1
|
Bakovic M, Starsiak L, Bennett S, McCaffrey R, Mantilla-Rivas E, Manrique M, Rogers GF, Oh AK. Socioeconomic Influence on Surgical Management and Outcomes in Patients with Craniosynostosis - A Systematic Review. Cleft Palate Craniofac J 2024:10556656241261838. [PMID: 38881366 DOI: 10.1177/10556656241261838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/18/2024] Open
Abstract
OBJECTIVE Disparities in insurance and socioeconomic status (SES) may impact surgical management and subsequent postoperative outcomes for patients with craniosynostosis. This systematic review summarizes the evidence on possible differences in surgical care, including procedure type, age at surgery, and differences in surgical outcomes such as complications, length of hospital stay, and child development based on SES. DESIGN The databases Scopus, PubMed, and CINAHL were searched between May and July 2022. Following PICO criteria, studies included focused on patients diagnosed with craniosynostosis; corrective surgery for craniosynostosis; comparison of insurance, income, or zip code; and surgical management of postoperative outcomes. RESULTS The initial search yielded 724 articles. After three stages of screening, 13 studies were included. Assessed outcomes included: type of procedure (6 articles), age at time of surgery (3 articles), post-operative complications (3 articles), referral delay (2 articles), length of stay (2 articles), hospital costs (2 articles), and child development (1 article). Of the studies with significant results, insurance type was the main SES variable of comparison. While some findings were mixed, these studies indicated that patients with public medical insurance were more likely to experience a delay in referral, undergo an open rather than minimally-invasive procedure, and have more complications, longer hospitalization, and higher medical charges. CONCLUSIONS This study demonstrated that SES may be associated with several differences in the management of patients with craniosynostosis. Further investigation into the impact of SES on the management of patients with craniosynostosis is warranted to identify possible interventions that may improve overall care.
Collapse
Affiliation(s)
- Melanie Bakovic
- Division of Plastic and Reconstructive Surgery, Children's National Hospital, Washington, DC, USA
| | - Lilliana Starsiak
- Division of Plastic and Reconstructive Surgery, Children's National Hospital, Washington, DC, USA
| | - Spencer Bennett
- Division of Plastic and Reconstructive Surgery, Children's National Hospital, Washington, DC, USA
| | - Ryan McCaffrey
- Division of Plastic and Reconstructive Surgery, Children's National Hospital, Washington, DC, USA
| | - Esperanza Mantilla-Rivas
- Division of Plastic and Reconstructive Surgery, Children's National Hospital, Washington, DC, USA
| | - Monica Manrique
- Division of Plastic and Reconstructive Surgery, Children's National Hospital, Washington, DC, USA
| | - Gary F Rogers
- Division of Plastic and Reconstructive Surgery, Children's National Hospital, Washington, DC, USA
| | - Albert K Oh
- Division of Plastic and Reconstructive Surgery, Children's National Hospital, Washington, DC, USA
| |
Collapse
|
2
|
Huynh EM, Elhusseiny AM, Dagi LR. Ophthalmic Manifestations of Unilateral Coronal Synostosis. Curr Eye Res 2023; 48:879-886. [PMID: 37382098 DOI: 10.1080/02713683.2023.2224536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 06/08/2023] [Indexed: 06/30/2023]
Abstract
PURPOSE To summarize the ophthalmic manifestations of unilateral coronal synostosis patients. METHODS We performed a literature search in the electronic database of PubMed, CENTRAL, Cochrane, and Ovid Medline guided by Preferred Reporting Items for Systematic Reviews and Meta-Analysis Statement for studies evaluating ophthalmic manifestations of unilateral coronal synostosis. RESULTS Unilateral coronal synostosis, also called unicoronal synostosis, may be mistaken for deformational plagiocephaly, an asymmetric skull flattening common in newborns. Characteristic facial features, however, distinguish the two. Ophthalmic manifestations of unilateral coronal synostosis include a "harlequin deformity", anisometropic astigmatism, strabismus, amblyopia, and significant orbital asymmetry. The astigmatism is greater on the side opposite the fused coronal suture. Optic neuropathy is uncommon unless unilateral coronal synostosis accompanies more complex multi-suture craniosynostosis. In many cases, surgical intervention is recommended; without intervention, skull asymmetry and ophthalmic disorders tend to worsen with time. Unilateral coronal synostosis can be managed by early endoscopic stripping of the fused suture and helmeting through a year of age or by fronto-orbital-advancement at approximately 1 year of age. Several studies have demonstrated that anisometropic astigmatism, amblyopia, and severity of strabismus are significantly lower after earlier intervention with endoscopic strip craniectomy and helmeting compared to treatment by fronto-orbital-advancement. It remains unknown whether the earlier timing or the nature of the procedure is responsible for the improved outcomes. As endoscopic strip craniectomy can only be performed in the first few months of life, early recognition of the facial, orbital, eyelid, and ophthalmic characteristics by consultant ophthalmologists enables expeditious referral and optimized ophthalmic outcomes. CONCLUSION Timely identification of craniofacial and ophthalmic manifestations of infants with unilateral coronal synostosis is important. Early recognition and prompt endoscopic treatment appears to optimize ocular outcomes.
Collapse
Affiliation(s)
- Elisah M Huynh
- University of Massachusetts Medical School, Worcester, MA, USA
| | - Abdelrahman M Elhusseiny
- Department of Ophthalmology, Harvey and Bernice Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Department of Ophthalmology, Boston Children's Hospital, Boston, MA, USA
| | - Linda R Dagi
- Department of Ophthalmology, Boston Children's Hospital, Boston, MA, USA
| |
Collapse
|
3
|
Dohlman JC, Prabhu SP, Staffa SJ, Kanack MD, Mackinnon S, Warkad VU, Meara JG, Proctor MR, Dagi LR. Orbital and Eyelid Characteristics, Strabismus, and Intracranial Pressure Control in Apert Children Treated by Endoscopic Strip Craniectomy versus Fronto-Orbital Advancement. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e4937. [PMID: 37180985 PMCID: PMC10171774 DOI: 10.1097/gox.0000000000004937] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 02/24/2023] [Indexed: 05/16/2023]
Abstract
Apert syndrome is characterized by eyelid dysmorphology, V-pattern strabismus, extraocular muscle excyclorotation, and elevated intracranial pressure (ICP). We compare eyelid characteristics, severity of V-pattern strabismus, rectus muscle excyclorotation, and ICP control in Apert syndrome patients initially treated by endoscopic strip craniectomy (ESC) at about 4 months of age versus fronto-orbital advancement (FOA) performed about 1 year of age. Methods Twenty-five patients treated at Boston Children's Hospital met inclusion criteria for this retrospective cohort study. Primary outcomes were magnitude of palpebral fissure downslanting at 1, 3, and 5 years of age, severity of V-pattern strabismus, rectus muscle excyclorotation, and interventions to control ICP. Results Before craniofacial repair and through 1 year of age, none of the studied parameters differed for FOA versus ESC treated patients. Palpebral fissure downslanting became statistically greater for those treated by FOA by 3 (P < 0.001) and 5 years of age (P = 0.001). Likewise, severity of palpebral fissure downslanting correlated with severity of V-pattern strabismus at 3 (P = 0.004) and 5 (P = 0.002) years of age. Palpebral fissure downslanting and rectus muscle excyclorotation were typically coexistent (P = 0.053). Secondary interventions to control ICP were required in four of 14 patients treated by ESC (primarily FOA) and in two of 11 patients initially treated by FOA (primarily third ventriculostomy) (P = 0.661). Conclusions Apert patients initially treated by ESC had less severe palpebral fissure downslanting and V-pattern strabismus, normalizing their appearance. Thirty percent initially treated by ESC required secondary FOA to control ICP.
