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Methods: The authors performed a retrospective chart review of all patients treated for lambdoid craniosynostosis, excluding the syndromic craniosynostoses. Operative data, scans, hospitalization, and subsequent surgical procedures were tracked. The described surgical approach varied with the presence or absence of an associated Chiari.
Results: Over 22 years, 1006 non-syndromic craniosynostosis patients were treated, 45 of these (4.5 percent) presented with lambdoid involvement: 25 single sutural and 20 multi-sutural (complex craniosynostosis). Magnetic resonance imaging revealed 60 percent of children with unilateral synostosis, and 70.6 percent with complex craniosynostosis, had associated Chiari deformations. The mean surgical age was 12-months, hospital stay < 2.4 days, and no major morbidities or mortalities were noted. The average follow up was 5.7 years: two patients developed syringomyelia, requiring decompressions; two had planned secondary remodeling procedures (complex synostoses) and one isolated synostosis underwent secondary remodeling during a subsequent Chiari decompression.
Conclusions: The treatment of lambdoid craniosynostosis with cranial remodeling procedures, and incontinuity suboccipital decompressions for those with Chiari deformations, was associated with no significant complications. 96 percent of those with isolated fusions were managed with a single procedure. We found a very substantial correlation between lambdoid synostoses and Chiari deformations suggesting the need for routine pre- and postoperative screening MR imaging.