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Cranial synostosis

Lisa M Morris
This article provides an overview of etiology, epidemiology, pathology, diagnosis, and treatment of nonsyndromic craniosynostosis, including sagittal, metopic, coronal, lambdoid, and complex synostosis. Detailed discussion is presented regarding indications for surgical intervention and management options, including frontoorbital advancement, cranial vault reconstruction, endoscopic strip craniectomy, spring-assisted strip craniectomy, and cranial vault distraction osteogenesis. Deformational plagiocephaly is also presented with treatment options including repositioning, physical therapy, and helmet therapy...
November 2016: Facial Plastic Surgery Clinics of North America
Jordan W Swanson, Jacqueline A Haas, Brianne T Mitchell, Philip B Storm, Scott P Bartlett, Gregory G Heuer, Jesse A Taylor
There is no clear consensus for the optimal treatment of sagittal craniosynostosis; however, recent studies suggest that improved neurocognitive outcomes may be obtained when surgical intervention imparts active cranial expansion or remodeling and is performed before 6 months of age. The authors consider spring-mediated cranioplasty (SMC) to optimally address these imperatives, and this is an investigation of how helmet orthoses before or after SMC affect aesthetic outcomes.The authors retrospectively evaluated patients treated with SMC and adjunct helmeting for sagittal synostosis...
September 2016: Journal of Craniofacial Surgery
Jan-Falco Wilbrand, Hans-Peter Howaldt, Marcus Reinges, Petros Christophis
OBJECTIVE: Premature craniosynostosis of the lambdoid suture is rare. The use of differential diagnosis to rule out positional occipital plagiocephaly is crucial. Nevertheless, once diagnosed, lambdoid craniosynostosis requires corrective surgery to prevent intracranial harm and aesthetic stigma by significant dyscrania. Operative correction of the lambdoid fusion is often performed by suturectomy and helmet therapy, total occipital remodeling interventions, transposition of occipital bone flaps, or occipital advancement procedures either with or without distraction osteogenesis...
August 6, 2016: Journal of Cranio-maxillo-facial Surgery
Marie-Lise C van Veelen, Marielle Jippes, Julius-Carl A Carolina, Johan de Rooi, Clemens M F Dirven, Leon N A van Adrichem, Irene M Mathijssen
BACKGROUND: Surgery for sagittal synostosis aims at correction of skull shape and restoration of growth potential. Small cranial volume is associated with raised intracranial pressure (ICP). Although many techniques have been described, information on postoperative volume related to early and late remodeling is lacking. METHODS: Between 2004 and 2008, a total of 95 patients were collected who underwent either early extended strip craniectomy or late total cranial remodeling according to age of presentation...
August 9, 2016: Journal of Cranio-maxillo-facial Surgery
Jonathan Pindrik, Joseph Molenda, Rafael Uribe-Cardenas, Amir H Dorafshar, Edward S Ahn
OBJECTIVE Subjective evaluations typically guide craniosynostosis repair. This study provides normative values of anthropometric cranial indices that are clinically useful for the evaluation of multiple types of craniosynostosis and introduces 2 new indices that are useful in the evaluation and management of metopic and bicoronal synostosis. The authors hypothesize that normative values of the new indices as well as for established measures like the cephalic index can be drawn from the evaluation of CT scans of normal individuals...
September 2, 2016: Journal of Neurosurgery. Pediatrics
David T Martin, Heike Gries, Nick Esmonde, Brian Diggs, Jeffrey Koh, Nathan R Selden, Martin Schreiber, Anna A Kuang
OBJECTIVE: Pediatric cranial vault remodeling for repair of craniosynostosis is associated with significant blood loss and transfusion requirements. Beginning in 2011, the authors evaluated the impact tranexamic acid (TXA) on blood loss and blood product transfusion for children less than 15 months of age undergoing primary surgical repair of nonsyndromic single suture craniosynostosis. METHODS: Following institutional review board approval, the authors performed a retrospective study of all children undergoing surgical correction of craniosynostosis at Oregon Health & Science University from 2005 to 2015...
September 2016: Journal of Craniofacial Surgery
Odelya Perets, Zvi Howard Perry, Lior Rosenberg, Eldad Silberstein, Reuben Gurphinkel, Avi Cohen
BACKGROUND: Craniosynostosis, the premature fusion of one or more of the cranial sutures, can occur as a part of a syndrome or as an isolated deformity. When not treated properly it may have major physical and social implications. STUDY HYPOTHESIS: We assumed that our center's results are similar to those reported in the literature, in terms of gender and anatomic characteristics, and different in terms of the number of syndromic cases. We also assume that only a few patients needed a second surgery and that this medical problem effects quality of life in term of cognitive impairment and aesthetic results...