Collapse
Affiliation(s)
- Jenny C. Dohlman
- From the Department of Ophthalmology, Boston Children’s Hospital, Boston, Mass
| | - Sanjay P. Prabhu
- Department of Radiology, Boston Children’s Hospital, Boston, Mass
| | - Steven J. Staffa
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Boston, Mass
| | - Melissa D. Kanack
- Department of Plastic and Oral Surgery, Boston Children’s Hospital, Boston, Mass
| | - Sarah Mackinnon
- From the Department of Ophthalmology, Boston Children’s Hospital, Boston, Mass
| | | | - John G. Meara
- Department of Plastic and Oral Surgery, Boston Children’s Hospital, Boston, Mass
| | - Mark R. Proctor
- Department of Neurosurgery, Boston Children’s Hospital, Boston, Mass
| | - Linda R. Dagi
- From the Department of Ophthalmology, Boston Children’s Hospital, Boston, Mass
| |
Collapse
|
4
|
Halim J, Silva A, Budden C, Dunaway DJ, Jeelani NUO, Ong J, James G. Initial UK series of endoscopic suturectomy with postoperative helmeting for craniosynostosis: early report of perioperative experience. Br J Neurosurg 2023; 37:20-25. [PMID: 33241967 DOI: 10.1080/02688697.2020.1846681] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Endoscopic suturectomy with postoperative helmeting (ESCH) has emerged as a successful treatment for craniosynostosis, initially in North America. We report early outcomes from the first cohort of ESCH patients treated in the United Kingdom (UK). METHODS Retrospective cohort study with electronic chart review. RESULTS 18 consecutive patients from the first ESCH procedure in UK (May 2017) until January 2020 identified. 12 male and 6 female infantsd, with a mean age of 4.6 months (range 2.5-7.8 months) and weight of 6.8 kg (range 4.8-9.8 kg). Diagnoses were metopic (n = 8), unicoronal (n = 7), sagittal (n = 2) and multi-sutural (n = 1) synostoses. Median incision length was 3 cm (range 2-10 cm). 16/18 received no blood products, with 2 (both metopics) requiring transfusion (1 donor exposure). Mean operative time (including anaesthesia) was 96 min (range 40-127 min). Median length of hospital stay was 1 night. 1 surgical complication (superficial infection). All patients are currently undergoing helmet orthosis therapy. So far, no patients have required revisional or squint surgery. CONCLUSION Early experience from the first UK cohort of ESCH suggests that this is a safe and well tolerated technique with low morbidity, transfusion and short hospital stay. Long-term results in terms of shape, cosmetic and developmental outcome are awaited.
Collapse
Affiliation(s)
- Jonathan Halim
- Barts and The London School of Medicine, QMUL, London, UK
| | - Adikarige Silva
- Department of Neurosurgery, Great Ormond Street Hospital, London, UK
| | - Curtis Budden
- Craniofacial Unit, Great Ormond Street Hospital, London, UK
| | - David J Dunaway
- Craniofacial Unit, Great Ormond Street Hospital, London, UK.,Great Ormond Street Institute of Child Health, UCL, London, UK
| | - N U Owase Jeelani
- Department of Neurosurgery, Great Ormond Street Hospital, London, UK.,Craniofacial Unit, Great Ormond Street Hospital, London, UK.,Great Ormond Street Institute of Child Health, UCL, London, UK
| | - Juling Ong
- Craniofacial Unit, Great Ormond Street Hospital, London, UK.,Great Ormond Street Institute of Child Health, UCL, London, UK
| | - Greg James
- Department of Neurosurgery, Great Ormond Street Hospital, London, UK.,Craniofacial Unit, Great Ormond Street Hospital, London, UK.,Great Ormond Street Institute of Child Health, UCL, London, UK
| |
Collapse
|
5
|
Elawadly A, Smith L, Borghi A, Nouby R, Silva AHD, Dunaway DJ, Jeelani NUO, Ong J, James G. 3-Dimensional Morphometric Outcomes After Endoscopic Strip Craniectomy for Unicoronal Synostosis. J Craniofac Surg 2023; 34:322-331. [PMID: 36184769 DOI: 10.1097/scs.0000000000009010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 07/07/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Endoscopic strip craniectomy with postoperative helmeting (ESCH) for unicoronal synostosis has shown to be a less morbid procedure when compared with fronto-orbital remodeling (FOR). We aim in this pilot study to report objective methods and quantitative morphologic outcomes of endoscopically treated unicoronal synostosis using 3-dimensional surface scans. METHODS Our electronic records were reviewed for ophthalmological, neurodevelopmental outcomes, and helmet-related complications. For morphologic outcomes, the following parameters were used: Cranial Index, Cranial Vault Asymmetry Index, Anterior Symmetry Ratio (ASR), and Root Mean Square between the normal and synostotic sides of the head. Three-dimensional stereophotogrammetry scans were evaluated at 3 time points preoperative, 6 months post-op, and at the end of the treatment, which was compared with age-matched scans of normal controls and FOR patients. Nonparametric tests were used for statistical analysis. RESULTS None of the ESCH cases developed strabismus, major neurodevelopmental delay, or helmet complications. All morphologic parameters improved significantly at 6 months post-op except for the Cranial Vault Asymmetry Index. The ASR was the only parameter to change significantly between 6 months post-op and final scans. At end of helmet treatment, ASR and Root Mean Square differed significantly between the ESCH and both FOR and control groups. CONCLUSIONS Endoscopic strip craniectomy with postoperative helmeting for single unicoronal synostosis had excellent clinical outcomes. Most of the improvement in head morphology occurred in the first 6 months of treatment. Despite the normalization of the overall head shape, there was residual asymmetry in the frontal and temporal regions of the head.
Collapse
Affiliation(s)
- Ahmed Elawadly
- Craniofacial Unit, Great Ormond Street Hospital
- Great Ormond Street Institute of Child Health, University College London, London, UK
- Neurosurgery Department, Aswan University, Aswan
| | - Luke Smith
- Craniofacial Unit, Great Ormond Street Hospital
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Alessandro Borghi
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Radwan Nouby
- Neurosurgery Department, Assuit University, Assuit, Egypt
| | | | - David J Dunaway
- Craniofacial Unit, Great Ormond Street Hospital
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Noor Ul O Jeelani
- Craniofacial Unit, Great Ormond Street Hospital
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Juling Ong
- Craniofacial Unit, Great Ormond Street Hospital
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Greg James
- Craniofacial Unit, Great Ormond Street Hospital
- Great Ormond Street Institute of Child Health, University College London, London, UK
| |
Collapse
|
6
|
Blessing M, Gallagher ER. Epidemiology, Genetics, and Pathophysiology of Craniosynostosis. Oral Maxillofac Surg Clin North Am 2022; 34:341-352. [PMID: 35787827 DOI: 10.1016/j.coms.2022.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Craniosynostosis, the premature fusion of the infant cranial skulls, can be recognized by characteristic head shape differences that worsen with head growth. Craniosynostosis can be syndromic or nonsyndromic and can involve one suture or multiple sutures. Timely cranial vault surgery is recommended to expand and reshape the skull, with a goal of preventing increased intracranial pressure and providing sufficient space for brain growth. Several gene variants and environmental exposures are known to increase the risk of single suture craniosynostosis (SSC), including in utero constraint, exposure to specific toxins and medications, and medical conditions such as thyroid dysregulation and metabolic bone disorders.
