Subscribe to RSS
DOI: 10.1055/s-0029-1220714
© Georg Thieme Verlag KG Stuttgart · New York
Surgical Technique and Validation of Outcome Assessment in Sagittal Synostosis
Publication History
Publication Date:
13 January 2010 (online)
![](https://www.thieme-connect.de/media/zblneurochir/201002/lookinside/thumbnails/10.1055-s-0029-1220714-1.jpg)
Abstract
Background: Aim of the study was to evaluate the outcome of children operated for sagittal synostosis, with special attention paid to the postoperative aesthetic result, as seen from the parents’ and the treating medical doctors’ perspective, and to assess the time point for operative correction.
Methods: A retrospective chart review of 87 patients operated over 15 years was performed. Data included age at the time of operation, perioperative complications, duration of hospital stay, intraoperative blood loss, transfusion volume, neurological outcome, and postoperative skull growth. Aesthetic outcome was assessed at 6, 12 and 18 months after surgery separately by the treating medical team and the children's parents.
Results: Sagittal synostosis was diagnosed in 98.9% of cases in the first six months of life. We performed the same operative technique in all children with bilateral total removal of parietal bones. The median age at operation was 5 months. There was no correlation between age at the time of operation and blood loss (p<0.602). 5.7% of the children presented with significant postoperative skull asymmetries. All of these children had undergone operation in the first four months of life (p<0.01). The evaluation of the postoperative aesthetic outcome as seen by parents and doctors was highly convergent, with 79.3% of children in the excellent or good outcome group
Conclusions: Our results suggest that the feasible time period for the method used by us is around the 5th – 6th month of life, with satisfying results. With regard to the aesthetic outcome assessment we recommend our approach using validation by parents as a valuable new principle.
Key words
sagittal synostosis - aesthetic and functional outcome - perioperative complications - parental satisfaction
References
- 1 Anderson FM, Geiger L. Craniosynostosis: a survey of 204 patients. J Neurosurg. 1965; 22 229-233
- 2 Bernardy M, Donauer E, Neuenfeldt D. Premature craniosynostosis. A retrospective analysis of a series of 52 cases. Acta Neurochir. 1994; 128 88-100
- 3 Breugem CC, Zeeman B. Retrospective study of nonsyndromic craniosynostosis treated over a 10-year period. J Craniofac Surg. 1999; 2 140-148
- 4 Boop FA, Shewmake K, Chadduck WM. Synostectomy versus complex cranioplasty for the treatment of sagittal synostosis. Childs Nerv Syst. 1996; 12 371-375
- 5 Colak A, Tahta K, Bertan V. et al . Craniosynostosis: A review of 143 surgically-treated cases. Turk J Pediatrics. 1992; 34 231-238
- 6 Denis D, Genitori L, Conrath J. et al . Ocular findings in children operated on for plagiocephaly and trigonocephaly. Childs Nerv Syst. 1996; 12 683-689
- 7 Epstein N, Epstein F, Newman G. Total vertex craniectomy for the treatment of sagittal synostosis. Childs Nerv Syst. 1982; 12 371-375
-
8 Fonseca RJ.
Oral and Maxillofacial Surgery . Philadelphia: W. B. Saunders Company 1991 6 pp 195-220 - 9 Gault D, Renier D, Marchac D. et al . Intracranial pressure and intracranial volume in children with craniosynostosis. J Craniofac Surg. 1990; 1 1-3
- 10 Gault D, Renier D, Marchac D. et al . Intracranial volume in children with craniosynostosis. Plast Reconstr Surg. 1990; 90 377-380
- 11 Grätz KW, Locher MC, Carls FR. et al . Cranial development after corrective skull surgery in craniosynostosis. Mund Kiefer Gesichtschir. 1998; 2 ((Suppl 1)) 49-51 [in German]
- 12 Guimarăes-Ferreira J, Gewalli F, David L. et al . Spring-mediated cranioplasty compared with the modified pi-plasty for sagittal synostosis. Scand J Plast Reconstr Surg Hand Surg. 2003; 37 208-215
- 13 Hassler W, Zentner J. Radical Osteoclastic Craniectomy in Sagittal Synostosis. . 1990; 27 539-543
