammadi, Hasan R., Zoheir Reihanian, Sara Ramezani e Shiva A. Baneh. "Comparison of Suturectomy and Cranioplasty Outcomes for Nonsyndromic Craniosynostosis". Neurosurgery Quarterly 26, n. 4 (novembre 2016): 298–301. http://dx.doi.org/10.1097/wnq.0000000000000187.

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Lober, Robert M., Shobhan Vachhrajani, Salim Mancho e Kambiz Kamian. "Gigli saw facilitates safe minimal access sagittal suturectomy in infants". Neurosurgical Focus: Video 4, n. 2 (aprile 2021): V3. http://dx.doi.org/10.3171/2021.1.focvid20134.

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The authors describe the use of the Gigli saw for craniectomy in minimal access surgery to address sagittal craniosynostosis. This modification allows for supine positioning and avoidance of potential brain compression with endoscopic instruments, and provides visually clear, safe, and facile removal of the fused suture and surrounding calvaria. The video can be found here: https://vimeo.com/511568750.

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Deraje, Vybhav, Swaroop Gopal, Derick A. Mendonca e Rajendra S. Gujjalanavar. "Endoscope-Assisted “Extended” Suturectomy for Unicoronal Craniosynostosis: A Technical Note". Plastic & Reconstructive Surgery 148, n. 6 (26 ottobre 2021): 1079e—1080e. http://dx.doi.org/10.1097/prs.0000000000008531.

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Chong, Sangjoon, Kyu-Chang Wang, Ji Hoon Phi, Ji Yeoun Lee e Seung-Ki Kim. "Minimally Invasive Suturectomy and Postoperative Helmet Therapy : Advantages and Limitations". Journal of Korean Neurosurgical Society 59, n. 3 (2016): 227. http://dx.doi.org/10.3340/jkns.2016.59.3.227.

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Joly, Aline, Arnaud Paré, Aurélie Sallot, Sophie Arsène, Antoine Listrat, Nadine Travers, Dominique Goga e Boris Laure. "Long-Term Assessment of Suturectomy in Trigonocephaly and Anterior Plagiocephaly". Journal of Craniofacial Surgery 27, n. 3 (maggio 2016): 627–30. http://dx.doi.org/10.1097/scs.0000000000002585.

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Lobb, David C., Smruti K. Patel, Brian S. Pan e Jesse Skoch. "Partial suturectomy for phenotypical craniosynostosis caused by incomplete fusion of cranial sutures: a novel surgical solution". Neurosurgical Focus 50, n. 4 (aprile 2021): E6. http://dx.doi.org/10.3171/2021.1.focus201024.

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OBJECTIVE Patients presenting with head shape changes phenotypical for craniosynostosis may have incomplete fusion of the involved sutures. The surgical literature is lacking in appropriate management strategies for these patients. In this paper, the authors evaluate their experience with a novel treatment strategy: suturectomy of only the fused portion followed by helmeting therapy in patients with skull deformity secondary to incomplete suture synostosis. METHODS Patients with craniosynostosis with incomplete suture fusion requiring operative intervention between 2018 and 2020 were included for evaluation. Patients were selected for partial suturectomy if the patent portion of the suture had a normal appearance. All patients underwent craniectomy of the involved portion of the synostosed suture. Intraoperative ultrasound was used to reassess the degree of fusion at the time of surgery and incision planning. A 2- to 3-cm strip craniectomy was performed under direct visualization through a single minimal access incision. Postoperative helmeting was utilized for all patients. Demographic and perioperative data were collected, including laser scan data in the form of cranial index (CI) and cranial vault asymmetry (CVA), defined as the difference between two diagonal measurements, from the frontozygomaticus to the opposite eurion. RESULTS Four males and 1 female with a mean age of 2.8 months (range 1.1–3.9 months) at presentation were included. All patients had incomplete sagittal synostosis (one patient also had an incomplete left lambdoid synostosis and another had an incomplete left coronal synostosis). The mean age at surgery was 3.5 months (range 2.0–4.7 months) without any major complications. All patients were compliant with postoperative helmeting. The average age at the last follow-up was 12.8 months (range 5.3–23.7 months) with a mean follow-up duration of 9.3 months (range 0.5–19.6 months). Final laser scan evaluations were available for 3 patients and showed an improvement of the CI from an average of 71.3 (range 70–73) to 84.3 (range 82–86). The CVA improved from an average of 9.67 mm (range 2–22 mm) to 1.67 mm (range 1–2 mm). CONCLUSIONS Minimally invasive direct excision of the involved portion of fused cranial sutures followed by helmet therapy for phenotypical craniosynostosis is a safe and effective treatment strategy. This technique is suitable for very young patients and appears to offer similar outcomes to complete suturectomy. Further studies are required to see if this approach reduces the deformity severity for patients requiring vault remodeling later in life.

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Fraga-Manteiga, E., T. Schwarz, D. N. Clements e J. M. Ryan. "Unilateral synostosis of the zygomaticotemporal suture associated with mandibular coronoid process impingement in a dog". Veterinary and Comparative Orthopaedics and Traumatology 26, n. 05 (2013): 421–24. http://dx.doi.org/10.3415/vcot-12-12-0157.

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SummaryA 13-month-old dog was investigated for the complaint of open-mouth locked jaw. There were not any previous episodes of trauma witnessed. Computed tomographic evaluation revealed unilateral zygomaticotemporal synostosis and associated craniofacial asymmetry, with impingement of the mandibular coronoid process resulting in unilateral temporomandibular joint subluxation. Closed reduction of the subluxation was not maintained. Partial zygomaticotemporal suturectomy resulted in resolution of the clinical signs. To the author's knowledge, isolated zygomaticotemporal synostosis with associated temporomandibular subluxation has not been reported in the dog.

