| Presenter: Curtis Bergquist, BA, Oregon Health and Science University
Authors: Curtis Bergquist (1), Nathan Selden (1), Allison Nauta (2), Anna Kuang (3)
(1) Oregon Health and Science University, Portland, OR, (2) OHSU, Portland, OR, (3) Oregon Health & Science University, Portland, OR
Curtis Bergquist, BA
Oregon Health and Science University
An important goal of treatment for non-syndromic sagittal synostosis is to maintain appropriate intracranial volume to protect brain development and function. There is no consensus as to the type or timing of surgery. Regression in head circumference post-operatively is recognized in published data. It is possible that timing of surgery may play a role in regression. We aim to examine our experience with regard to age at time of surgery and maintenance of cranial expansion.
We retrospectively reviewed all patients who underwent sub-total cranial vault reconstruction for non-syndromic sagittal craniosynostosis between 2005 and 2011. Head circumference (HC) was recorded preoperatively, 3 months post-operatively, and then yearly until 6 years of age. Preoperative, and immediate- and 2 year- postoperative computed tomography (CT) imaging was also used to calculate the cranial index (CI). Head circumference percentile changes and CI were analyzed using one-way repeated measures analysis of variance (ANOVA).
We identified 61 patients and 33 met inclusion criteria. Eleven patients (33%) were >6 months old at the time of operation. Average age at operation was 6.4mo (3.2 to 40.9). The HC percentile was increased 3 months after surgery. One year after surgery, HC percentile was reduced compared to preoperative baseline. The average preoperative HC percentile was 87.5, which decreased to 75.6 at one year and to 69.7 at two years (*p<0.05). Patients who were >6 months old at time of operation experienced a smaller reduction in HC percentile two years after surgery than younger patients (-7.1 vs. -23.2, *p<0.05). In all patients, cranial index (CI) increased from an average of 76.7 to 86.5 approximately 2.4 years after surgery (*p<0.05). There was no significant effect of age at time of surgery on CI on 2-way ANOVA.
Subtotal cranial vault reconstruction to treat sagittal synostosis resulted in short- but not long-term over-correction in HC percentile. However, children operated >6 months of age, showed less regression in HC than children operated at <6 months of age. CI was improved in all patients. Older age at the time of cranial vault reconstruction for sagittal synostosis may play a role in the long-term maintenance of cranial expansion.