May 2016: Harefuah
Dana Johns, Erin Anstadt, Daniel Donato, John Kestle, Jay Riva-Cambrin, Faizi Siddiqi, Barbu Gociman
Posterior cranial vault distraction (PCVD) has become an important modality in the management of complex craniosynostosis to increase intracranial volume and improve the cranial vault appearance. This technique can safely be performed as early as 3 months of age for the initial management of patients with complex craniosynostosis. A retrospective review was performed of all the patients with syndromic, multiple-suture synostosis treated with PCVD at Primary Children's Hospital in Salt Lake City, Utah, between 2012 and 2014...
September 2016: Craniomaxillofacial Trauma & Reconstruction
Alexander R Graf, Kristen A Klement, Arlen D Denny
Frontal orbital advancement (FOA) for metopic synostosis results in cranial vault expansion, supporting underlying growth of the developing brain and improving head shape. Previous studies have shown that FOA in younger infants leads to a greater incidence of long-term growth restriction of intracranial volume; however, it is still unknown as to whether this is due to undercorrection at the time of surgery versus primary suture pathology. The purpose of our study is to provide a method for objective analyses of intracranial volumes in the early post-FOA period...
October 2016: Journal of Craniofacial Surgery
Mark P Mooney, Jocelyn M Shand, Anne Burrows, Timothy D Smith, John F Caccamese, Gregory M Cooper, James J Cray, James Gilbert, Bernard J Costello, Joseph E Losee, Amr M Moursi, Michael I Siegel
OBJECTIVES:   An overexpression of Tgf-β2 leads to calvarial hyperostosis and suture fusion in individuals with craniosynostosis. Inhibition of Tgf-β2 may help rescue fusing sutures and restore normal growth. The present study was designed to test this hypothesis. DESIGN:   Twenty-eight New Zealand White rabbits with delayed-onset coronal synostosis had radiopaque markers placed on either side of the coronal sutures at 10 days of age. The rabbits were randomly assigned to: (1) sham control rabbits (n = 10), (2) rabbits with control IgG (100 μg/suture) delivered in a collagen vehicle (n = 9), and (3) rabbits with Tgf-β2 neutralizing antibody (100 μg/suture) delivered in a collagen vehicle (n = 9)...
August 9, 2016: Cleft Palate-craniofacial Journal
Martijn Cornelissen, Bianca den Ottelander, Dimitris Rizopoulos, René van der Hulst, Aebele Mink van der Molen, Chantal van der Horst, Hans Delye, Marie-Lise van Veelen, Gouke Bonsel, Irene Mathijssen
INTRODUCTION: Craniosynostosis represents premature closure of cranial sutures. Prevalence is approximately 3.1-6.4 in 10.000 live births, which is reportedly rising. This epidemiologic study aims to provide insight into this rise through an accurate description of the prevalence, exploring regional variation and change over time. METHODS: The Dutch Association for Cleft Palate and Craniofacial Anomalies was consulted to identify patients with craniosynostosis born between 2008 and 2013...
September 2016: Journal of Cranio-maxillo-facial Surgery
Y Bennis, A Wolber, M Vinchon, A Belkhou, V Duquennoy-Martinot, P Guerreschi
Craniosynostosis are rare congenital malformations of the skull resulting from the premature fusion of one or several cranial sutures. Prevalence is considered in approximately 1 on 2000 births. Non syndromic craniosynostosis (NSC) or isolated form are the most frequent forms (85 % of the cases). They are classified most of the time according to the synostotic suture(s) and the engendered cranial deformation: sagittal synostosis or scaphocephaly, metopic synostosis or trigonocephaly, bicoronal synostosis or brachycephaly, coronal synostosis or plagiocephaly and oxycephaly...
October 2016: Annales de Chirurgie Plastique et Esthétique
Francesco Giovanni Sgulò, Pietro Spennato, Ferdinando Aliberti, Giuliana Di Martino, Daniele Cascone, Giuseppe Cinalli
Chiari malformation type I (CM-I) and hydrocephalus are often associated with complex craniosynostosis. On the contrary, their simultaneous occurrence in monosutural synostosis is extremely rare. The pathophysiological hypothesis is that they may alter posterior fossa growth and lead to cerebellar tonsil herniation also without skull base primary involvement. Hydrocephalus is multifactorial and may be secondary to fourth ventricle outlet obstruction. The management of these cases is quite complex and not well defined...