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Dornelles, Rodrigo de Faria Valle, Vera Lúcia Nocchi Cardim, Marília Trierveiler Martins, Ana Carolina Brandão de Campos Fonseca Pinto e Nivaldo Alonso. "Spring-mediated skull expansion: overall effects in sutural and parasutural areas. An experimental study in rabbits". Acta Cirurgica Brasileira 25, n. 2 (aprile 2010): 169–75. http://dx.doi.org/10.1590/s0102-86502010000200009.

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PURPOSE: The use of springs in cranial expansion has proven to be effective in the treatment of craniosynostosis. Spring-mediated expansion has been studied both in the sagittal and in parasagittal regions, especially in scaphocephaly. A rabbit model was used in the present study to analyze the effects of springs on the cranial vault and sutures. METHODS: Thirteen 4-week-old New Zealand rabbits were divided into 4 groups: in group I, only amalgam markers were used as control; in group II, amalgam markers were used and sagittal suturectomy was performed; in group III, amalgam markers were used, a sagittal suturectomy was performed and an expansible spring was fitted in the interparietal region and in group IV, markers were used and linear parasagittal craniectomy was carried out with springs. Animals were sacrificed after 2, 4, 8 and 12 weeks. Radiological control and histological analysis were performed in the area of spring implantation. RESULTS: In the groups using springs distraction of the craniectomy borders was greater than in those that did not use springs. New bone formation was observed in all groups, and was faster in group II. Bone growth started from the borders and depth. Bone regeneration presented a similar histological pattern in the groups with spring in the sagittal and parasagittal region. CONCLUSION: The rabbit model proved to be adequate for the analysis proposed by the study. The use of springs in the groups with sagittal and parasagittal osteotomy led to a similar distraction of amalgam markers and both groups had similar ossification histological pattern.

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Murray, Dylan J., Michael O. Kelleher, A. McGillivary, David Allcutt e Michael J. Earley. "Sagittal synostosis: A review of 53 cases of sagittal suturectomy in one unit". Journal of Plastic, Reconstructive & Aesthetic Surgery 60, n. 9 (settembre 2007): 991–97. http://dx.doi.org/10.1016/j.bjps.2007.02.003.

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Hermann, Christopher D., Kelsey Lawrence, Rene Olivares-Navarrete, Joseph K. Williams, Robert E. Guldberg, Barbara D. Boyan e Zvi Schwartz. "Rapid re-synostosis following suturectomy in pediatric mice is age and location dependent". Bone 53, n. 1 (marzo 2013): 284–93. http://dx.doi.org/10.1016/j.bone.2012.11.019.

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Shen, Weiming, Jie Cui, Jianbin Chen, Barbara Buffoli, Luigi Fabrizio Rodella, Jijun Zou, Yi Ji e Haini Chen. "Piezosurgical Suturectomy and Sutural Distraction Osteogenesis for the Treatment of Unilateral Coronal Synostosis". Plastic and Reconstructive Surgery - Global Open 3, n. 8 (agosto 2015): e475. http://dx.doi.org/10.1097/gox.0000000000000382.

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Sauerhammer, Tina M., Mitchel Seruya, Alexander E. Ropper, Albert K. Oh, Mark R. Proctor e Gary F. Rogers. "Craniectomy Gap Patency and Neosuture Formation following Endoscopic Suturectomy for Unilateral Coronal Craniosynostosis". Plastic and Reconstructive Surgery 134, n. 1 (luglio 2014): 81e—91e. http://dx.doi.org/10.1097/prs.0000000000000285.

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Premaratne, Ishani D., Gary Kocharian, Charlene Thomas, Corinne Rabbin-Birnbaum e Thomas A. Imahiyerobo. "Comparing Use of Sonopet Ultrasonic Bone Aspirator to Traditional Instrumentation for Endoscopic Suturectomy". Journal of the American College of Surgeons 231, n. 4 (ottobre 2020): S178. http://dx.doi.org/10.1016/j.jamcollsurg.2020.07.286.

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Wang, Catherine Y., Alisha R. Bonaroti, Brandon A. Miller e James Liau. "Sagittal synostosis scaphocephaly cranial reconstruction with spiral cut cranioplasty". Neurosurgical Focus: Video 4, n. 2 (aprile 2021): V14. http://dx.doi.org/10.3171/2021.1.focvid20104.

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Abstract (sommario):

Sagittal craniosynostosis, the most common form of craniosynostosis, affects 1 per 1000 live births. The main surgical treatments include endoscopic suturectomy and open cranial vault remodeling. This video describes an open reconstruction method, including strip resection of the sagittal suture, biparietal craniotomies with spiral cut cranioplasty, and barrel staves of the posterior occiput. Ideally used between 4 and 15 months of age, this approach takes advantage of the flexibility of the cranial bones to expand, allowing for immediate and long-term increases of the parietal width and correction of cosmetic deformity, without necessitating the use of cranial molding devices postoperatively. The video can be found here: https://vimeo.com/516699203

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Hwang, Jong Ha, Jeyul Yang, Kyung Hyun Kim, Ji Hoon Phi, Seung-Ki Kim, Kyu-Chang Wang e Ji Yeoun Lee. "Combined unilateral coronal-lambdoid suture synostosis: surgical outcome of suturectomy and postoperative helmet therapy". Child's Nervous System 37, n. 1 (12 maggio 2020): 277–86. http://dx.doi.org/10.1007/s00381-020-04650-2.

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Park, Dong Ha, e Soo Han Yoon. "Transsutural distraction osteogenesis for 285 children with craniosynostosis: a single-institution experience". Journal of Neurosurgery: Pediatrics 17, n. 2 (febbraio 2016): 230–39. http://dx.doi.org/10.3171/2015.5.peds14585.