Collapse
Affiliation(s)
- Matthew Blessing
- Department of Pediatrics, Division of Craniofacial Medicine, University of Washington and Seattle Children's Hospital, 4800 Sand Point Way NE, M/S OB.9.520, PO Box 5371, Seattle, WA 98145-5005, USA
| | - Emily R Gallagher
- Department of Pediatrics, Division of Craniofacial Medicine, University of Washington and Seattle Children's Hospital, 4800 Sand Point Way NE, M/S OB.9.520, PO Box 5371, Seattle, WA 98145-5005, USA.
| |
Collapse
|
7
|
Sood S, Marupudi N, Reisen B, Rozzelle A. Endoscopy in craniosynostosis surgery: Evolution and current trends. J Pediatr Neurosci 2022; 17:S44-S53. [DOI: 10.4103/jpn.jpn_47_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 04/04/2022] [Indexed: 11/04/2022] Open
|
8
|
Impact of the Craniofacial Surgery Simulation in Anterior Plagiocephaly on Orbits and Oculomotor Muscles: Biomechanical Analysis With a Finite Element Model. J Craniofac Surg 2021; 32:2344-2348. [PMID: 34054084 DOI: 10.1097/scs.0000000000007784] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PURPOSE The aim of this study was to show the displacements and strain induced by the supraorbital band advancement during a craniofacial surgery for an anterior plagiocephaly on the orbital bones and the orbital content thanks to a numerical surgical simulation using the finite element method. METHODS A three-dimensional (3D) finite element model of a child with an anterior plagiocephaly was entirely created from a tomodensitometry of a patient followed by our Craniofacial Pediatric team. Data of the tomodensitometry were computed with Slicer 3D to re-create the orbit geometry. Mesh production, properties of the model, and simulations of the fronto-orbital advancement were conducted on Hyperworks software (Altair Engineering, Inc., Detroit, MI, USA). RESULTS The resulting 3D Finite Element Model was used to perform the supraorbital advancement simulation. Displacement and strain patterns were studied for orbital bones, oculomotor muscles, and eyeballs. Relative high strain in the both trochlear area and excycloration of the right orbit are among the most interesting results as torsional strabismus as V-pattern strabismus are often described in children with an anterior plagiocephaly. CONCLUSIONS This pediatric Finite-Element Model of both orbits of a child with an anterior plagiocephaly showed the impact of the fronto-orbital advancement on the oculomotor system. This model described the relationship between the craniofacial surgery and the strabismus in the unilateral coronal synostosis. The advantages of this model are the many opportunities for improvement, including postoperative period and additional surgical procedures.
Collapse
|
9
|
A Cohort Study of Strabismus Rates Following Correction of the Unicoronal Craniosynostosis Deformity: Conventional Bilateral Fronto-Orbital Advancement Versus Fronto-Orbital Distraction Osteogenesis. J Craniofac Surg 2021; 32:2362-2365. [PMID: 34054083 DOI: 10.1097/scs.0000000000007773] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND The purpose of this prospective study is to compare perioperative morbidity and strabismus rates between traditional fronto-orbital advancement reconstruction (FOAR) and fronto-orbital distraction osteogenesis (FODO) in unicoronal craniosynostosis (UCS). METHOD A consecutive group of 15 patients undergoing FODO for isolated UCS were compared to a contemporaneous group of 15 patients undergoing traditional FOAR for UCS. Patient age, operative time, blood loss, blood replacement, technical details of the surgery, length of stay, complications, and strabismus rates were documented and compared statistically using chi-square and Student t test with a significance value of 0.05. RESULTS The 15 patients undergoing FODO were younger (6.3 and 9.8 months, P < 0.05), experienced less operative time for the initial procedure (111 versus 190 minutes, P < 0.01), less blood loss (26% versus 50% of total blood volume, P < 0.01), and less blood replacement (40% versus 60% of total blood volume, P < 0.05). One patient in the FODO group experienced a new-onset strabismus postoperatively compared with 5 in the FOAR group (P < 0.05). There were no complications requiring a return to the operating room in either group. CONCLUSIONS Fronto-orbital distraction osteogenesis for the treatment of isolated UCS is associated with a favorable perioperative morbidity profile and a decreased incidence of postoperative strabismus compared with traditional FOAR. These positive factors are tempered by the need for an additional procedure for removal of the device and lack of long-term outcomes data on the technique.
Collapse
|
10
|
McKee RM, Carbullido MK, Ewing E, Kamel GN, Ryan J, Zaldana-Flynn MV, Cronin BJ, Lance SH, Gosman AA. Orbital Volumetric Analysis in Patients With Unicoronal Craniosynostosis: A Comparison Between Distraction Osteogenesis and Fronto-Orbital Advancement. Ann Plast Surg 2021; 86:S367-S373. [PMID: 33833173 DOI: 10.1097/sap.0000000000002816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Unicoronal craniosynostosis is associated with orbital restriction and asymmetry. Surgical treatment aims to both correct the aesthetic deformity and prevent the development of ocular dysfunction. We used orbital quadrant and hemispheric volumetric analysis to assess orbital restriction and compare the effectiveness of distraction osteogenesis with anterior rotational cranial flap (DO) and bilateral fronto-orbital advancement and cranial vault remodeling (FOAR) with respect to the correction of orbital restriction in patients with unicoronal craniosynostosis. METHODS A retrospective review of all patients with a diagnosis of unicoronal craniosynostosis and treated with either DO or FOAR from 2000 to 2019 was performed. Preoperative and postoperative total orbital volumes, as well as quadrant and hemispheric volume ratios, were calculated from 3-dimensional head computed tomography scans. Selected preoperative and postoperative orbital measurements, including the maxillary length of the orbit (MLO; zygomaticofrontal suture to the top of zygomatic arch) and the sphenoid length of the orbit (SLO; the top of sphenoid suture to the top of zygomatic arch), were also obtained. RESULTS Data were available for 28 patients with unicoronal craniosynostosis. Mean preoperative total orbital volume was significantly smaller on the synostotic side compared with the nonsynostotic side (10.94 vs 12.20 cm3, P = 0.04). Preoperative MLO and SLO were significantly longer on the synostotic side compared with the nonsynostotic side (MLO: 20.26 vs 17.75 mm, P < 0.001; SLO: 26.91 vs 24.93 mm, P = 0.01). Distraction osteogenesis and FOAR produced significantly different changes in orbital quadrant and/or hemispheric volume ratios on the nonsynostotic side but not on the synostotic side. CONCLUSIONS Before correction, patients with unicoronal craniosynostosis have significantly smaller total orbital volumes on the synostotic side compared with the nonsynostotic side and significantly greater MLO and SLO on the synostotic side compared with the nonsynostotic side. There is no significant difference between DO and FOAR with regard to correcting the observed orbital restriction in these patients.
