Long-term follow-up of dynamic cranioplasty for brachycephaly--non-syndromal bicoronal synostosis

Posterior cranial vault expansion in the treatment of craniosynostosis. Comparison of current techniques

INTRODUCTION

Surgical procedures which aim at expanding the posterior cranial vault have come to play an increasingly important role in the treatment of syndromic craniosynostosis. The posterior cranial vault may be expanded by formal cranioplasty or by less invasive methods based on gradual posterior cranial vault expansion or distraction. These procedures share the common goals to prevent intracranial hypertension and progression toward turricephaly by effectively increasing the intracranial volume. They also reduce any local brain compression within the posterior cranial fossa.

PATIENTS AND METHODS

This review describes the various techniques available for less invasive and gradual posterior cranial vault expansion and their rationale based on our experience on the last 40 cases. Volumetric data for three different surgical techniques have been compared (two cases of posterior cranial vault expansion by free-floating parieto-occipital bone flap, two with springs, and two with internal distractors). The volumetric analysis showed an expansion of 13 and 24 % for the free posterior flap, 18 and 25 % for the translambdoid springs, and 22 and 29 % for the distractors.

DISCUSSION

Although these figures are not strictly comparable, our data suggest that these three techniques offer a potential for a significant increase in skull volume. The indications for such procedures must, however, be tailored according to the age and condition of the single patient.

Maternal reports of satisfaction with care and outcomes for children with craniosynostosis

Craniosynostosis is a congenital deformity caused by premature fusion of cranial suture(s). Surgical outcomes of craniosynostosis have been well documented; however, limited published data are available regarding access to care and social and psychological health outcomes for children with craniosynostosis. The authors conducted a population-based, multistate study of maternal perceptions of care and outcomes for children with craniosynostosis born from January 1998 through December 2003. Mothers of 147 children were contacted and asked to complete a structured telephone interview; 82 mothers (55.8%) participated. Overall, the mean ages of children and their mothers at the time of interview were 4.4 and 34.8 years, respectively. Mothers interviewed tended to be white and, at a minimum, high school graduates. Most mothers reported being satisfied with the craniosynostosis-related information and support provided by medical care providers, and access to primary and specialty care was most often rated as satisfactory. Mothers tended to report the physical health of their child to be good; however, delays in cognitive and emotional development, hearing loss, and speech problems were identified. In addition, statistically significant differences among mothers in each state were noted for reports of the quality of team care, primary care, learning interventions, and perceived need for additional surgeries. These results suggest some limitations in craniosynostosis-related care and provide guidance to medical and surgical care providers in making need-based improvements in craniosynostosis surgery and care. Future studies are recommended to replicate this evaluation in additional populations.

Modeling of Scaphocephaly Using Superelastic Titanium-Nickel Rings: A Preliminary Report

As long as resection of sagittal suture eliminates craniostenosis it leads to desired cranium broadening and shortening solely in the case of children under six months of age. In the majority of cases, especially in older children, boat-shaped cranium remains rather unchanged and its effective modeling requires extensive dissection and osteotomy of the whole cranium vault (e.g., frontal, occipital and parietal bones). Lauritzen's method is an alternative solution. It consists of distraction of cranium vault bones with the aid of steel springs. In order to simplify and improve the efficacy of treatment since 2002, the authors originated the application of titanium-nickel rings to model the cranium. After the sparing excision of cranium vault sutures in the shape of letter "H" the compressed ring is given in the sagittal axis oval shape and in this form it is fixed to osseous margins. The ring's expansion at the same time broadens and shortens the cranium vault. Material was analyzed from 7 children (range, 9 months to 4 years of age), who were treated in the years 2002-2006 because of sagittal craniostenosis. Observations made so far and good treatment results indicate purposefulness of discussed treatment continuation.

Advances in Craniosynostosis Research and Management

The purpose of the present paper is to analyze the most recent advances in the field of craniosynostosis basic and clinical research and management, and to give an overview of the more frequently adopted surgical strategies. After reviewing some basic concepts regarding normal craniofacial embryology and growth, aetiopathogenesis of craniosynostosis and craniofacial dysostosis, classification and diagnosis and historical evolution of surgical treatment, the authors elaborate on a selection of topics that have modified our current understanding of and therapeutical approach to these disease processes. Areas covered include advances in molecular biology and genetics, imaging techniques and surgical planning, resorbable fixation technology, bone substitutes and tissue engineering, distraction osteogenesis and the spring-mediated cranioplasties, resorbable distractor devices, minimally invasive surgery and in utero surgery. A review of the main subtypes of craniosynostosis and craniofacial dysostosis is presented, including their specific clinical features and a commentary on the presently available surgical options.