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OBJECT Although distraction osteogenesis (DO) requires a secondary procedure in the surgical correction of craniosynostosis, it is relatively simple, requires less transfusion, results in a shorter intensive care unit stay, and is quite safe. Because of these positive factors, various DO techniques have been developed. However, there is disagreement regarding the superiority of DO. The authors reported on a new DO technique, transsutural DO (TSDO), 6 years ago that was performed in 23 patients over a period of 6 months, and it continues to be used at the present time. In this paper the authors report the results of TSDO performed in 285 patients with craniosynostosis over a period of 6 years at a single institution. METHODS TSDO consists of a simple suturectomy of the pathological suture followed by direct distraction of the suturectomy site only. Types of TSDO conducted included sagittal TSDO in 95 patients, bicoronal in 14, unilateral coronal in 57, lambdoid in 26, metopic in 13, multiple in 19, syndromic in 33, and secondary in 28. The mean age (± SD) of the patients was 19.4 ± 23.0 months, and mean follow-up was 39.5 ± 21.0 months. RESULTS The mean operating time was 115 ± 43 minutes, and mean anesthesia time was 218 ± 56 minutes. The mean transfusion volume of red blood cell components was 48 ± 58 ml, and mean transfusion volume of fresh-frozen plasma was 19 ± 35 ml. Total transfusion volume was significantly less in infants younger than 12 months of age and in children with lower lumbar puncture pressures (p < 0.05). Complications included 1 (0.4%) death from postoperative acute pneumonia after a distractor removal operation and 23 (8%) surgical morbidities comprising 10 revisions (3.5%) and 13 early removals of distracters (4.6%). CONCLUSIONS TSDO is a simple, effective, and safe method to use for treating all types of craniosynostosis. Some morbidity was experienced in this study, but it may be attributed to the learning curve of the technique.

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Putz, David A., Seth M. Weinberg, Timothy D. Smith, Anne M. Burrows, Gregory M. Cooper, H. Wolfgang Losken, Michael I. Siegel e Mark P. Mooney. "Coronal Suturectomy Does Not Cause Acute Postoperative Displacement in the Cranial Bases of Craniosynostotic Rabbits". Journal of Craniofacial Surgery 13, n. 2 (marzo 2002): 196–201. http://dx.doi.org/10.1097/00001665-200203000-00002.

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Rattani, Abbas, Coleman P. Riordan, John G. Meara e Mark R. Proctor. "Comparative analysis of cranial vault remodeling versus endoscopic suturectomy in the treatment of unilateral lambdoid craniosynostosis". Journal of Neurosurgery: Pediatrics 26, n. 2 (agosto 2020): 105–12. http://dx.doi.org/10.3171/2020.2.peds19522.

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OBJECTIVEUnilateral lambdoid synostosis is the premature fusion of a lambdoid suture or sutures and represents the least common form of craniosynostosis, occurring in 1 in 40,000 births. Cranial vault remodeling (CVR) and endoscopic suturectomy with helmet therapy (ES) are surgical approaches that are used to allow for normal brain growth and improved craniofacial symmetry. The authors conducted a comparative outcomes analysis of patients with lambdoid synostosis undergoing either CVR or ES.METHODSThe authors conducted a retrospective consecutive cohort study of patients with nonsyndromic lambdoid synostosis who underwent surgical correction identified from a single-institution database of patients with craniosynostosis seen between 2000 and 2018. Cranial growth was measured in head circumference percentile and z score.RESULTSNineteen patients (8 female and 11 male) with isolated unilateral lambdoid synostosis were identified (8 right and 11 left). Six underwent CVR and 13 underwent ES. No statistically significant differences were noted between surgical groups with respect to suture laterality, the patient’s sex, and length of follow-up. Patients treated with ES presented and underwent surgery at a younger age than those treated with CVR (p = 0.0002 and p = 0.0001, respectively). Operating and anesthesia time, estimated blood loss, and ICU and total hospital days were significantly lower in ES (all p < 0.05). No significant differences were observed in pre- and postoperative head circumference percentiles or z scores between groups up to 36 months postoperatively. No patients required reoperation as of last follow-up.CONCLUSIONSEndoscopic management of lambdoid synostosis is safe, efficient, and efficacious in terms of intraoperative and long-term cranial growth outcomes when compared to CVR. The authors recommend this minimally invasive approach as an option for correction of lambdoid synostosis in patients presenting early in their course.

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Shrestha, Bishal, Pritam Gurung, Jessica Kayastha, Aditi Agarwal, Resha Shrestha, Samir Acharya, Sudan Dhakal, Pravesh Rajbhandari, Pranaya Shrestha e Basant Pant. "An eminent rendezvous with a series of cranial vault remodeling for Craniosynostosis". Nepal Journal of Neuroscience 19, n. 2 (7 luglio 2022): 55–61. http://dx.doi.org/10.3126/njn.v19i2.42999.

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In defiance with the meager tally of craniosynostosis, the surgical treatment of non syndromic craniosynostosis is one of the most common stratagem detained by craniofacial surgeon. By dint of the onerous anatomy secondary to the imperfection in embryogenesis, a long haul of drill is required to obtain perfection in surgical sequel.1 With the advancement in neurosurgical gadgetry and improvement in agility of neurosurgical authority, a multitude of strategy has evolved over time with the eminent intent to bring forth the supreme aftermath. Browsing through the archives of craniofacial reconstruction discloses vault remodeling techniques evolving over time with disparate modification tactics to the inception of state-of-the-art strategies like endoscopic suturectomy, spring treatment and cranial vault distraction osteogenesis.2 Regardless of all these alternatives, we still resort to the standard cranial vault remodeling with a fairly approving outcome. We herein attempt to disclose our result of vault remodeling in a series of patients with craniosynostosis.

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Thenier-Villa, José Luis, Pablo Sanromán-Álvarez, Pablo Miranda-Lloret e María Estela Plaza Ramírez. "Incomplete reossification after craniosynostosis surgery—incidence and analysis of risk factors: a clinical-radiological assessment study". Journal of Neurosurgery: Pediatrics 22, n. 2 (agosto 2018): 120–27. http://dx.doi.org/10.3171/2018.2.peds17717.

