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  • Author or Editor: Christopher A. Derderianx
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Pang-Yun Chou, Rami R. Hallac, Shitel Patel, Min-Jeong Cho, Neil Stewart, James M. Smartt, James R. Seaward, Alex A. Kane, and Christopher A. Derderian

OBJECTIVE

Outcome studies for sagittal strip craniectomy have largely relied on the 2D measure of the cephalic index (CI) as the primary indicator of head shape. The goal of this study was to measure the 2D and 3D changes in head shape that occur after sagittal strip craniectomy and postoperative helmet therapy.

开云体育世界杯赔率

The authors performed a retrospective review of patients treated with sagittal strip craniectomy at their institution between January 2012 and October 2015. Inclusion criteria were as follows: 1) isolated sagittal synostosis; 2) age at surgery < 200 days; and 3) helmet management by a single orthotist. The CI was calculated from 3D images. Color maps and dot maps were generated from 3D images to demonstrate the regional differences in the magnitude of change in head shape over time.

RESULTS

Twenty-one patients met the study inclusion criteria. The mean CI was 71.9 (range 63.0–77.9) preoperatively and 81.1 (range 73.0–89.8) at the end of treatment. The mean time to stabilization of the CI after surgery was 57.2 ± 32.7 days. The mean maximum distances between the surfaces of the preoperative and 1-week postoperative and between the surfaces of the preoperative and end-of-treatment 3D images were 13.0 ± 4.1 mm and 24.71 ± 6.83 mm, respectively. The zone of maximum change was distributed equally in the transverse and vertical dimensions of the posterior vault.

CONCLUSIONS

CI矢状地带cra之后迅速恢复正常niectomy (57.2 days), with equal distribution of the change in CI occurring before and during helmet therapy. Three-dimensional analysis revealed significant vertical and transverse expansion of the posterior cranial vault. Further studies are needed to assess the 3D changes that occur after other sagittal strip craniectomy techniques.

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Imran Rizvi, Rami R. Hallac, Emily L. Geisler, Jeyna K. Perez, Bar Y. Ainuz, Mark P. Pressler, Sarah A. Jackson, Gary B. Skolnick, Matthew D. Smyth, James R. Seaward, Christopher A. Derderian, Lisa R. David, Christopher M. Runyan, Kamlesh B. Patel, and Alex A. Kane

OBJECTIVE

A literature gap exists comparing whole head shape outcome following correction of sagittal craniosynostosis. The objective of this multicenter study was to provide an analysis of long-term results following three different endoscopic strip craniectomy techniques for correction of sagittal craniosynostosis: 1) spring-assisted strip craniectomy, 2) wide-strip craniectomy with biparietal and bitemporal barrel-stave wedge osteotomies plus helmet orthosis, and 3) narrow-strip craniectomy plus orthosis without barrel staves.

开云体育世界杯赔率

Pre- and postoperative 3D stereophotogrammetric images were collected from patients who underwent craniosynostosis surgery. Procedures were divided among institutions as follows: spring-assisted strip craniectomies were performed at Atrium Health Wake Forest Baptist Hospital; narrow-strip craniectomies were performed at St. Louis Children’s Hospital by one craniofacial surgeon; and wide-vertex craniectomies were performed at St. Louis Children’s Hospital prior to 2010, and then continued at Children’s Medical Center Dallas. Pre- and postoperative 3D whole-head composite images were generated for each procedure to visually represent outcomes at final follow-up and compared with age-matched normal controls.

RESULTS

Patients in the spring-assisted strip craniectomy group showed normalization of frontal bossing and skull height compared with age-matched controls, whereas patients undergoing wide-strip craniectomy showed greater correction of occipital protrusion. Patients in the narrow-strip craniectomy cohort had intermediate results between these outcomes. Nested aggregate head shapes showed good correction of head shapes from all techniques.

CONCLUSIONS

This large, retrospective, multicenter study illustrated whole head shape outcomes from three different craniectomy procedures. Although each procedure showed some differences in loci of primary correction, all three surgical methods demonstrated good correction of primary scaphocephalic deformity.

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