Collapse
Affiliation(s)
| | - M Kristine Carbullido
- Division of Plastic and Reconstructive Surgery, University of California, San Diego, La Jolla
| | - Emily Ewing
- Rady Children's Hospital San Diego, San Diego
| | | | - Justin Ryan
- Rady Children's Hospital San Diego, San Diego
| | | | - Brendan J Cronin
- Division of Plastic and Reconstructive Surgery, University of California, Los Angeles, Los Angeles, CA
| | | | | |
Collapse
|
11
|
Nationwide Perioperative Analysis of Endoscopic Versus Open Surgery for Craniosynostosis: Equal Access, Unequal Outcomes. J Craniofac Surg 2020; 32:149-153. [DOI: 10.1097/scs.0000000000007178] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
|
12
|
Age at Craniosynostosis Surgery and Its Impact on Ophthalmologic Diagnoses: A Single-Center Retrospective Review. Plast Reconstr Surg 2020; 146:375e-376e. [PMID: 32472907 DOI: 10.1097/prs.0000000000007111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
13
|
Jivraj BA, Ahmed N, Karia K, Menon R, Robertson E, Sodha A, Wormald JCR, O'hara J, Jeelani O, Dunaway D, James G, Ong J. A 24-month cost and outcome analysis comparing traditional fronto-orbital advancment and remodeling with endoscopic strip craniectomy and molding helmet in the management of unicoronal craniosynostosis: A retrospective bi-institutional review. JPRAS Open 2020; 20:35-42. [PMID: 32158870 PMCID: PMC7061657 DOI: 10.1016/j.jpra.2019.01.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 01/23/2019] [Indexed: 11/12/2022] Open
Abstract
Introduction Endoscopic strip craniectomy with helmeting (ESCH) has been shown to be a safe and efficacious alternative to fronto-orbital remodeling (FOR) for selected children with craniosynostosis. In addition to clinical factors, there may be economic benefits from the use of ESCH instead of FOR. Methods A retrospective review of 23 patients with nonsyndromic unicoronal craniosynostosis (UCS) treated with FOR was carried out at Great Ormond Street Hospital (GOSH) for Children in London, UK. Secondary data were used for the ESCH cohort from a paper published by Jimenez and Barone (2013). Data were collected on surgical time, transfusion rates, length of hospital stay, adverse event rates, reintervention rates, and overall costs. Costs were categorized and then assigned to the appropriate data sets. Results The mean age of patients undergoing FOR (vs. ESCH) was 17.4 mo (vs. 3.1 mo) with a mean surgical time of 234 min (vs. 55 min), mean transfusion volume of 221.6 mL (vs. 80.0 mL), mean transfusion rate of 14/23 (vs. 2/115), and a total immediate overnight stay of 3.13 days (vs. 97% next-day discharge). The FOR group had a higher adverse event rate (5/23 vs. 4/115, p=<0.005) and a higher number requiring extraocular muscle surgery (4/23 vs. 7/109, p=0.16). There was a substantial difference in overall costs between the two groups. Total variance cost for the FOR group was £7436.5 vs. £4951.35, representing a cost difference of £2485.15 over the 24-month study period. Conclusion ESCH, in comparison to FOR, appears as a more economical method in the management of USC patients, as well as having clinical benefits including reduced adverse event rate and improved ophthalmic outcomes.
Collapse
Affiliation(s)
- B A Jivraj
- Great Ormond Street Hospital for Children, Great Ormond St, London WC1N 3JH, UK
| | - N Ahmed
- Great Ormond Street Hospital for Children, Great Ormond St, London WC1N 3JH, UK
| | - K Karia
- Great Ormond Street Hospital for Children, Great Ormond St, London WC1N 3JH, UK
| | - R Menon
- Great Ormond Street Hospital for Children, Great Ormond St, London WC1N 3JH, UK
| | - E Robertson
- Great Ormond Street Hospital for Children, Great Ormond St, London WC1N 3JH, UK
| | - A Sodha
- Great Ormond Street Hospital for Children, Great Ormond St, London WC1N 3JH, UK
| | - J C R Wormald
- Great Ormond Street Hospital for Children, Great Ormond St, London WC1N 3JH, UK
| | - J O'hara
- Great Ormond Street Hospital for Children, Great Ormond St, London WC1N 3JH, UK
| | - O Jeelani
- Great Ormond Street Hospital for Children, Great Ormond St, London WC1N 3JH, UK
| | - D Dunaway
- Great Ormond Street Hospital for Children, Great Ormond St, London WC1N 3JH, UK
| | - G James
- Great Ormond Street Hospital for Children, Great Ormond St, London WC1N 3JH, UK
| | - J Ong
- Great Ormond Street Hospital for Children, Great Ormond St, London WC1N 3JH, UK
| |
Collapse
|
14
|
Yu JW, Xu W, Wink JD, Wes AM, Bartlett SP, Taylor JA. Strabismus in Unicoronal Craniosynostosis: Effect of Orbital Dysmorphology and Fronto-Orbital Advancement and Remodeling. Plast Reconstr Surg 2020; 145:382e-390e. [PMID: 31985648 DOI: 10.1097/prs.0000000000006479] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The purpose of this study was to determine what craniometric changes occur to both orbits of unicoronal craniosynostosis patients undergoing fronto-orbital advancement and remodeling, and which of these changes are associated with new onset of postoperative strabismus. METHODS A retrospective analysis was performed of the preoperative and postoperative orbits of 24 unicoronal craniosynostosis patients and the orbits of 24 control subjects, totaling 144 orbits. Eight parameters were evaluated using multivariate logistic regression analysis. One of the parameters was modified orbital index, an indicator of severity of harlequin deformity. RESULTS Significant differences in orbital dimensions and angles were present bilaterally in unicoronal craniosynostosis orbits when compared to controls. Fronto-orbital advancement and remodeling increased the ipsilateral unicoronal craniosynostosis orbital volume from 13,184 ± 2003 mm to 16,220 ± 2323 mm (p < 0.001). Ipsilateral horizontal cone angles were increased from 48 ± 5 degrees to 54 ± 7 degrees (p = 0.004). Ipsilateral vertical cone angles were decreased from 73 ± 8 degrees to 66 ± 10 degrees (p = 0.003). Ipsilateral modified orbital index improved from 0.83 ± 0.06 to 0.88 ± 0.06 (p = 0.003). Three of the 19 unicoronal craniosynostosis patients developed transient postoperative strabismus. Logistic regression analysis displayed a strong significant association between new-onset strabismus and a change in modified orbital index with a coefficient of 30.84 ± 14.51 (p < 0.05). CONCLUSIONS The orbital dysmorphology in unicoronal craniosynostosis is bilateral in nature, and it is not wholly treated with conventional fronto-orbital advancement and remodeling. The severity of ipsilateral orbital dysmorphology is correlated with the incidence of postoperative strabismus following conventional fronto-orbital advancement and remodeling. Future research is needed to develop strategies to mitigate the risk of development of strabismus in this group of patients. CLINICAL QUESTION/LEVEL OF EVIDENCE Risk, III.
Collapse
Affiliation(s)
- Jason W Yu
- From the Division of Plastic Surgery, Hospital of the University of Pennsylvania and Children's Hospital of Philadelphia
| | - Wen Xu
- From the Division of Plastic Surgery, Hospital of the University of Pennsylvania and Children's Hospital of Philadelphia
| | - Jason D Wink
- From the Division of Plastic Surgery, Hospital of the University of Pennsylvania and Children's Hospital of Philadelphia
| | - Ari M Wes
- From the Division of Plastic Surgery, Hospital of the University of Pennsylvania and Children's Hospital of Philadelphia
| | - Scott P Bartlett
- From the Division of Plastic Surgery, Hospital of the University of Pennsylvania and Children's Hospital of Philadelphia
| | - Jesse A Taylor
- From the Division of Plastic Surgery, Hospital of the University of Pennsylvania and Children's Hospital of Philadelphia
| |
Collapse
|
15
|
Riordan CP, Zurakowski D, Meier PM, Alexopoulos G, Meara JG, Proctor MR, Goobie SM. Minimally Invasive Endoscopic Surgery for Infantile Craniosynostosis: A Longitudinal Cohort Study. J Pediatr 2020; 216:142-149.e2. [PMID: 31685225 DOI: 10.1016/j.jpeds.2019.09.037] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 08/22/2019] [Accepted: 09/13/2019] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To evaluate patient outcomes of minimally invasive endoscopic strip craniectomy (ESC) for craniosynostosis. STUDY DESIGN This is a retrospective cohort analysis (2004-2018) of 500 consecutive infants with craniosynostosis treated by ESC with orthotic therapy at a single center. Operative outcomes included transfusions, complications, and reoperations as well as head circumference change based on World Health Organization percentiles. Multivariable logistic regression was used to identify risk factors associated with blood transfusion. Paired t tests were used for within-patient comparisons and Fisher exact test to compare syndromic and nonsyndromic subgroups. RESULTS ESC was associated with low rates of blood transfusion (6.6%), complications (1.4%), and reoperations (3.0%). Risk factors for transfusion included syndromic craniosynostosis (P = .01) and multiple fused sutures (P = .02). Median surgical time was 47 minutes, and hospital length of stay 1 day. Transfusion and reoperation rates were higher among syndromic patients (both P < .001). Head circumference normalized by 12 months of age relative to World Health Organization criteria in infants with sagittal, coronal, and multisuture craniosynostosis (all P < .001). CONCLUSIONS ESC is a safe, effective, and durable correction of infantile craniosynostosis. ESC can achieve head growth normalization with low risks of blood transfusion, complications, or reoperation. Early identification of craniosynostosis in the newborn period and prompt referral by pediatricians allows families the option of ESC vs larger and riskier open reconstruction procedures.
