Dynamic skull reshaping for sagittal craniosynostosis

Abstract

Objectives: The present investigation was aimed at expanding the knowledge base regarding the skull morphology in sagittal craniosynostosis and at assessing the safety and efficacy of two dynamic cranioplasty procedures, the modified pi-plasty procedure and the spring-mediated cranioplasty. Methods: The patient population consisted of children with non-syndromic sagittal craniosynostosis. (I) A group of 105 unoperated patients was studied with a com-puterized method of comprehensive cephalometric analysis. A control group of 72 children with unilateral incomplete cleft lip was used. (II) One hundred and ten patients operated on with the modified pi-plasty procedure were evaluated in terms of transfusion re-quirements and complications. Objective cephalometric outcome measures were used. The radiographic digital markings were studied. A parental questionnaire was used as a subjective aesthetical outcome assessment. (III) Eighty-two patients op-erated on with the modified pi-plasty procedure were analyzed longitudinally with the method of cephalometric analysis mentioned above. A control group of 45 chil-dren with unilateral incomplete cleft lip was used. (IV) Ten patients operated on with the spring-mediated cranioplasty were analyzed and compared to a control group of ten children operated on with the modified pi-plasty procedure. Periopera-tive variables, cephalometric outcome measures, and parental subjective esthetical outcome assessment were studied.Results: The calvarial shape in sagittal craniosynostosis differed significantly from the control, both in the lateral and in the frontal views. The following variables were significantly different: skull length (larger), width (smaller), and interorbital distance (larger). Transfusion requirements and hospital stay were significantly lower with the spring-mediated cranioplasty. Only minor complications were registered with the modified pi-plasty procedure and none in the spring procedure group. Both techniques produced significant objective changes to-wards normality in the study variables (with a greater change of the height ratio in the spring-mediated group, and lower mean transfusion requirement and hospitalization time), as well as a high degree of parental sat-isfaction. Conclusions: Sagittal synostosis was characterized by an extensive cranial vault deformity, with an essentially normal cranial base, and a widened interorbital dis-tance. Both the modified pi-plasty procedure and the spring-mediated cranioplasty were found to be safe and effective. The spring-mediated procedure was morphologically more effective than the modified pi-plasty procedure, with the additional benefit of a lower mean transfusion requirement and hospitalization time.