The Management of Sagittal Synostosis with Endoscopic Craniectomy and Post-operative Helmet Molding Therapy
Emily Ridgway, MD1, John Candelario, BS2, Gary F. Rogers, MD< JD, MBA1, Mark R. Proctor, MD1.
1Children's Hospital Boston, Brookline, MA, USA, 2Harvard Medical School, Boston, MA, USA.
Background: Suturectomy was largely replaced during the last four decades by more extensive, but predictable, cranial remodeling procedures. More recently, technical innovations (i.e., use of endoscope and post-operative orthotic reshaping) have led to a resurgence of interest in suturectomy.
Methods: A retrospective chart review was performed of all cases of sagittal synostosis treated by the senior surgeon (MP) with endoscopic sagittal suture strip craniectomy and helmet therapy between 2004 and 2009. Data collected included prematurity, genetic evaluations and syndromic status, age at the time of operation, duration of procedure, need for transfusion, length of hospital stay, preoperative and postoperative head circumference percentile, cranial index, duration of helmet use, length of follow-up, complications and need for revisions. Standard statistical analyses were performed including paired t-test and multiple regression.
Results: Fifty-six non-syndromic patients with isolated sagittal synostosis were treated with endoscopic suturectomy and completed helmet therapy. Mean age at time of procedure was 3.21 months (SD±1.48 months). Mean operative time was 45.23 minutes (SD±11.23 minutes). Mean hospital stay was 1.39 days (SD± 0.39 days). Hospital stay length was one night for 48 patients, two nights for 7 patients and 3 nights for one patient. Two transfusions were reported. No deaths occurred. Among those that have completed therapy, the mean length of follow-up was 2.34 years (SD± 0.94). Helmets were maintained a mean of 7.47 months duration (SD± 1.93). Head circumference percentile (HCP) increased from 61.42%ile (SD± 34.43) to 91.41%ile (SD± 13.63) within 1-year of follow up, 86.68%ile (SD± 21.72) within 1-2 years follow up, and 89.27%ile(SD± 16.82) over 2 years follow up. Cranial index (CI) increased from a mean of 0.69 (SD± 0.04) to 0.77 (SD±0.04) within 1-year follow up, 0.76 (SD± 0.05) within 1-2 years follow up, and 0.76 (SD± 0.03) over 2 years follow up. Complications included one incisional abscess requiring admission for incision and drainage, one sagittal suture refusion and two cases of additional suture fusion requiring open cranial vault remodeling.
Conclusions: Sagittal synostoses can be safely treated with endoscopic suturectomy and helmet therapy with reliable and enduring results.
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