Collapse
Affiliation(s)
- Coleman P Riordan
- Department of Neurosurgery, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - David Zurakowski
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA; Department of General Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Petra M Meier
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Georgios Alexopoulos
- Department of Neurosurgery, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - John G Meara
- Department of Plastic and Oral Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Mark R Proctor
- Department of Neurosurgery, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Susan M Goobie
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA.
| |
Collapse
|
16
|
Elhusseiny AM, Huynh EM, Dagi LR. Evaluation and Management of V pattern Strabismus in Craniosynostosis. J Binocul Vis Ocul Motil 2020; 70:40-45. [PMID: 31855112 DOI: 10.1080/2576117x.2019.1693822] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Revised: 11/11/2019] [Accepted: 11/11/2019] [Indexed: 06/10/2023]
Abstract
V pattern strabismus is the most common ocular motor disorder reported in patients with craniosynostosis. Strabismus management may prove challenging, and few studies provide perspective on surgical approach. The purpose of this review is to discuss evaluation and surgical options for treating V pattern strabismus in patients with craniosynostosis. We provide a step-by-step approach to facilitate surgical planning.
Collapse
Affiliation(s)
- Abdelrahman M Elhusseiny
- Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Elisah M Huynh
- Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Linda R Dagi
- Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
17
|
Dalmas F, Pech-Gourg G, Gallucci A, Denis D, Scavarda D. Craniosynostosis and oculomotor disorders. Neurochirurgie 2019; 66:91-96. [PMID: 31866515 DOI: 10.1016/j.neuchi.2019.10.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 09/28/2019] [Accepted: 10/13/2019] [Indexed: 10/25/2022]
Abstract
Simple, complex or syndromic craniosynostosis may be responsible for ocular and especially oculomotor pathologies. Among simple craniosynostosis, anterior plagiocephaly is the most frequently associated with oculomotor disorders. Oculomotor disorders encountered in craniosynostosis are specific to this pathology. They may be related to orbital deformities or oculomotor muscle malformations. Early craniofacial surgery reduces the onset and severity of these oculomotor disorders which is very important for ophtalmological patient care. Indeed, these oculomotor disorders are difficult to treat for the ophthalmologist with most of the time several surgeries needed, and lead to amblyopia if neglected.
Collapse
Affiliation(s)
- F Dalmas
- Department of Ophthalmology, Marseille University Hospital, Marseille, 13015 France
| | - G Pech-Gourg
- Department of Pediatric Neurosurgery, Marseille University Hospital, Marseille, 13005 France.
| | - A Gallucci
- Department of Maxillofacial Surgery, Marseille University Hospital, Marseille, 13005 France
| | - D Denis
- Department of Ophthalmology, Marseille University Hospital, Marseille, 13015 France
| | - D Scavarda
- Department of Pediatric Neurosurgery, Marseille University Hospital, Marseille, 13005 France
| |
Collapse
|
18
|
Proctor MR, Meara JG. A review of the management of single-suture craniosynostosis, past, present, and future. J Neurosurg Pediatr 2019; 24:622-631. [PMID: 31786542 DOI: 10.3171/2019.7.peds18585] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 07/29/2019] [Indexed: 11/06/2022]
Abstract
BACKGROUND Craniosynostosis is a condition in which 2 or more of the skull bones fuse prematurely. The spectrum of the disorder most commonly involves the closure of a single suture in the skull, but it can also involve syndromic diagnoses in which multiple skull bones and/or bones outside of the cranium are affected. Craniosynostosis can result in cosmetic deformity as well as potential limitations in brain growth and development, and the neurocognitive impact of the condition is just starting to be studied more thoroughly. Our knowledge regarding the genetics of this condition has also evolved substantially. In this review, the authors explore the medical and surgical advancements in understanding and treating this condition over the past century, with a focus on how the diagnosis and treatment have evolved. METHODS In this review article, the authors, who are the leaders of a craniofacial team at a major academic pediatric hospital, focus on single-suture craniosynostosis (SSC) affecting the 6 major cranial sutures and discuss the evolution of the treatment of SSC from its early history in modern medicine through the current state of the art and future trends. This discussion is based on the authors' broad experience and a comprehensive review of the literature. SUMMARY The management of SSC has evolved substantially over the past 100 years. There have been major advances in technology and medical knowledge that have allowed for safer treatment of this condition through the use of newer techniques and technologies in the fields of surgery, anesthesia, and critical care. The use of less invasive surgical techniques along with other innovations has led to improved outcomes in SSC patients. The future of SSC treatment will likely be guided by elucidation of the causes of neurocognitive delay in these children and assessment of how the timing and type of surgery can mitigate adverse outcomes.
Collapse
Affiliation(s)
| | - John G Meara
- 2Plastic and Oral Surgery, Boston Children's Hospital, Boston, Massachusetts
| |
Collapse
|
19
|
Affiliation(s)
- Frank Weng
- Department of Ophthalmology, Boston Children's Hospital/Harvard Medical School, Boston, Massachusetts
| | - John G Meara
- Department of Plastic and Oral Surgery, Boston Children's Hospital/Harvard Medical School, Boston, Massachusetts
| | - Linda R Dagi
- Department of Ophthalmology, Boston Children's Hospital/Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
20
|
Bennett KG, Vick AD, Ettinger RE, Archer SM, Vercler CJ, Buchman SR. Age at Craniosynostosis Surgery and Its Impact on Ophthalmologic Diagnoses: A Single-Center Retrospective Review. Plast Reconstr Surg 2019; 144:696-701. [PMID: 31461031 PMCID: PMC6729144 DOI: 10.1097/prs.0000000000005915] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Ocular abnormalities in craniosynostosis are a persistent concern for patients and providers, and some surgeons feel that early surgical intervention for synostosis alleviates the progression of ophthalmologic abnormalities. In contradistinction, the authors hypothesize that operating early will have no bearing on postoperative ophthalmologic outcomes. METHODS Single-suture craniosynostosis patients who underwent surgical correction between 1989 and 2015 were reviewed. Patients with multisuture craniosynostosis, syndromic diagnoses, no preoperative ophthalmology evaluation, and less than 2 years of follow-up were excluded. Logistic regression was used to determine odds of preoperative and postoperative ophthalmologic abnormalities by age, while controlling for patient-level covariates. RESULTS One hundred seventy-two patients met inclusion criteria. The median age at surgery was 10 months (interquartile range, 7 to 12.9 months). Increasing age at the time of surgery was associated with increased odds of preoperative ophthalmologic diagnoses (OR, 1.06; p = 0.037) but not postoperative diagnoses (OR, 1.00; p = 0.91). Increasing age at surgery was also not associated with increased odds of ophthalmologic diagnoses, regardless of timing (OR, 1.04; p = 0.08). Patients with coronal synostosis (OR, 3.94; p = 0.036) had significantly higher odds of preoperative ophthalmologic diagnoses. Patients with metopic (OR, 5.60; p < 0.001) and coronal (OR, 7.13; p < 0.001) synostosis had significantly higher odds of postoperative ophthalmologic diagnoses. CONCLUSIONS After reviewing an expansive cohort, associations of both overall and postoperative ophthalmologic diagnoses with age at surgery were not found. The authors' findings thus run counter to the theory that early surgical intervention lessens the likelihood of postoperative ophthalmologic diagnoses and improves ophthalmologic outcomes. CLINICAL QUESTION/LEVEL OF EVIDENCE Risk, III.
