Download PDF
CC BY 4.0 · Journal of Child Science 2022; 12(01): e212-e223
DOI: 10.1055/s-0042-1758809
Original Study

An Open Cranial Vault Remodeling Procedure for Craniosynostosis: A Retrospective Study

Anas Abdallah 
1   Department of Neurosurgery, Istanbul Training and Research Hospital, Samatya, Istanbul, Turkey
,
Meliha Gündağ Papaker 
2   Department of Neurosurgery, Bezmialem Vakif University, Fatih, Istanbul, Turkey
,
Gökhan Baloğlu 
3   Department of Neurosurgery, Osmaniye State Hospital, Merkez, Osmaniye, Turkey
› Author Affiliations
› Further Information
   Permissions and Reprints

Abstract

Craniosynostosis is a skull malformation occurring due to the premature fusion of one or more cranial sutures. This pathological entity is a relatively commonly observed congenital malformation and is reportedly seen in 1/1,700–1,900 live births. The study aimed to evaluate the surgical outcomes of the open cranial vault remodeling (OCVR) in children with craniosynostosis.

Medical records of 76 children with craniosynostosis who were diagnosed at the neurosurgery departments of our centers for 11 years (from January 2010 to December 2020) were retrospectively examined. Among them, 54 consecutive children who underwent OCVR were included in this study. Surgical outcomes were discussed with a related literature review.

Fifty-four (32 males and 22 females) consecutive children received OCVR for craniosynostosis with a mean age of 12.6 ± 7.1 months. Eight children were syndromic. Three children were shunt-induced craniosynostosis. Syndromic children were four with Apert, two with Pfeiffer, and two with Crouzon syndrome. Twelve children were brothers/sisters. The misshapen skull was the most commonly recorded symptom in 49 children (90.7%). The most affected sutures were bicoronal craniosynostosis found in 20 children. The complication rate was 9.3% (n = 5). Two of these five children needed reoperation for optimal remodeling. One child died postoperatively in the intensive care unit due to cardiac arrest.

These findings demonstrated that the OCVR approach is an efficient surgical method to get good outcomes. Satisfactory results with an acceptable complication rate can be obtained with expert hands. Further studies are warranted to support these findings.

Keywords

craniosynostosis - open cranial vault remodeling - cranioplasty - children - surgical outcomes

Author Contributions

Conception or design of the work: Anas Abdallah and Meliha Gündağ Papaker; data collection: Meliha Gündağ Papaker and Anas Abdallah; data analysis and interpretation: Anas Abdallah and Meliha Gündağ Papaker; drafting the article: Anas Abdallah; critical revision of the article: Anas Abdallah, Meliha Gündağ Papaker, and Gökhan Baloğlu; other (study supervision, fundings, materials, validation, etc.): Gökhan Baloğlu, Meliha Gündağ Papaker, and Anas Abdallah.


All authors (Anas Abdallah, Meliha Gündağ Papaker, and Gökhan Baloğlu) reviewed the results and approved the final version of the manuscript.




