Results of early surgery for sagittal suture synostosis: long-term follow-up and the occurrence of raised intracranial pressure.

Abstract

PURPOSE:

Numerous techniques are used to correct sagittal synostosis. Although cosmetic results and operative complications are well documented, little is known about functional outcome. In our institution, the technique for extended strip craniectomy evolved over time. This study compares cosmetic results, complications, and signs of raised intracranial pressure (ICP) between the variants of the extended strip craniectomy.

METHODS:

Seventy-nine consecutive patients undergoing early extended strip craniectomy for scaphocephaly (2002-2008) were included. Four techniques were used: A, a simple bilateral parietal flap with out-fracturing of the bone flap; B, C, and D included remodeling of the parietal flap by adding triangular cuts and bending or suturing the resulting fingers. In technique D, the sagittal strip was rotated and fixed between the parietal flaps. Data on head circumference (HC), skull X-ray, and fundoscopy were collected prospectively.

RESULTS:

For all patients, the average cranial index (CI) was 74 after 3 months and 72 after 2 years. Although technique D resulted in the best initial improvement, there was no significant percentage increase in CI after 24 months between the four techniques. Postoperatively, 9 % of the patients developed papilledema, 42 % developed a fontanel bulge, and 57 % had diminished HC. Four patients were reoperated on because of raised ICP.

CONCLUSIONS:

Postoperative CI is mainly determined by preoperative CI and hardly affected by type of extended strip craniectomy. Signs of raised ICP occurred more frequently than expected, therefore structural follow-up is required to detect such signs. Technique and timing of surgery should aim at creating sufficient intracranial volume.

• Authors: Marie-Lise C van Veelen, Oscar H J Eelkman Rooda, Tim de Jong, Ruben Dammers, Leon N A van Adrichem, Irene M J Mathijssen
• Journal: Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery (Childs Nerv Syst) Vol. 29 Issue 6 Pg. 997-1005 (Jun 2013) ISSN: 1433-0350 [Electronic] Germany
• PMID: 23334575 (Publication Type: Journal Article)

Topics

• Child
• Child, Preschool
• Cranial Sutures (surgery)
• Craniosynostoses (surgery)
• Craniotomy (adverse effects)
• Female
• Humans
• Intracranial Hypertension (etiology)
• Longitudinal Studies
• Male
• Postoperative Complications (physiopathology)
• Retrospective Studies
• Time Factors
• Tomography, X-Ray Computed