Collapse
Affiliation(s)
- Katelyn G. Bennett
- Section of Plastic Surgery, Department of Surgery,
University of Michigan
| | - Alexis D. Vick
- University of Toledo School College of Medicine and Life
Sciences
| | | | | | | | | |
Collapse
|
21
|
van de Beeten SDC, Cornelissen MJ, van Seeters RM, van Veelen MLC, Versnel SL, Loudon SE, Mathijssen IMJ. Papilledema in unicoronal synostosis: a rare finding. J Neurosurg Pediatr 2019; 24:139-144. [PMID: 31100720 DOI: 10.3171/2019.3.peds18624] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 03/22/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Unicoronal synostosis results in frontal plagiocephaly and is preferably treated before the patient is 1 year of age to prevent intracranial hypertension (ICH). However, data on the prevalence of ICH in these patients is currently lacking. This study aimed to establish the prevalence of preoperative and postoperative signs of ICH in a large cohort of patients with unicoronal synostosis and to test whether there is a correlation between papilledema and occipitofrontal head circumference (OFC) curve stagnation in unicoronal synostosis. METHODS The authors included all patients with unicoronal synostosis treated before 2 years of age at a single center between 2003 and 2013. The presence of ICH was evaluated by routine fundoscopy. The OFC growth curve was analyzed for deflection and in relationship to signs of ICH. RESULTS In total, 104 patients were included in this study, 84 (81%) of whom were considered to have nonsyndromic unicoronal synostosis. Preoperatively, none of the patients had papilledema as determined by fundoscopy (mean age at surgery 11 months). Postoperatively, 5% of patients with syndromic synostosis and 3% of those with nonsyndromic synostosis had papilledema, and this was confirmed by optical coherence tomography. Raised intracranial pressure was confirmed in 1 patient with syndromic unicoronal synostosis. Six of 78 patients had OFC stagnation, which was not significantly correlated to papilledema (p = 0.22). One child with syndromic unicoronal synostosis required repeated surgery for ICH (0.96%). CONCLUSIONS Papilledema was not found in patients with unicoronal synostosis when they underwent surgery before the age of 1 year and was also very rare during follow-up. There was no relationship between papilledema and OFC stagnation.
Collapse
Affiliation(s)
| | | | | | | | | | - Sjoukje E Loudon
- 3Ophthalmology, Sophia Children's Hospital, Erasmus University Medical Center, Rotterdam, The Netherlands
| | | |
Collapse
|
22
|
|
23
|
Short- and Long-Term Outcomes by Procedure Type for Nonsagittal Single-Suture Craniosynostosis. J Craniofac Surg 2019; 30:458-464. [PMID: 30640851 DOI: 10.1097/scs.0000000000005129] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Minimally invasive approaches for the treatment of single-suture craniosynostosis are sometimes touted as equivalent to cranial vault reconstruction. While techniques for sagittal synostosis have been reviewed previously, evidence regarding open and less invasive surgical techniques for metopic, coronal, and lambdoid synostosis has yet to be reviewed. METHODS Systematic searches were performed using Embase.com and PubMed. Included studies reported short- or long-term outcomes, compared at least 2 standard techniques, discussed single-suture coronal, metopic, or lambdoid craniosynostosis, and enrolled at least 20 study participants. Two authors screened titles and abstracts, and also performed full text review and data extraction. Given heterogeneous outcomes, qualitative synthesis was performed after data extraction. RESULTS The search strategy yielded 2348 articles. Of these, 313 were removed as duplicates, and 1935 were excluded during title/abstract review. After full text review of 100 articles, 19 were selected for data extraction. The heterogeneity of outcomes precluded meta-analysis and required qualitative synthesis. While short-term outcomes indicated decreased morbidity of minimally invasive techniques, only 2 articles presented long-term reoperation rates. One study reported higher reoperation rates in the less invasive technique, and the second reported no reoperations in the median follow-up period of 33 months. CONCLUSION Studies comparing long-term outcomes between different surgical techniques for single-suture craniosynostosis remain deficient. The development of standardized outcome measures is essential, and prospective, multicenter studies are necessary to assess the long-term efficacy of these procedures.
Collapse
|
24
|
Postoperative Changes in Orbital Dysmorphology in Patients With Unicoronal Synostosis. J Craniofac Surg 2019; 30:483-488. [DOI: 10.1097/scs.0000000000005169] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
25
|
|
26
|
Yan H, Abel TJ, Alotaibi NM, Anderson M, Niazi TN, Weil AG, Fallah A, Phillips JH, Forrest CR, Kulkarni AV, Drake JM, Ibrahim GM. A systematic review of endoscopic versus open treatment of craniosynostosis. Part 2: the nonsagittal single sutures. J Neurosurg Pediatr 2018; 22:361-368. [PMID: 29979132 DOI: 10.3171/2018.4.peds17730] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Despite increasing adoption of endoscopic techniques for repair of nonsagittal single-suture craniosynostosis, the efficacy and safety of the procedure relative to established open approaches are unknown. In this systematic review the authors aimed to directly compare open surgical and endoscope-assisted techniques for the treatment of metopic, unilateral coronal, and lambdoid craniosynostosis, with an emphasis on quantitative reported outcomes. METHODS A literature search was performed in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Relevant articles were identified from 3 electronic databases (MEDLINE, EMBASE, and CENTRAL [Cochrane Central Register of Controlled Trials]) from their inception to August 2017. The quality of methodology and bias risk were assessed using the Effective Public Health Practice Project (EPHPP) Quality Assessment Tool for Quantitative Studies. RESULTS Of 316 screened records, 7 studies were included in a qualitative synthesis of the evidence, of which none were eligible for meta-analysis. These reported on 111 unique patients with metopic, 65 with unilateral coronal, and 12 with lambdoid craniosynostosis. For all suture types, 100 (53%) children underwent endoscope-assisted craniosynostosis surgery and 32 (47%) patients underwent open repair. These studies all suggest that blood loss, transfusion rate, operating time, and length of hospital stay were superior for endoscopically treated children. Although potentially comparable or better cosmetic outcomes are reported, the paucity of evidence and considerable variability in outcomes preclude meaningful conclusions. CONCLUSIONS Limited data comparing open and endoscopic treatments for metopic, unilateral coronal, and lambdoid synostosis suggest a benefit for endoscopic techniques with respect to blood loss, transfusion, length of stay, and operating time. This report highlights shortcomings in evidence and gaps in knowledge regarding endoscopic repair of nonsagittal single-suture craniosynostosis, emphasizing the need for further matched-control studies.