- 14 Jane JA, Edgerton MT, Futrell JW. et al . Immediate correction of sagittal synostosis. J Neurosurg. 1978; 49 705-710
- 15 Jimenez DF, Barone CM, MacGee ME. et al . Endoscopy-assisted wide-vertex craniectomy, barrel stave osteotomies, and postoperative helmet molding therapy in the management of sagittal suture craniosynostosis. J Neurosurg. 2004; 100 ((5 Suppl Pediatrics)) 407-417
- 16 Jones BM, Jani P, Bingham RM. et al . Complications in pediatric craniofacial surgery: An initial four year experience. Br J Plast Surg. 1992; 45 ((3)) 225-231
- 17 Kolk van der CA, Carlson BS, Robertson BC. et al . The occipital bar and internal osteosynthesis in the treatment of lambdoidal synostosis. J Craniomaxillofac Surg. 1993; 4 112-118
- 18 Marsh JL. Metopic and sagittal synostosis: Intracranial volume measurements prior to and after cranioorbital reshaping in childhood (Discussion). Plast Reconstr Surg. 1995; 96 310
- 19 Maugans TA, MacComb JG, Levy ML. Surgical management of sagittal synostosis: a comparative analysis of strip craniectomy and calvarial vault remodeling. Pediatr Neurosurg. 1997; 27 137-148
- 20 MacComb JG. Occipital reduction-biparietal widening technique for correction of sagittal synostosis. Pediatr Neurosurg. 1994; 27 137-148
- 21 Mursch K, Brockmann K, Lang JK. et al . Visually evoked potentials in 52 children requiring repair of craniosynostosis. Pediatr Neurosurg. 1998; 29 320-323
- 22 Polley JW, Cherbel FT, Kim D. et al . Nonsyndromal craniosynostosis: longitudinal outcome following cranio-orbital reconstruction in infancy. Plast Reconstr Surg. 1998; 102 619-632
- 23 Posnick JC, Armstrong D, Bite U. Metopic and sagittal synostosis: Intracranial volume measurements prior to and after cranio-orbital reshaping in childhood. Plast Reconstr Surg. 1995; 96 299
- 24 Posnick JC, Armstrong D, Bite U. Crouzon and Apert syndromes: Intracranial volume measurements before and after cranio-orbital reshaping in childhood. Plast Reconstr Surg. 1995; 96 539-548
- 25 Poole MD. Complications in craniofacial surgery. Br J Plast Surg. 1988; 41 ((6)) 608-613
-
26 Powirtowski H. Surgery of craniostenosis in advanced cases. In: Krayenbuhl H, et al. (eds)
Advances and Technical Standards in Neurosurgery . New York Berlin Heidelberg: Springer 1974 1 pp 93-120 - 27 Prader A, Largo RH, Molinari L. et al . Physical growth of Swiss children from birth to 20 years of age. Helv Paediat Acta Suppl. 1998; 52 3-31
- 28 Reinhart E, Reuther J, Collmann H. et al . Long-term outcome after corrective surgery of the neuro-viscerocranium of patients with simple and syndrome-related premature craniosynostosis. Mund Kiefer Gesichts Chir. 1998; 2 ((Suppl 1)) 44-48 [in German]
-
29 Roden A, Marsh JL, Vannier MW.
Cranial capacity in craniosynostosis. In: Proceedings of the 6th International Congress on Cleft Palate and Related Craniofacial Anomalies . Jerusalem, Israel 1989: 61 - 30 Shillito J, Matson D. Craniosynostosis; a review of 519 surgical patients. Pediatrics. 1968; 41 829-853
- 31 Shillito J. A plea for early operation for craniosynostosis. Surg Neurol. 1992; 37 182-188
- 32 Sloan GM, Wells KC, Raffel C. et al . Surgical treatment of craniosynostosis: outcome analysis of 250 consecutive patients. Pediatrics. 1997; 100 ((1)) e2
- 33 Stavrou P, Sgouros S, Willshaw HE. et al . Visual failure caused by raised intracranial pressure in craniosynostosis. Childs Nerv Syst. 1997; 13 64-67
- 34 Tuite GF, Chong WK, Evanson J. The effectiveness of papilledema as indicator of raised intracranial pressure in children with craniosynostosis. . 1996; 38 272-278
- 35 Whitaker LA, Bartlett SP, Shut L. et al . Craniosynostosis: an analysis of the timing, treatment and complications in 164 consecutive patients. Plast Reconstr Surg. 1987; 80 195-206
Correspondence
Prof. Dr. M. U. Schuhmann
Department of Neurosurgery
University of Tübingen
Hoppe-Seyler-Straße 3
72076 Tübingen
Germany
Phone: +49/070/71 29 86 44 8
Fax: +49/070/71 29 44 04
Email: martin.schuhmann@med.uni-tuebingen.de