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OBJECTIVEOne of the principles of the surgical treatment of craniosynostosis includes the release of fused bone plates to prevent recurrence. Such bone defects require a reossification process after surgery to prevent a cosmetic problem or brain vulnerability to damage. The objective of this study is to describe and analyze the radiological and clinical evolution of bone defects after craniosynostosis.METHODSFrom January 2005 to May 2016, 248 infants underwent surgical correction of craniosynostosis at HUiP La Fe Valencia; the authors analyzed data from 216 of these cases that met the inclusion criteria for this study. Various surgical techniques were used according to the age of the patient and severity of the case, including endoscopic-assisted suturectomy, open suturectomy, fronto-orbital advancement, and cranial vault remodeling. Clinical follow-up and radiological quantitative measurements in 2 periods—12–24 months and 2 years after surgery—were analyzed; 94 patients had a postoperative CT scan and were included in the radiological analysis.RESULTSAt the end of the follow-up period, 92 of 216 patients (42.59%) showed complete closure of the bone defect, 112 patients (51.85%) had minor bone defects, and 12 patients (5.56%) had significant bone defects that required surgical intervention. In the multivariate analysis, age at first surgery was not significantly associated with incomplete reossification (p = 0.15), nor was surgical site infection (p = 0.75). Multivariate analysis identified area of cranial defect greater than 5 cm2 in the first CT scan as predictive of incomplete reossification (p = 0.04). The mean area of cranial defect in the first CT scan (12–24 months after surgery) was 3.69 cm2 in patients treated with open surgery and 7.13 cm2 in those treated with endoscopic-assisted procedures; in the multivariate analysis, type of procedure was not related to incomplete reossification (p = 0.46). The positive predictive value of palpation as evaluation of bone cranial defects was 50% for significant defects and 71% for minor defects.CONCLUSIONSThe incidence of cranial defects due to incomplete reossification requiring cranioplasty was 5.56% in our series. Defects greater than 5 cm2 in the first postoperative CT scan showed a positive association with incomplete reossification. Patients treated with endoscope-assisted procedures had larger defects in the initial follow-up, but the final incidence of cranial defects was not significantly different in the endoscope-assisted surgery group from that in the open surgery group.

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Isaac, Kathryn V., John G. Meara e Mark R. Proctor. "Analysis of clinical outcomes for treatment of sagittal craniosynostosis: a comparison of endoscopic suturectomy and cranial vault remodeling". Journal of Neurosurgery: Pediatrics 22, n. 5 (novembre 2018): 467–74. http://dx.doi.org/10.3171/2018.5.peds1846.

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OBJECTIVEComparative effectiveness studies are needed for analyzing the clinical outcomes of treatment of sagittal craniosynostosis (SC) with endoscopic suturectomy (ES) or cranial vault remodeling (CVR).METHODSFrom 2004–2015, patients were consecutively reviewed and data recorded for operative details and complications. Cranial growth was measured by head circumference percentile (HCP) and cranial index (CI) Z-score. Aesthetic outcomes were compared using the Whitaker classification.RESULTSA total of 207 patients with nonsyndromic SC were treated with ES (n = 187) or CVR (n = 20). The ES group had a lower median operative duration (45 vs 195 minutes), length of stay (1 vs 3 days), and transfusion rate (2% vs 85%; p < 0.0001). Median age at follow-up was 3.0 years (interquartile range [IQR] 2.5–4.5, ES) and 3.9 years (IQR 2–5, CVR; p = 0.12). In both groups, HCP gradually decreased during a 3-year follow-up (p = 0.282). CI Z-scores were initially more favorable in the ES group (p < 0.05); 3 years following surgical intervention, Z-scores were equal between groups (p = 0.392). One nonsyndromic patient treated with ES (0.5%) demonstrated reossification and required secondary expansion. Most patients were Whitaker class I (99% of ES, 95% of CVR); 5% of CVR patients were class II and 1% of ES patients were class III. Four syndromic patients presented without clear evidence of a syndrome, were treated by ES, and subsequently required secondary expansion for raised intracranial pressure.CONCLUSIONSES is an effective treatment for nonsyndromic SC with comparable head growth, aesthetic outcomes, and less morbidity relative to CVR. In the absence of a syndrome, secondary cranial expansion following ES is rarely required.

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Cheng, Du, Melissa Yuan, Imali Perera, Ashley O’Connor, Alexander I. Evins, Thomas Imahiyerobo, Mark Souweidane e Caitlin Hoffman. "Developing a 3D composite training model for cranial remodeling". Journal of Neurosurgery: Pediatrics 24, n. 6 (dicembre 2019): 632–41. http://dx.doi.org/10.3171/2019.6.peds18773.

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Abstract (sommario):

OBJECTIVECraniosynostosis correction, including cranial vault remodeling, fronto-orbital advancement (FOA), and endoscopic suturectomy, requires practical experience with complex anatomy and tools. The infrequent exposure to complex neurosurgical procedures such as these during residency limits extraoperative training. Lack of cadaveric teaching tools given the pediatric nature of synostosis compounds this challenge. The authors sought to create lifelike 3D printed models based on actual cases of craniosynostosis in infants and incorporate them into a practical course for endoscopic and open correction. The authors hypothesized that this training tool would increase extraoperative facility and familiarity with cranial vault reconstruction to better prepare surgeons for in vivo procedures.METHODSThe authors utilized representative craniosynostosis patient scans to create 3D printed models of the calvaria, soft tissues, and cranial contents. Two annual courses implementing these models were held, and surveys were completed by participants (n = 18, 5 attending physicians, 4 fellows, 9 residents) on the day of the course. These participants were surveyed during the course and 1 year later to assess the impact of this training tool. A comparable cohort of trainees who did not participate in the course (n = 11) was also surveyed at the time of the 1-year follow-up to assess their preparation and confidence with performing craniosynostosis surgeries.RESULTSAn iterative process using multiple materials and the various printing parameters was used to create representative models. Participants performed all major surgical steps, and we quantified the fidelity and utility of the model through surveys. All attendees reported that the model was a valuable training tool for open reconstruction (n = 18/18 [100%]) and endoscopic suturectomy (n = 17/18 [94%]). In the first year, 83% of course participants (n = 14/17) agreed or strongly agreed that the skin and bone materials were realistic and appropriately detailed; the second year, 100% (n = 16/16) agreed or strongly agreed that the skin material was realistic and appropriately detailed, and 88% (n = 14/16) agreed or strongly agreed that the bone material was realistic and appropriately detailed. All participants responded that they would use the models for their own personal training and the training of residents and fellows in their programs.CONCLUSIONSThe authors have developed realistic 3D printed models of craniosynostosis including soft tissues that allow for surgical practice simulation. The use of these models in surgical simulation provides a level of preparedness that exceeds what currently exists through traditional resident training experience. Employing practical modules using such models as part of a standardized resident curriculum is a logical evolution in neurosurgical education and training.