Collapse
Affiliation(s)
- Han Yan
- 1Division of Neurosurgery, Department of Surgery, University of Toronto
| | - Taylor J Abel
- 2Division of Neurosurgery, The Hospital for Sick Children, Toronto
| | - Naif M Alotaibi
- 1Division of Neurosurgery, Department of Surgery, University of Toronto
| | - Melanie Anderson
- 3Library and Information Services, University Health Network, University of Toronto, Ontario, Canada
| | - Toba N Niazi
- 4Division of Neurosurgery, Nicklaus Children's Hospital, University of Miami Miller School of Medicine, Miami, Florida
| | - Alexander G Weil
- 5Division of Neurosurgery, CCHU-Ste-Justine Children's, Montreal, Quebec, Canada
| | - Aria Fallah
- 6Department of Neurosurgery, Mattel Children's Hospital, David Geffen School of Medicine at University of California Los Angeles, California; and
| | - John H Phillips
- 7Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto, Ontario, Canada
| | - Christopher R Forrest
- 7Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto, Ontario, Canada
| | - Abhaya V Kulkarni
- 1Division of Neurosurgery, Department of Surgery, University of Toronto.,2Division of Neurosurgery, The Hospital for Sick Children, Toronto
| | - James M Drake
- 1Division of Neurosurgery, Department of Surgery, University of Toronto.,2Division of Neurosurgery, The Hospital for Sick Children, Toronto
| | - George M Ibrahim
- 1Division of Neurosurgery, Department of Surgery, University of Toronto.,2Division of Neurosurgery, The Hospital for Sick Children, Toronto
| |
Collapse
|
27
|
Dalle Ore CL, Dilip M, Brandel MG, McIntyre JK, Hoshide R, Calayag M, Gosman AA, Cohen SR, Meltzer HS. Endoscopic surgery for nonsyndromic craniosynostosis: a 16-year single-center experience. J Neurosurg Pediatr 2018; 22:335-343. [PMID: 29979128 DOI: 10.3171/2018.2.peds17364] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE In this paper the authors review their 16-year single-institution consecutive patient experience in the endoscopic treatment of nonsyndromic craniosynostosis with an emphasis on careful review of any associated treatment-related complications and methods of complication avoidance, including preoperative planning, intraoperative management, and postoperative care and follow-up. METHODS A retrospective chart review was conducted on all patients undergoing endoscopic, minimally invasive surgery for nonsyndromic craniosynostosis at Rady Children's Hospital from 2000 to 2015. All patients were operated on by a single neurosurgeon in collaboration with two plastic and reconstructive surgeons as part of the institution's craniofacial team. RESULTS Two hundred thirty-five patients underwent minimally invasive endoscopic surgery for nonsyndromic craniosynostosis from 2000 to 2015. The median age at surgery was 3.8 months. The median operative and anesthesia times were 55 and 105 minutes, respectively. The median estimated blood loss (EBL) was 25 ml (median percentage EBL 4.2%). There were no identified episodes of air embolism or operative deaths. One patient suffered an intraoperative sagittal sinus injury, 2 patients underwent intraoperative conversion of planned endoscopic to open procedures, 1 patient experienced a dural tear, and 1 patient had an immediate reexploration for a developing subgaleal hematoma. Two hundred twenty-five patients (96%) were admitted directly to the standard surgical ward where the median length of stay was 1 day. Eight patients were admitted to the intensive care unit (ICU) postoperatively, 7 of whom had preexisting medical conditions that the team had identified preoperatively as necessitating a planned ICU admission. The 30-day readmission rate was 1.7% (4 patients), only 1 of whom had a diagnosis (surgical site infection) related to their initial admission. Average length of follow-up was 2.8 years (range < 1 year to 13.4 years). Six children (< 3%) had subsequent open procedures for perceived suboptimal aesthetic results, 4 of whom (> 66%) had either coronal or metopic craniosynostosis. No patient in this series either presented with or subsequently developed signs or symptoms of intracranial hypertension. CONCLUSIONS In this large single-center consecutive patient series in the endoscopic treatment of nonsyndromic craniosynostosis, significant complications were avoided, allowing for postoperative care for the vast majority of infants on a standard surgical ward. No deaths, catastrophic postoperative morbidity, or evidence of the development of symptomatic intracranial hypertension was observed.
Collapse
Affiliation(s)
| | - Monisha Dilip
- 1Department of Neurosurgery, University of California San Diego; and
| | - Michael G Brandel
- 1Department of Neurosurgery, University of California San Diego; and
| | | | - Reid Hoshide
- 1Department of Neurosurgery, University of California San Diego; and
| | - Mark Calayag
- 3Pediatric Neurosurgery, Rady Children's Hospital San Diego, California
| | | | | | - Hal S Meltzer
- 1Department of Neurosurgery, University of California San Diego; and.,3Pediatric Neurosurgery, Rady Children's Hospital San Diego, California
| |
Collapse
|
28
|
Yan H, Abel TJ, Alotaibi NM, Anderson M, Niazi TN, Weil AG, Fallah A, Phillips JH, Forrest CR, Kulkarni AV, Drake JM, Ibrahim GM. A systematic review and meta-analysis of endoscopic versus open treatment of craniosynostosis. Part 1: the sagittal suture. J Neurosurg Pediatr 2018; 22:352-360. [PMID: 29979135 DOI: 10.3171/2018.4.peds17729] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE In this systematic review and meta-analysis the authors aimed to directly compare open surgical and endoscope-assisted techniques for the treatment of sagittal craniosynostosis, focusing on the outcomes of blood loss, transfusion rate, length of stay, operating time, complication rate, cost, and cosmetic outcome. METHODS A literature search was performed in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Relevant articles were identified from 3 electronic databases (MEDLINE, EMBASE, and CENTRAL [Cochrane Central Register of Controlled Trials]) from their inception to August 2017. The quality of methodology and bias risk were assessed using the Effective Public Health Practice Project Quality Assessment Tool for Quantitative Studies. Effect estimates between groups were calculated as standardized mean differences with 95% CIs. Random and fixed effects models were used to estimate the overall effect. RESULTS Of 316 screened records, 10 met the inclusion criteria, of which 3 were included in the meta-analysis. These studies reported on 303 patients treated endoscopically and 385 patients treated with open surgery. Endoscopic surgery was associated with lower estimated blood loss (p < 0.001), shorter length of stay (p < 0.001), and shorter operating time (p < 0.001). From the literature review of the 10 studies, transfusion rates for endoscopic procedures were consistently lower, with significant differences in 4 of 6 studies; the cost was lower, with differences ranging from $11,603 to $31,744 in 3 of 3 studies; and the cosmetic outcomes were equivocal (p > 0.05) in 3 of 3 studies. Finally, endoscopic techniques demonstrated complication rates similar to or lower than those of open surgery in 8 of 8 studies. CONCLUSIONS Endoscopic procedures are associated with lower estimated blood loss, operating time, and days in hospital. Future long-term prospective registries may establish advantages with respect to complications and cost, with equivalent cosmetic outcomes. Larger studies evaluating patient- or parent-reported satisfaction and optimal timing of intervention as well as heterogeneity in outcomes are indicated.
