Craniectomy Gap Patency and Neosuture Formation following Endoscopic Suturectomy for Unilateral Coronal Craniosynostosis

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Abstract

Background:

The combination of endoscope-assisted suturectomy and postoperative helmet therapy has been advocated to treat unilateral coronal synostosis. However, surgical outcomes can vary. One possible explanation for this inconsistency is early closure of the craniectomy gap. The authors examined short-term postoperative patency of the craniectomy gap and its relationship to phenotypic improvement.

Methods:

A retrospective review was performed that included patients who (1) underwent endoscope-assisted suturectomy and postoperative helmet therapy for isolated unilateral coronal synostosis and (2) had preoperative and postoperative (>7 months) computed tomographic imaging. High-resolution computed tomographic images were analyzed for craniectomy gap patency.

Results:

Seventeen patients met the inclusion criteria. Mean age at operation was 2.5 months (range, 1.1 to 4.7 months). Mean duration of follow-up was 32.9 months (range, 10.6 to 64.9 months) and age at latest postsurgical computed tomography was 16.8 months (range, 7.5 to 40.9 months). Fifteen patients demonstrated “neosuture” formation and coronal patency on postoperative computed tomography. Three patients (17.6 percent) had complete formation of a normal-appearing coronal suture, whereas 12 patients (70.6 percent) had areas composed of both reformed suture and persistent craniectomy gap. These 15 patients demonstrated satisfactory phenotypic improvement and did not require subsequent procedures. The remaining two patients (11.8 percent) exhibited focal areas of refusion interspersed with areas of neosuture formation and persistent craniectomy gap. Both had poor phenotypic improvement; one underwent fronto-orbital advancement.

Conclusion:

Persistence of a craniectomy gap and neosuture formation are common early findings after endoscope-assisted suturectomy and postoperative helmet therapy and appear to correlate with better phenotypic improvement.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.

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