Natural History Of Nonsyndromic Sagittal Synostosis Morphometrics Following Open Middle And Posterior Cranial Vault Expansion
Benjamin B. Massenburg, M.D.1, Ezgi Mercan, PhD1, Elizabeth Shepard, MD2, Craig B. Birgfeld, MD1, Srinivas M. Susarla, MD, DMD, MPH1, Amy Lee, MD3, Richard G. Ellenbogen, MD3, Richard A. Hopper, MD, MS1.
1Craniofacial Center, Seattle Children's Hospital, Seattle, WA, USA, 2University of Washington School of Medicine, Seattle, WA, USA, 3Department of Neurological Surgery, University of Washington, Seattle, WA, USA.
PURPOSE: This study aims to quantify the change in three-dimensional skull morphometrics for patients with sagittal synostosis (SS) between presentation, after surgery, and at two-year follow-up.
METHODS: CT scans from 91 patients with isolated SS were age, gender, and race matched to 273 controls. We performed vector analysis with logarithmic regressions to model the impact of open middle and posterior cranial vault remodeling on cranial shape and growth.
RESULTS: Anterior cranial volume, bossing angle, and frontal shape were not changed by surgery but normalized without intervention by two years. Bi-parietal narrowing and middle cranial volume was expanded after surgery and maintained at two years. Occipital protuberance was improved after surgery and normalized at two years. Posterior cranial volume was decreased by the occipital remodeling and remained slightly lower than control volumes at two years. Persistent residual deformities at two years included supero-lateral narrowing at the level of opisthion and supero-anterior vertex bulge. Logarithmic models suggested older age at surgery resulted in more scaphocephaly and enlarged posterior cranial vault volumes at two years, without impacting other volume outcomes. Initial preoperative severity score was most predictive of two-year morphometrics.
CONCLUSION: Initial severity of SS deformity was the best predictor of two-year morphometric outcomes. An anterior vertex bulge can persist and supero-posterior cranial width decreases with time after open surgery, but frontal dysmorphology self-corrects without surgical intervention.
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