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Melin, Alyson A., Joseph Moffitt, David C. Hopkins, Manish N. Shah, Stephen A. Fletcher, David I. Sandberg, John F. Teichgraeber e Matthew R. Greives. "Is Less Actually More? An Evaluation of Surgical Outcomes Between Endoscopic Suturectomy and Open Cranial Vault Remodeling for Craniosynostosis". Journal of Craniofacial Surgery 31, n. 4 (giugno 2020): 924–26. http://dx.doi.org/10.1097/scs.0000000000006152.

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Hermann, Christopher D., Christopher S. D. Lee, Siddharth Gadepalli, Kelsey A. Lawrence, Megan A. Richards, Rene Olivares-Navarrete, Joseph K. Williams, Zvi Schwartz e Barbara D. Boyan. "Interrelationship of Cranial Suture Fusion, Basicranial Development, and Resynostosis Following Suturectomy in Twist1+/− Mice, a Murine Model of Saethre-Chotzen Syndrome". Calcified Tissue International 91, n. 4 (18 agosto 2012): 255–66. http://dx.doi.org/10.1007/s00223-012-9632-3.

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Tellado, Manuel Gómez, e Ana Lema. "Coronal Suturectomy Through Minimal Incisions and Distraction Osteogenesis Are Enough Without Other Craniotomies for the Treatment of Plagiocephaly Due to Coronal Synostosis". Journal of Craniofacial Surgery 20, n. 6 (novembre 2009): 1975–77. http://dx.doi.org/10.1097/scs.0b013e3181bd2cd6.

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Grandhi, Ramesh, Geoffrey W. Peitz, Lesley M. Foley, Christopher M. Bonfield, Wendy Fellows-Mayle, T. Kevin Hitchens e Mark P. Mooney. "The influence of suturectomy on age-related changes in cerebral blood flow in rabbits with familial bicoronal suture craniosynostosis: A quantitative analysis". PLOS ONE 13, n. 6 (1 giugno 2018): e0197296. http://dx.doi.org/10.1371/journal.pone.0197296.

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Nguyen, Dennis C., Scott J. Farber, Gary B. Skolnick, Sybill D. Naidoo, Matthew D. Smyth, Alex A. Kane, Kamlesh B. Patel e Albert S. Woo. "One hundred consecutive endoscopic repairs of sagittal craniosynostosis: an evolution in care". Journal of Neurosurgery: Pediatrics 20, n. 5 (novembre 2017): 410–18. http://dx.doi.org/10.3171/2017.5.peds16674.

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OBJECTIVEEndoscope-assisted repair of sagittal craniosynostosis was adopted at St. Louis Children’s Hospital in 2006. This study examines the first 100 cases and reviews the outcomes and evolution of patient care protocols at our institution.METHODSThe authors performed a retrospective chart review of the first 100 consecutive endoscopic repairs of sagittal craniosynostosis between 2006 and 2014. The data associated with length of hospital stay, blood loss, transfusion rates, operative times, cephalic indices (CIs), complications, and cranial remolding orthosis were reviewed. Measurements were taken from available preoperative and 1-year postoperative 3D reconstructed CT scans.RESULTSThe patients’ mean age at surgery was 3.3 ± 1.1 months. Of the 100 patients, 30 were female and 70 were male. The following perioperative data were noted. The mean operative time (± SD) was 77.1 ± 22.2 minutes, the mean estimated blood loss was 34.0 ± 34.8 ml, and the mean length of stay was 1.1 ± 0.4 days; 9% of patients required transfusions; and the mean pre- and postoperative CI values were 69.1 ± 3.8 and 77.7 ± 4.2, respectively. Conversion to open technique was required in 1 case due to presence of a large emissary vein that was difficult to control endoscopically. The mean duration of helmet therapy was 8.0 ± 2.9 months. Parietal osteotomies were eventually excluded from the procedure.CONCLUSIONSThe clinical outcomes and improvements in CI seen in our population are similar to those seen at other high-volume centers. Since the inception of endoscope-assisted repair at our institution, the patient care protocol has undergone several significant changes. We have been able to remove less cranium using our “narrow-vertex” suturectomy technique without affecting patient safety or outcome. Patient compliance with helmet therapy and collaborative care with the orthotists remain the most essential aspects of a successful outcome.

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Jimenez, David F., e Constance M. Barone. "Multiple-suture nonsyndromic craniosynostosis: early and effective management using endoscopic techniques". Journal of Neurosurgery: Pediatrics 5, n. 3 (marzo 2010): 223–31. http://dx.doi.org/10.3171/2009.10.peds09216.