Publication History

Received: 21 August 2022

Accepted: 23 August 2022

Article published online:
23 November 2022

© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Morrison KA, Lee JC, Souweidane MM, Feldstein NA, Ascherman JA. Twenty-year outcome experience with open craniosynostosis repairs: an analysis of reoperation and complication rates. Ann Plast Surg 2018; 80 (4, Suppl 4) S158-S163
    CrossrefPubMedGoogle Scholar
  • 2 Sloan GM, Wells KC, Raffel C, McComb JG. Surgical treatment of craniosynostosis: outcome analysis of 250 consecutive patients. Pediatrics 1997; 100 (01) E2
    CrossrefPubMedGoogle Scholar
  • 3 Garza RM, Khosla RK. Nonsyndromic craniosynostosis. Semin Plast Surg 2012; 26 (02) 53-63
    Article in Thieme ConnectPubMedGoogle Scholar
  • 4 Sakamoto H, Matsusaka Y, Kunihiro N, Imai K. Physiological changes and clinical implications of syndromic craniosynostosis. J Korean Neurosurg Soc 2016; 59 (03) 204-213
    CrossrefPubMedGoogle Scholar
  • 5 Pogliani L, Zuccotti GV, Furlanetto M. et al. Cranial ultrasound is a reliable first step imaging in children with suspected craniosynostosis. Childs Nerv Syst 2017; 33 (09) 1545-1552
    CrossrefPubMedGoogle Scholar
  • 6 Shimoji T, Kimura T, Shimoji K, Miyajima M. The metopic-sagittal craniosynostosis-report of 35 operative cases. Childs Nerv Syst 2017; 33 (08) 1335-1348
    CrossrefPubMedGoogle Scholar
  • 7 Taylor WJ, Hayward RD, Lasjaunias P. et al. Enigma of raised intracranial pressure in patients with complex craniosynostosis: the role of abnormal intracranial venous drainage. J Neurosurg 2001; 94 (03) 377-385
    CrossrefPubMedGoogle Scholar
  • 8 Fox AJ, Tatum SA. The coronal incision: sinusoidal, sawtooth, and postauricular techniques. Arch Facial Plast Surg 2003; 5 (03) 259-262
    CrossrefPubMedGoogle Scholar
  • 9 Munro IR, Fearon JA. The coronal incision revisited. Plast Reconstr Surg 1994; 93 (01) 185-187
    CrossrefPubMedGoogle Scholar
  • 10 Fisher DM, Goldman BE, Mlakar JM. Template for a zigzag coronal incision. Plast Reconstr Surg 1995; 95 (03) 614-615
    CrossrefPubMedGoogle Scholar
  • 11 Kim SW, Yun BM, Song JK, Kim SK, Wang KC. V-Y advancement flaps for scalp closure after acute cranial volume expansion. Ann Plast Surg 2011; 66 (03) 249-252
    CrossrefPubMedGoogle Scholar
  • 12 Jimenez DF, Barone CM, Cartwright CC, Baker L. Early management of craniosynostosis using endoscopic-assisted strip craniectomies and cranial orthotic molding therapy. Pediatrics 2002; 110 (1, Pt 1): 97-104
    CrossrefPubMedGoogle Scholar
  • 13 Jaszczuk P, Rogers GF, Guzman R, Proctor MR. X-linked hypophosphatemic rickets and sagittal craniosynostosis: three patients requiring operative cranial expansion: case series and literature review. Childs Nerv Syst 2016; 32 (05) 887-891
    CrossrefPubMedGoogle Scholar
  • 14 Carmichael SL, Ma C, Rasmussen SA. et al. Craniosynostosis and risk factors related to thyroid dysfunction. Am J Med Genet A 2015; 167A (04) 701-707
    CrossrefPubMedGoogle Scholar
  • 15 Park DH, Chung J, Yoon SH. The role of distraction osteogenesis in children with secondary craniosynostosis after shunt operation in early infancy. Pediatr Neurosurg 2009; 45 (06) 437-445
    CrossrefPubMedGoogle Scholar
  • 16 Fawzy HH, Choi JW, Ra YS. One-piece fronto-orbital distraction with midline splitting but without bandeau for metopic craniosynostosis: craniometric, volumetric, and morphologic evaluation. Ann Plast Surg 2019; 83 (03) 285-292
    CrossrefPubMedGoogle Scholar
  • 17 Pearson GD, Havlik RJ, Eppley B, Nykiel M, Sadove AM. Craniosynostosis: a single institution's outcome assessment from surgical reconstruction. J Craniofac Surg 2008; 19 (01) 65-71
    CrossrefPubMedGoogle Scholar
  • 18 Seruya M, Oh AK, Boyajian MJ. et al. Long-term outcomes of primary craniofacial reconstruction for craniosynostosis: a 12-year experience. Plast Reconstr Surg 2011; 127 (06) 2397-2406
    CrossrefPubMedGoogle Scholar
  • 19 McCarthy JG, Glasberg SB, Cutting CB. et al. Twenty-year experience with early surgery for craniosynostosis: I. Isolated craniofacial synostosis–results and unsolved problems. Plast Reconstr Surg 1995; 96 (02) 272-283
    CrossrefPubMedGoogle Scholar
  • 20 McCarthy JG, Glasberg SB, Cutting CB. et al. Twenty-year experience with early surgery for craniosynostosis: II. The craniofacial synostosis syndromes and pansynostosis–results and unsolved problems. Plast Reconstr Surg 1995; 96 (02) 284-295 , discussion 296–298
    CrossrefPubMedGoogle Scholar
  • 21 Breugem CC, van R Zeeman BJ. Retrospective study of nonsyndromic craniosynostosis treated over a 10-year period. J Craniofac Surg 1999; 10 (02) 140-143
    CrossrefPubMedGoogle Scholar
  • 22 Fearon JA, Ruotolo RA, Kolar JC. Single sutural craniosynostoses: surgical outcomes and long-term growth. Plast Reconstr Surg 2009; 123 (02) 635-642
    CrossrefPubMedGoogle Scholar
  • 23 Esparza J, Hinojosa J. Complications in the surgical treatment of craniosynostosis and craniofacial syndromes: apropos of 306 transcranial procedures. Childs Nerv Syst 2008; 24 (12) 1421-1430
    CrossrefPubMedGoogle Scholar