Comparison Between Two Different Isolated Craniosynostosis Techniques: Does It Affect Cranial Bone Growth?

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. These patients had undergone a computed tomography (CT) scan before surgery and/or at 3 years of age postoperatively. These were operated between 2002 and 2012. Intracranial volume was measured using a MATLAB application. The control group was age and sex-matched individuals who had CT scans for trauma or neurological indications. All results with P value <0.05 were considered statistically significant.

RESULTS: A total of 185 patients were included in the study with a preoperative CT scan (143 sagittal synostosis and 42 metopic synostosis). Postoperatively 160 patients were identified including 103 sagittal synostosis and 57 metopic synostosis. These patients were compared to 414 controls. There was a statistically significant reduction in intracranial volume (ICV) in patients operated for metopic synostosis with both techniques. It also demonstrated a statistically significant difference in ICV in patients with sagittal synostosis operated with Pi-plasty and a nonsignificant difference in ICV in patients operated with strip craniotomy and springs.

CONCLUSION: In conclusion, these measurements of ICV have revealed that extensive cranioplasties for premature craniosynostosis can lead to minor but significant growth restriction and reduced ICV at long-term follow-up.