Collapse
Affiliation(s)
- Han Yan
- 1Division of Neurosurgery, Department of Surgery, University of Toronto
| | - Taylor J Abel
- 2Division of Neurosurgery, The Hospital for Sick Children, Toronto
| | - Naif M Alotaibi
- 1Division of Neurosurgery, Department of Surgery, University of Toronto
| | - Melanie Anderson
- 3Library and Information Services, University Health Network, University of Toronto, Ontario, Canada
| | - Toba N Niazi
- 4Division of Neurosurgery, Nicklaus Children's Hospital, University of Miami Miller School of Medicine, Miami, Florida
| | - Alexander G Weil
- 5Division of Neurosurgery, CCHU-Ste-Justine Children's, Montreal, Quebec, Canada
| | - Aria Fallah
- 6Department of Neurosurgery, Mattel Children's Hospital, David Geffen School of Medicine at University of California Los Angeles, California; and
| | - John H Phillips
- 7Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto, Ontario, Canada
| | - Christopher R Forrest
- 7Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto, Ontario, Canada
| | - Abhaya V Kulkarni
- 1Division of Neurosurgery, Department of Surgery, University of Toronto.,2Division of Neurosurgery, The Hospital for Sick Children, Toronto
| | - James M Drake
- 1Division of Neurosurgery, Department of Surgery, University of Toronto.,2Division of Neurosurgery, The Hospital for Sick Children, Toronto
| | - George M Ibrahim
- 1Division of Neurosurgery, Department of Surgery, University of Toronto.,2Division of Neurosurgery, The Hospital for Sick Children, Toronto
| |
Collapse
|
29
|
|
30
|
Pendharkar AV, Shahin MN, Cavallo C, Zhao X, Ho AL, Sussman ES, Grant GA. Minimally invasive approaches to craniosynostosis. J Neurosurg Sci 2018; 62:745-764. [PMID: 29790726 DOI: 10.23736/s0390-5616.18.04483-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Craniosynostosis (CS) is defined as the premature fusion of one or more calvarial sutures. This carries several consequences, including abnormal/asymmetric cranial vault development, increased intracranial pressure, compromised neurocognitive development, and craniofacial deformity. Definitive management is surgical with the goal of protecting cerebral development by re-establishing normal cranial vault expansion and correcting cosmetic deformity. In today's practice, CS surgery has advanced radically from simple craniectomies to major cranial vault reconstructive (CVR) procedures. More recently there has been considerable interest in endoscopic assisted surgery (EAS). Theoretical benefits include decreased operative time, morbidity, blood loss, postoperative pain, cost and faster recovery times. In this focused review, we summarize the current body of literature reporting clinical outcomes in EAS and review the data comparing EAS and CVR.
Collapse
Affiliation(s)
- Arjun V Pendharkar
- Division of Pediatric Neurosurgery, Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA -
| | - Maryam N Shahin
- Division of Pediatric Neurosurgery, Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Claudio Cavallo
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Xiaochun Zhao
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Allen L Ho
- Division of Pediatric Neurosurgery, Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Eric S Sussman
- Division of Pediatric Neurosurgery, Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Gerald A Grant
- Division of Pediatric Neurosurgery, Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA
| |
Collapse
|
31
|
Dagi LR, MacKinnon S, Zurakowski D, Prabhu SP. Rectus muscle excyclorotation and V-pattern strabismus: a quantitative appraisal of clinical relevance in syndromic craniosynostosis. Br J Ophthalmol 2017; 101:1560-1565. [DOI: 10.1136/bjophthalmol-2016-309996] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 01/24/2017] [Accepted: 02/25/2017] [Indexed: 11/04/2022]
|
32
|
Ophthalmologic Outcomes Following Fronto-Orbital Advancement for Unicoronal Craniosynostosis. J Craniofac Surg 2016; 27:1629-1635. [DOI: 10.1097/scs.0000000000003085] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
33
|
|
34
|
Long-Term Assessment of Suturectomy in Trigonocephaly and Anterior Plagiocephaly. J Craniofac Surg 2016; 27:627-30. [DOI: 10.1097/scs.0000000000002585] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
|
35
|
Wu A, Collins ME. Newer Understanding of Eye Issues in Craniofacial Malformations. CURRENT OPHTHALMOLOGY REPORTS 2015. [DOI: 10.1007/s40135-015-0084-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
36
|
The prevalence of strabismus in unilateral coronal synostosis. Childs Nerv Syst 2015; 31:589-96. [PMID: 25399319 DOI: 10.1007/s00381-014-2580-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Accepted: 10/27/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND While there is a clear correlation between unilateral coronal synostosis (UCS) and ocular motility abnormalities, the literature provides little information as to the true epidemiology of strabismus, or the underlying etiology of these paralleled pathologies. The purpose of this study is to investigate the rate of oculomotor abnormalities associated with UCS and its management. METHODS A retrospective review of all patients identified to have single-suture, nonsyndromic UCS treated by fronto-orbital advancement at a tertiary craniofacial referral center from 1977 to 2013 was performed. Inclusion criteria mandated complete medical, surgical, and ophthalmological records. Patients were evaluated for strabismus both preoperatively and postoperatively, and as to whether eye muscle surgery was performed. RESULTS A total of 181 patients underwent treatment for UCS at our institution during the study period, of which 79 met the inclusion criteria. Twenty-nine patients had strabismus prior to any craniofacial surgical intervention. Following fronto-orbital advancement, 23 patients (46 %) developed a new onset strabismus. Fifty-five patients had no change in their preoperative ocular examination, and one patient had resolution of preoperative strabismus. Of the 51 patients who had postoperative strabismus, 30 went on to have eye muscle surgery. There were no statistically significant differences in gender (p=0.477), race (p=0.395), sidedness of suture involvement (p=0.552), or age at intervention (p=0.66) in comparing the group with new postoperative strabismus and those without. CONCLUSIONS This study sheds new light on the prevalence of strabismus in UCS, and more importantly, the risk of developing strabismus in the setting of conventional fronto-orbital advancement. This data will allow more accurate preoperative counseling and reinforces the important role of ophthalmologists as members of the multidisciplinary craniofacial team.
Collapse
|
37
|
Abstract
INTRODUCTION Craniosynostosis is a rare condition that affects approximately one child in every 2,000 live births, and involves pathological fusion of two or more skull bones. Consequences of craniosynostosis include possible limitation of brain growth and cosmetic effects on the appearance of the child. Traditional repairs for these conditions over the past 3-4 decades have involved an open operation with a large skin incision and major manipulations of the skull bones. More recently, minimally invasive endoscopic techniques have been developed to release the skull bones, followed by postoperative treatment with either an external orthosis or internal springs and distractors to achieve the desired correction. METHODS In this review minimally invasive endoscopic repair will be reviewed. A general overview of the condition and techniques for correction will be discussed, followed by specific application of these surgeries for different craniosynostosis diagnoses. Attention to the subtleties of each specific condition will be highlighted. SUMMARY Over the past two decades clinical experience and a large number of publications have substantiated the benefits of minimally invasive endoscopic techniques for the treatment of craniosynostosis. These techniques have clear benefits for selected patients, and should be part of the standard of care for this condition at craniofacial centers.
Collapse
Affiliation(s)
- Mark R Proctor
- Department of Neurosurgery, Children's Hospital Boston, Harvard Medical School, Boston, MA 02115, USA
| |
Collapse
|
38
|
Craniectomy Gap Patency and Neosuture Formation following Endoscopic Suturectomy for Unilateral Coronal Craniosynostosis. Plast Reconstr Surg 2014; 134:81e-91e. [DOI: 10.1097/prs.0000000000000285] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
39
|
Meier PM, Guzman R, Erb TO. Endoscopic pediatric neurosurgery: implications for anesthesia. Paediatr Anaesth 2014; 24:668-77. [PMID: 24725264 DOI: 10.1111/pan.12405] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/11/2014] [Indexed: 11/30/2022]
Abstract
Endoscopic surgery is increasingly utilized in neurosurgery for all pediatric age groups. Endoscopic intraventricular neurosurgery represents a unique approach to intracranial pathology but may cause a unique set of limitations and potential complications. Important endoscopic neurosurgical techniques and their indications, perioperative anesthesia management, complications, and success rates are reviewed with special emphasis on endoscopic third ventriculostomy and endoscopic-assisted strip craniectomy in early infancy. Despite encouraging short- and long-term results of early pediatric endoscopic neurosurgery, multicenter randomized studies will be needed to further determine safety and the effect on cognitive development and quality of life.
Collapse
Affiliation(s)
- Petra M Meier
- Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | | | | |
Collapse
|