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Object The authors present the results of treating infants with multiple-suture nonsyndromic craniosynostosis in whom the authors used minimally invasive endoscopy-assisted techniques and postoperative cranial molding over an 11-year period. Methods A total of 21 patients who presented with multiple-suture (nonsyndromic) craniosynostosis were treated using minimally invasive endoscopy-assisted craniectomies. Surgery was followed by treatment with custommade cranial orthoses for up to 12 months. A total of 48 sutures were treated. The most common was the coronal suture (38 cases) and this was followed by the sagittal (11 cases), metopic (6 cases), and lambdoid (3 cases) sutures. There were 13 male and 8 female pediatric patients. Their ages ranged between 3 weeks and 9 months (mean 3.2 months, median 2.5 months). The sagittal suture was treated with a wide vertex craniotomy via 2 incisions located behind the anterior fontanel and in front of the lambda. The metopic suture underwent a suturectomy as did the coronal and lambdoid sutures. Results The mean follow-up duration was 61 months (range 3–135 months). There were no deaths. In patients with bicoronal synostosis, brachycephaly was corrected. Patients presenting with vertical dystopia or nasal deviation had these deformities corrected as well. The mean blood loss was 42 ml (range 10–120 ml). The mean hospital length of stay was 1 day. The intraoperative transfusion rate was 0%. The results indicate that nonsyndromic multiple-suture synostosis can be safely and effectively treated using endoscopic techniques. Conclusions Early treatment of complex multiple-suture synostosis with endoscopic techniques provides an excellent surgical alternative. The results of the present study indicate marked correction of skull base and craniofacial deformities. Endoscopy provides a safe and effective way to treat these patients.

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Hersh, David S., Julie E. Hoover-Fong, Natalie Beck, Amir H. Dorafshar e Edward S. Ahn. "Endoscopic surgery for patients with syndromic craniosynostosis and the requirement for additional open surgery". Journal of Neurosurgery: Pediatrics 20, n. 1 (luglio 2017): 91–98. http://dx.doi.org/10.3171/2017.2.peds16710.

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OBJECTIVERecent reports have described early endoscopic suturectomy as a treatment option for patients with syndromic craniosynostosis, but such patients often require subsequent calvarial remodeling. The authors describe their experience with this patient population and seek to identify predictors of sufficiency of endoscopic surgery alone.METHODSThe medical records of patients with syndromic craniosynostosis who underwent endoscopic repair were retrospectively reviewed. Demographic data, operative details, and follow-up data were collected.RESULTSA total of 6 patients with syndromic craniosynostosis underwent endoscopic surgery followed by helmet therapy during the study period. Of these, 3 patients were male. The involved syndromes included Crouzon, Pfeiffer, Jackson-Weiss, Muenke, Saethre-Chotzen, and craniosynostosis-3 (n = 1 each). The patients underwent endoscopic surgery at a median age of 2.1 months (range 0.9–4.1 months). The median estimated blood loss was 30 ml (range 20–100 ml), with 2 patients requiring a transfusion. The median length of stay in the hospital was 1.5 days (range 1–4 days), and the median follow-up was 29.0 months (range 16.8–81.7 months), with 1 patient (16.7%) requiring an open revision. Three patients (50%) were classified as Whitaker Category I at the last follow-up. The patients for whom additional open surgery was performed or recommended (Whitaker Category IV) were the oldest patients in the cohort, ranging from 2.6 to 4.1 months at the time of surgery.CONCLUSIONSThis series demonstrates that endoscopic surgery can be sufficient to treat syndromic craniosynostosis without subsequent open calvarial remodeling over a median follow-up period of at least 2 years. The findings suggest that younger age at the time of endoscopic surgery may be an important factor in determining the sufficiency of this procedure. Even among patients who require subsequent open calvarial remodeling, early endoscopic surgery may allow for growth and development of the brain and skull while delaying the need for open remodeling until the patient is older and can better tolerate the procedure.

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Mircevsk, Vladimir, Elizabeta Zogovska, Aleksandar Chaparoski, Mile Micunovic, Venko Filipce, Mirko Mishel Mirchevski, Milenko Kostov e Ljubica Мicunovic. "Trigonocephaly – Our Experience and Treatment in the Republic of Macedonia". PRILOZI 38, n. 1 (1 marzo 2017): 35–40. http://dx.doi.org/10.1515/prilozi-2017-0004.

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Abstract Introduction: Prematurely fused metopic suture results in developmental anomaly named trigonocephaly. The treatment of trigonocephaly is a surgical reconstruction, starting from the simple suturectomy toward the complicated cranial vault reconstructions with aim to obtain enough endocranial space for normal development of the brain and aesthetic correction as well. The aim: The aim of our paper is to present our experience on this pathology in the Republic of Macedonia, stressing the trigonocephaly as one of the rare forms of craniosynostosis. Our material: During a period of 20 years (from 1996 to 2015) at the Pediatric department of the Clinic for Neurosurgery in Skopje, we observed 18 babies with trigonocephaly, including one with Carpenter syndrome and trigonocephaly, 14 males and 4 females. All children had simple trigonocephaly, one had syndromic trigonocephaly (Carpenter’s syndrome). According to Oi and Matsumoto classification done in 19865 severe trigonocephaly is observed in 11 cases and, moderate trigonocephaly in 7 cases. Our method: Our treatment consisted of slightly modified Di Rocco’s3 surgical procedure named “shell” operation, adding transposition of the “bone flap”. Results: The postoperative period was uneventful except for the expected forehead swelling. The babies were discharged from the hospital on average at the 8th postoperative day. At the three months control after the surgery, the head had excellent aesthetic appearance, with regular psychomotor development according to the age of the patient (Fig 3а and 3b). We had no serious complications except the expected postoperative swelling of the forehead. All operated children had excellent “long term” aesthetic effect and normal psychomotor development. Conclusion: The early recognition of these anomalies including all craniosynostoses, the deformities of the newborn and infant’s head and the preventive operative reconstruction would prevent abnormal disturbance of the psychomotor development during the child’s growth. The multidisciplinary approach can prevent new disabled individuals in the society. Our technique allows shortening the entire surgical procedure, especially in the departments where blood saving devices are not available.

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Arko, Leopold, Jordan W. Swanson, Tamara M. Fierst, Rosemary E. Henn, Daniel Chang, Phillip B. Storm, Scott P. Bartlett, Jesse A. Taylor e Gregory G. Heuer. "Spring-mediated sagittal craniosynostosis treatment at the Children’s Hospital of Philadelphia: technical notes and literature review". Neurosurgical Focus 38, n. 5 (maggio 2015): E7. http://dx.doi.org/10.3171/2015.3.focus153.