July 22, 2016: Child's Nervous System: ChNS: Official Journal of the International Society for Pediatric Neurosurgery
Karen A Eley, Gregory P L Thomas, Fintan Sheerin, Deirdre Cilliers, Steven Wall, David Johnson
The squamosal suture is one of the lateral minor skull sutures, separating the parietal and squamous temporal bones. While the phenotypic appearances and sequelae of synostosis of the major cranial vault sutures are well documented, little is reported concerning synostosis of the squamosal suture (SQS). The aim of this study was to determine the frequency of squamosal suture synostosis, and to document the significance of this entity.A retrospective review of the diagnostic imaging for all new pediatric patients (aged ≤16 years) referred to the Oxford Craniofacial Unit between January 2008 and February 2013 was completed to identify patients with SQS...
September 2016: Journal of Craniofacial Surgery
Khalid Arab, Sara Fischer, Madiha Bahtti-Softeland, Giovanni Maltese, Lars Kolby, Peter Tarnow
INTRODUCTION: Craniosynostosis is a premature closure of a cranial suture. Cranioplasty is indicated to correct skull deformity, relieve increased intracranial pressure, and promote homogenous cranial growth. Different techniques have been adopted to achieve optimal outcomes. Although surgical benefits are widely accepted, this intervention might also affect cranial skeletal growth. METHODS: The authors conducted a retrospective case-control study including patients operated for isolated metopic or sagittal synostosis...
July 2016: Journal of Craniofacial Surgery
John Layliev, Roop Gill, Marcia Spear, Javier Cifuentes, Li Wang, Kevin J Kelly
There is a lack of consensus on the optimal timing for primary cranial vault reconstruction in cranial synostosis. The purpose of this study was to assess the impact of age at primary reconstruction on the need for revision surgery in nonsyndromic craniosynostosis. A retrospective review was conducted on all children undergoing cranial vault reconstruction for nonsyndromic craniosynostosis during a 10-year period. Demographics and length of follow-up was collected for each patient. Complications, mortality, need for reoperation, and type of reoperation were recorded...
September 2016: Journal of Craniofacial Surgery
C Guevara, A Wallender, B Steinberg, N J Ranalli
Primary delayed onset craniosynostosis is a rarely reported phenomenon. The unique case of a 2-year-old boy who had computed tomography (CT) scans performed 20 months apart demonstrating the post-gestational development of sagittal suture craniosynostosis is presented. The otherwise healthy male initially presented to the emergency department at age 7 months with soft tissue swelling over his left parietal region secondary to a fall. A CT scan revealed a possible left parietal skull fracture without intracranial pathology and patent cranial sutures with a normocephalic calvarial configuration...
June 4, 2016: International Journal of Oral and Maxillofacial Surgery
Hiroaki Sakamoto, Yasuhiro Matsusaka, Noritsugu Kunihiro, Keisuke Imai
Syndromic craniosynostosis has severe cranial stenosis and deformity, combined with hypoplastic maxillary bone and other developmental skeletal lesions. Among these various lesions, upper air way obstruction by hypoplastic maxillary bone could be the first life-threatening condition after birth. Aggressive cranial vault expansion for severely deformed cranial vaults due to multiple synostoses is necessary even in infancy, to normalize the intracranial pressure. Fronto-orbital advancement (FOA) is recommended for patients with hypoplastic anterior part of cranium induced by bicoronal and/or metopic synostoses, and posterior cranial vault expansion is recommended for those with flattening of the posterior part of the cranium by lambdoid synostosis...
May 2016: Journal of Korean Neurosurgical Society
Jung Min Ko
Craniosynostosis is defined as the premature fusion of one or more of the cranial sutures. It leads not only to secondary distortion of skull shape but to various complications including neurologic, ophthalmic and respiratory dysfunction. Craniosynostosis is very heterogeneous in terms of its causes, presentation, and management. Both environmental factors and genetic factors are associated with development of craniosynostosis. Nonsyndromic craniosynostosis accounts for more than 70% of all cases. Syndromic craniosynostosis with a certain genetic cause is more likely to involve multiple sutures or bilateral coronal sutures...
May 2016: Journal of Korean Neurosurgical Society
Bao Nan, Chu Jun, Wang Xue, Bo Yang, Yunhai Song, Jinjing Cai
OBJECTIVE: This study aimed to evaluate the effort of applying frontal and occipital bones in extensive cranioplasty and preserving multiple cranial bone flaps adhered to the dura mater in the treatment of sagittal synostosis. METHODS: From April 2008 to June 2013, sixty-three children with sagittal synostosis, aged 5 months to 3 years, were included in the study. The frontal bone flap was removed using an air drill. The occipital and bilateral temporal bone flaps were cut open but not detached from the dura mater or fixed to produce floating bone flaps...
January 2016: Zhonghua Zheng Xing Wai Ke za Zhi, Zhonghua Zhengxing Waike Zazhi, Chinese Journal of Plastic Surgery
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