Morphological and surgical results in sagittal synostosis: early craniectomy versus later cranioplasty

Background and purpose Morphological correction is one of the main aims of surgery for sagittal synostosis (SSO). Different surgical techniques have been developed; however, few studies have compared the different surgical protocols. The morphological outcome is poorly documented, because a consensu...

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Bibliographic Details
Published in:Child's nervous system 2021-07, Vol.37 (7), p.2335-2341
Main Authors: Vinchon, Matthieu, Guerreschi, Pierre, Karnoub, Melodie-Anne, Wolber, Alexis
Format: Article
Language:English
Subjects:
Life Sciences
Medicine
Medicine & Public Health
Neurosciences
Neurosurgery
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Summary:Background and purpose Morphological correction is one of the main aims of surgery for sagittal synostosis (SSO). Different surgical techniques have been developed; however, few studies have compared the different surgical protocols. The morphological outcome is poorly documented, because a consensual evaluation tool is lacking. Material and methods We performed a prospective study of children operated for SSO in our institution. Children were operated whenever possible at 4 months for craniectomy; by default, children underwent cranioplasty at or after 9 months. The morphological outcome of all children was evaluated using traditional craniometry with head circumference (HC) and the cephalic index (CI), and with the Rotterdam scaphocephaly morphology score (RSMS), a total of semi-quantitative assessments of morphological hallmarks. Results Craniectomy was significantly associated with a shorter operation time and hospital stay, and a better impact on HC and CI measurements, compared with cranioplasty. The RSMS was markedly improved after surgery in both groups; however, we found no significant difference in improvement between the two groups. Although the transfusion rate and the prevalence of developmental delay were lower in the craniectomy group, and reoperations for calvarial lacunae or complex craniosynostosis occurred only this group, these differences were not significant. Conclusions Our results support early surgery with craniectomy whenever possible; however, cranioplasty at a later age is a very acceptable by-default indication. In addition to classical craniometry, morphological evaluation using the RSMS or a similar quantitative scale appears highly desirable for future studies
ISSN:0256-7040
1433-0350
DOI:10.1007/s00381-021-05178-9