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OBJECT Sagittal craniosynostosis has been treated using both cranial remodeling techniques and modification of the sagittal strip craniectomy. A more recent technique is to implant springs in conjunction with a suturectomy to transversely expand the parietal bones to accommodate the growing brain. In this paper the authors describe and evaluate several modifications to the spring-mediated cranioplasty (SMC) technique, most notably use of an ultrasonic scalpel to limit dural dissection and maximize opening of the stenosed suture by placement of multiple spring devices. In addition, the literature is reviewed comparing SMC to other surgical treatments of sagittal synostosis. METHODS The authors retrospectively reviewed patients who presented to the Children’s Hospital of Philadelphia with a diagnosis of sagittal synostosis from August 2011 to November 2014. A pooled data set was created to compare our institutional data to previously published work. A comprehensive literature review was performed of all previous studies describing the SMC technique, as well as other techniques for sagittal synostosis correction. RESULTS Twenty-two patients underwent SMC at our institution during the study period. Patients were 4.2 months of age on average, had a mean blood loss of 56.3 ml, and average intensive care unit and total hospital stays of 29.5 hours and 2.2 days, respectively. The cranial index was corrected to an average of 73.7 (SD 5.2) for patients who received long-term radiological follow-up. When comparing the authors’ institutional data to pooled SMC data, blood loss and length of stay were both significantly less (p = 0.005 and p < 0.001, respectively), but the preoperative cranial index was significantly larger (p = 0.01). A review of the SMC technique compared with other techniques to actively expand the skull of patients with sagittal synostosis demonstrated that SMC can be performed at a significantly earlier age compared with cranial vault reconstruction (CVR). CONCLUSIONS The authors found that their institutional modifications of the SMC technique were safe and effective in correcting the cranial index. In addition, this technique can be performed at a younger age than CVRs. SMC, therefore, has the potential to maximize the cognitive benefits of early intervention, with lower morbidity than the traditional CVR.

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Hoffman, Caitlin, Alyssa B. Valenti, Eseosa Odigie, Kwanza Warren, Ishani D. Premaratne e Thomas A. Imahiyerobo. "Impact of health disparities on treatment for single-suture craniosynostosis in an era of multimodal care". Neurosurgical Focus 50, n. 4 (aprile 2021): E13. http://dx.doi.org/10.3171/2021.1.focus201000.

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Craniosynostosis is the premature fusion of the skull. There are two forms of treatment: open surgery and minimally invasive endoscope-assisted suturectomy. Candidates for endoscopic treatment are less than 6 months of age. The techniques are equally effective; however, endoscopic surgery is associated with less blood loss, minimal tissue disruption, shorter operative time, and shorter hospitalization. In this study, the authors aimed to evaluate the impact of race/ethnicity and insurance status on age of presentation/surgery in children with craniosynostosis to highlight potential disparities in healthcare access. Charts were reviewed for children with craniosynostosis at two tertiary care hospitals in New York City from January 1, 2014, to August 31, 2020. Clinical and demographic data were collected, including variables pertaining to family socioeconomic status, home address/zip code, insurance status (no insurance, Medicaid, or private), race/ethnicity, age and date of presentation for initial consultation, type of surgery performed, and details of hospitalization. Children with unknown race/ethnicity and those with syndromic craniosynostosis were excluded. The data were analyzed via t-tests and chi-square tests for statistical significance (p < 0.05). A total of 121 children were identified; 62 surgeries were performed open and 59 endoscopically. The mean age at initial presentation of the cohort was 6.68 months, and on the day of surgery it was 8.45 months. Age at presentation for the open surgery cohort compared with the endoscopic cohort achieved statistical significance at 11.33 months (SD 12.41) for the open cohort and 1.86 months (SD 1.1473) for the endoscopic cohort (p < 0.0001). Age on the day of surgery for the open cohort versus the endoscopic cohort demonstrated statistical significance at 14.19 months (SD 15.05) and 2.58 months (SD 1.030), respectively. A statistically significant difference between the two groups was noted with regard to insurance status (p = 0.0044); the open surgical group comprised more patients without insurance and with Medicaid compared with the endoscopic group. The racial composition of the two groups reached statistical significance when comparing proportions of White, Black, Hispanic, Asian, and other (p = 0.000815), with significantly more Black and Hispanic patients treated in the open surgical group. The results demonstrate a relationship between race and lack of insurance or Medicaid status, and type of surgery received; Black and Hispanic children and children with Medicaid were more likely to present later and undergo open surgery.

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Villavisanis, Dillan F., Daniel Y. Cho, Sameer Shakir, Christopher L. Kalmar, Connor S. Wagner, Liana Cheung, Jessica D. Blum et al. "Parietal bone thickness for predicting operative transfusion and blood loss in patients undergoing spring-mediated cranioplasty for nonsyndromic sagittal craniosynostosis". Journal of Neurosurgery: Pediatrics 29, n. 4 (1 aprile 2022): 419–26. http://dx.doi.org/10.3171/2021.12.peds21541.

