Abstract: Neosuture Formation after Endoscopic-Assisted Craniosynostosis Repair (Plastic Surgery 2014)

Saturday, October 11, 2014: 2:55 PM

Afshin Salehi, MD , Neurosurgery, Washington University in St. Louis, saint louis, MO

Katherine Ott, BA , School of Medicine, washington university in st. louis, saint louis, MO

Gary Skolnick, BA , Plastic Surgery, washington University in St. Louis, St. Louis, MO

Sybill Naidoo, NP, CPNP, PhD , Plastic Surgery, Washington University in St. Louis, Saint Louis, MO

Albert S Woo, MD , Division of Plastic and Reconstructive Surgery,, Washington University School of Medicine, St Louis, MO

Matthew D Smyth, MD , Neurosurgery, Washington University in St. Louis, Saint Louis, MO

Kamlesh B Patel, MD , Plastic Surgery, Washington University in St. Louis, St. Louis, MO

Presentation PDF file

Neosuture Formation after Endoscopic-Assisted Craniosynostosis Repair

Background: Continued fusion and synostosis of unaffected sutures has been noted after both traditional calvarial vault remodeling and endoscopic-assisted synostosis repair.¹^,² Agrawal and colleagues identified reformation of the sagittal suture after strip craniectomy in 17% of their cases.³ We have also observed a neosuture in patients after endoscopic-assisted strip craniectomy and molding helmet therapy. We aim to identify the rate of a neosuture in patients with craniosynostosis treated after endoscopic–assisted strip craniectomy.

Methods: A total of 146 endoscopic-assisted cases for nonsyndromic craniosynostosis were retrospectively reviewed between 2006 and 2013. Patients with a syndromic diagnosis and multi-suture synostosis other than bilateral coronal were excluded. Pre and one year postoperative head computed tomography scans were reviewed and patients that developed a neosuture were identified. The Neosuture was classified as complete or incomplete. Patients with non-anatomic neosuture formation were excluded. Three-dimensional digital reconstructions of the CT data were used to measure cephalic index (ratio of head width and length) of patients with sagittal synostosis. A student t-test with significant value predetermined at p < 0.05 was used to calculate significant differences between the groups (Microsoft Excel 2010).

Experience: Seventy-six patients (61 sagittal, 6 bilateral coronal, 5 unilateral coronal, 4 lambdoid) treated by endoscopic-assisted technique with pre and one year postoperative scans were identified.

Results: Neosuture development occurred in 22 patients (29%): 13 sagittal, 2 bilateral coronal, 5 unilateral coronal and 2 lambdoid synostosis (Fig. 1). Complete neosuture formation was seen in 13 of 22 patients (8 of 13 sagittal, 2 of 2 bilateral coronal, 1 of 5 unilateral coronal, 2 of 2 lambdoid). Pre and postoperative cephalic index in the neosuture group was 67.5% and 76.9% and in the fused suture group it was 69.6% and 77.6%. No statistical difference in cephalic index was seen between neosuture and fused suture groups pre or 1-year postoperatively in patients with sagittal synostosis.

Conclusions: Neosuture development can occur after endoscopic-assisted strip craniectomy and molding helmet therapy for patients with craniosynostosis. Its relevance is still to be determined. Further studies are required to determine long-term outcomes comparing patients with continued fusion versus neosuture formation.

Figure 1. (Left) Preoperative CT scan showing sagittal synostosis. (Right) 1-year postoperative CT scan with complete neosuture formation.

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