Myung Chul Lee1,2, Kyu Won Shim1,2, In Sik Yun1,2, Eun Kyung Park1,2, Yong Oock Kim1,2. 1. Seoul, Republic of Korea. 2. From the Department of Plastic and Reconstructive Surgery, Konkuk University School of Medicine; the Department of Medicine, Yonsei University Graduate School of Medicine; the Department of Pediatric Neurosurgery, Severance Children's Hospital; and the Department of Plastic and Reconstructive Surgery, Institute for Human Tissue Restoration, Yonsei University College of Medicine.
Abstract
BACKGROUND: Distraction osteogenesis has been used to correct sagittal craniosynostosis in various ways. The purpose of this study was to introduce three distraction osteogenesis procedures by describing four objective measurements. METHODS: Fifty-four patients with sagittal synostosis were recruited and assigned to one of three therapeutic groups: group 1, anteroposterior compression with bitemporal expansion (n = 35); group 2, bitemporal expansion (n = 9); and group 3, anteroposterior expansion with bitemporal expansion (n = 10). Distraction procedures were performed while maintaining dural attachment. Four indices-namely cranial index, head circumference, intracranial volume, and neurodevelopmental index (using the Bayley Scales of Infant Development II), were analyzed. RESULTS: The preoperative cranial index of group 1 (68.51 ± 4.73) differed significantly from those of groups 2 (76.75 ± 2.4; p < 0.05) and 3 (86.8 ± 3.99; p < 0.05). Postoperative cranial index in all groups converged to the mesocephalic cranial index. Preoperative intracranial volume determinations were within the normal range for the majority of participants in groups 1 and 2; however, most fell below -1 SD in group 3 [n = 8 (80 percent)]. Postoperatively, 90 percent of group 3 participants had intracranial volume values within the normal range. The preoperative mental and psychomotor developmental indices of group 3 were significantly lower than those in the other two groups. The postoperative analysis showed significant improvement in these indices in groups 1 and 3 or when all patients were analyzed. CONCLUSION: Symmetric sagittal synostosis can be effectively treated with distraction osteogenesis reformation guided by strategic categorization. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
BACKGROUND: Distraction osteogenesis has been used to correct sagittal craniosynostosis in various ways. The purpose of this study was to introduce three distraction osteogenesis procedures by describing four objective measurements. METHODS: Fifty-four patients with sagittal synostosis were recruited and assigned to one of three therapeutic groups: group 1, anteroposterior compression with bitemporal expansion (n = 35); group 2, bitemporal expansion (n = 9); and group 3, anteroposterior expansion with bitemporal expansion (n = 10). Distraction procedures were performed while maintaining dural attachment. Four indices-namely cranial index, head circumference, intracranial volume, and neurodevelopmental index (using the Bayley Scales of Infant Development II), were analyzed. RESULTS: The preoperative cranial index of group 1 (68.51 ± 4.73) differed significantly from those of groups 2 (76.75 ± 2.4; p < 0.05) and 3 (86.8 ± 3.99; p < 0.05). Postoperative cranial index in all groups converged to the mesocephalic cranial index. Preoperative intracranial volume determinations were within the normal range for the majority of participants in groups 1 and 2; however, most fell below -1 SD in group 3 [n = 8 (80 percent)]. Postoperatively, 90 percent of group 3 participants had intracranial volume values within the normal range. The preoperative mental and psychomotor developmental indices of group 3 were significantly lower than those in the other two groups. The postoperative analysis showed significant improvement in these indices in groups 1 and 3 or when all patients were analyzed. CONCLUSION: Symmetric sagittal synostosis can be effectively treated with distraction osteogenesis reformation guided by strategic categorization. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.