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OBJECTIVE Variables that can predict outcomes in patients with craniosynostosis, including bone thickness, are important for surgical decision-making, yet are incompletely understood. Recent studies have demonstrated relative risks and benefits of surgical techniques for correcting head shape in patients with nonsyndromic sagittal craniosynostosis. The purpose of this study was to characterize the relationships between parietal bone thickness and perioperative outcomes in patients who underwent spring-mediated cranioplasty (SMC) for nonsyndromic sagittal craniosynostosis. METHODS Patients who underwent craniectomy and SMC for nonsyndromic sagittal craniosynostosis at a quaternary pediatric hospital between 2011 and 2021 were included. Parietal bone thickness was determined on patient preoperative CT at 27 suture-related points: at the suture line and at 0.5 cm, 1.0 cm, 1.5 cm, and 2.0 cm from the suture at the anterior parietal, midparietal, and posterior parietal bones. Preoperative skull thickness was compared with intraoperative blood loss, need for intraoperative transfusion, and hospital length of stay (LOS). RESULTS Overall, 124 patients with a mean age at surgery ± SD of 3.59 ± 0.87 months and mean parietal bone thickness of 1.83 ± 0.38 mm were included in this study. Estimated blood loss (EBL) and EBL per kilogram were associated with parietal bone thickness 0.5 cm (ρ = 0.376, p < 0.001 and ρ = 0.331, p = 0.004; respectively) and 1.0 cm (ρ = 0.324, p = 0.007 and ρ = 0.245, p = 0.033; respectively) from the suture line. Patients with a thicker parietal bone 0.5 cm (OR 18.08, p = 0.007), 1.0 cm (OR 7.16, p = 0.031), and 1.5 cm (OR 7.24, p = 0.046) from the suture line were significantly more likely to have undergone transfusion when controlling for age, sex, and race. Additionally, parietal bone thickness was associated with hospital LOS (β 0.575, p = 0.019) when controlling for age, sex, and race. Patient age at the time of surgery was not independently associated with these perioperative outcomes. CONCLUSIONS Parietal bone thickness, but not age at the time of surgery, may predict perioperative outcomes including transfusion, EBL, and LOS. The need for transfusion and EBL were most significant for parietal bone thickness 0.5 cm to 1.5 cm from the suture line, within the anticipated area of suturectomy. For patients undergoing craniofacial surgery, parietal bone thickness may have important implications for anticipating the need for intraoperative transfusion and hospital LOS.

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Vera Portilla, Laura Isabel, Melissa Fernanda Froment Blum, Mónica Valeria Larrea Idrovo, Gabriela Carolina Lara Pérez e Marlon Andrés López García. "Craneosinostosis de la sutura coronal. Reporte de caso y revisión bibliográfica". Salud, Ciencia y Tecnología 2 (6 novembre 2022): 107. http://dx.doi.org/10.56294/saludcyt2022107.

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Introducción: la craneosinostosis es una patología identificada por el cierre precoz de una o varias suturas de la bóveda craneal causando una asimetría cráneo facial evidente, la forma va a depender del lugar y el momento en que se produzca la sinostosis; se desconoce la etiología sin embargo existen factores involucrados como la duramadre local, base craneal y los factores de crecimiento de los fibroblastos. Su diagnóstico puede ser clínico, ecográfico y la confirmación es a través de la tomografía axial computarizada en 3d, su tratamiento es quirúrgico entre los 6 a 12 meses, consiguiendo resultados mejorables en estas edades.Reporte de caso: se basó en una lactante de 6 meses diagnosticada en el tercer control médico por presentar asimetría cráneo-facial, confirmada con tomografía axial computarizada de cráneo con reconstrucción en 3 d (TAC) cuadro de sinostosis coronal derecha; por lo que fue intervenida a esta edad por neurocirugía, cuyo procedimiento fue suturectomía hemicoronal derecha más remodelación de hueso frontal, procedimiento sin complicaciones. En su posterior visita médica se solicitó nueva TAC, cuyo reporte indica sutura coronal derecha permeable y remodelación del hueso frontal. Paciente que al momento evoluciona psicomotriz e intelectualmente normal, con perímetro craneal en el percentil para la edad. Se concluye que el diagnóstico oportuno con la intervención endoscópica mínimamente invasiva es la mejor indicación para solucionar esta patología, debido a que es segura, eficaz y duradera, se asocia a un menor riesgo de transfusión de sangre, complicaciones o reoperación.

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50

"Endoscopic assisted suturectomy for primary craniosynostosis in infancy". Journal of Clinical Review & Case Reports 3, n. 2 (10 aprile 2018). http://dx.doi.org/10.33140/jcrc/03/02/00007.

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Background: Multiple procedures have been used for the treatment of craniosynostosis, ranging from simple suturectomy to extensive calvarial vault remodeling. The optimal timing for surgery is still controversial. The goal of therapy is to provide adequate intracranial volume, in addition to an aesthetically almost normal skull shape. Endoscopic synostosis repair described in 1998 by Jimenez and Baron [1]. This technique allows for a less invasive method that can result in excellent longstanding reconstruction of the cranial skeleton. This method is a minimally invasive approach that has less morbidity involved with traditional reconstruction techniques. Aim: Evaluation of early endoscopic suturectomy and its impact on both neurological functions and cosmetic appearance of infants up to 6 months of age suffering primary craniosynostosis. Methodology: This is a prospective analytical study of 50 patients with primary non syndromic craniosynostosis either single suture or multiple sutures, up to sixth months of age; with evident of skull shape deformity and or manifestations of increase intracranial pressure. from; October 2009 to October 2016 were managed byendoscopic assisted suturectomy the approach of Jimenez and Baron, in both Neurosurgery Department Shebin Elkom teaching hospital and Neurosurgery Department in Elsahel teaching hospital. Clinical and radiological follow up for six months postoperative. Results: This is a prospective analytical study of 50 patients with primary craniosynostosis, 28 patients are male and 22 patients are female. The age of patients range from one and half months to sixth months. The majority of cases presented with deformity alone 68%. Other clinical presentations as manifestations of increased intracranial pressure, fits, and delayed milestones plus deformity was 20%, 8%, and 4% respectively. Estimated blood loss, the mean loss was 56cc, minimum 30cc, and maximum was 100cc, with stander deviation ±18cc.The minimum hospital stay was one day and maximum was three days.There is significant change of head shape and head circumference postoperatively this observed by highly significant P value in head circumference (< 0.001). Conclusion: Endoscopic assisted suturectomy is minimally invasive approach with a very narrow range of complications, very limited need to blood transfusion and if it occurs, it is small volume in relation to total volume. Very short ICU and hospital stay also decrease the economic load.

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