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Protocol for Two-Stage Correction of Asymmetric Multisutural Craniosynostosis: An Approach to the Child with Cranial Scoliosis
Michael R Bykowski, Sameer Shakir, Sanjay Naran, Jesse Goldstein, Joseph Losee
University of Pittsburgh Medical Center
2014-03-14
Presenter: Michael R Bykowski
Affidavit:
70% of this work represents that solely by the resident. The remaining 30% is from the co-authors.
Director Name: Joseph Losee
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Craniomaxillofacial
BACKGROUND:
Asymmetric multisutural craniosynostosis (AMC) is a complex and rare problem. Despite the potential high morbidity of a one-stage surgical repair, many craniofacial surgeons correct AMC with a single stage.
METHODS:
We conducted a retrospective review of all craniosynostotic patients who presented to our Pediatric Tertiary Referral Center and underwent surgical correction between January 2004 to December 2013. Patients were limited to those with AMC who underwent two-stage repair. The first stage included sagittal strip craniectomy, followed by a period of helmet therapy, and then fronto-orbital advancement. A minimum of 1-year follow-up was required from the second stage for inclusion in this study.
RESULTS:
Four patients met our inclusion criteria. All had unilateral coronal and sagittal synostosis. On average, patients underwent their first and second stages of surgery at 0.24 and 0.96 years of age, respectively. No patients were syndromic or had a known genetic mutation. The average follow-up period was 3.7 years. At follow-up, three patients were considered to have developmentally normal vocabulary; whereas one patient was noted to have fair vocabulary development, as evaluated by a Speech and Language Pathologist. No patients developed blindness, learning disabilities, or signs of elevated intracranial pressure.
CONCLUSIONS:
AMC is a rare clinical entity. Early two-stage repair of AMC resulted in resolution or prevention of typical craniosynostotic sequelae. Performing the correction in two-stages afforded two shorter, relatively low morbidity procedures while allowing "touch-up" modifications during the second procedure. Our protocol for two-stage correction resulted in good functional and aesthetic outcomes.
