Evolution In Management Of Isolated Sagittal Craniosynostosis: A Single Center, High-volume Experience
Ian C. Hoppe, MD, Lawrence Lin, BS, Rosaline Zhang, BS, Jordan W. Swanson, MD, Jesse A. Taylor, MD, Scott P. Bartlett, MD.
University of Pennsylvania, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
PURPOSE: The purpose of this study is to examine a single high-volume pediatric center's experience and changing paradigms in the management of isolated sagittal craniosynostosis (ISC), specifically with regards to posterior skull height (PSH) as a superior method of describing outcomes.
METHODS: All surgical procedures performed for ISC during the period of 1981 - 2017 were reviewed. Age at initial management and initial procedure were recorded. Trends throughout different time periods were analyzed. A sub-group analysis was performed to examine the increase in PSH (opisthion to the outer cortex perpendicular to the Frankfort horizontal) following posterior vault reconstruction procedures. These values were compared using independent t-tests.
RESULTS: During this time period 397 patients underwent a procedure for ISC. Of these, 319 had enough information for analysis. A middle-vault procedure was performed initially in 40.3% of patients, a posterior vault in 24%, a strip craniectomy with springs in 19.5%, an anterior vault in 10.6% and a total vault reconstruction in 4.6%. In recent years the most common initial procedures performed were spring-assisted craniectomy (mean age 3.8 months) and posterior vault remodeling (mean age 26.6 months). PSH was significantly increased following posterior vault remodeling procedures (121.74 to 125.46 mm; p<0.0001).
CONCLUSION: The protocol for treatment of ISC has evolved to favor early minimally invasive treatment with springs in younger children and a posterior vault remodeling procedure in older children. PSH is significantly increased following traditional posterior vault remodeling. Future studies will elucidate the changes in PSH produced by minimally invasive alternatives.
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