Visualization of skull remodeling and re-ossification after reconstructive surgery and mosaic-like cranioplasty in sagittal synostosis and deformational brachycephaly1

Abstract

Introduction

Extended vertex craniectomy in sagittal synostosis (SS) and transposition craniectomy in severe deformational brachycephaly (DB) combined with mosaic-like cranioplasty (M-LC) have been performed in 17 and 24 infants from 2001 to 2003. The hitherto not well-known mechanisms of remodeling and effectiveness of M-LC is assessed by X-ray and anthropometry.

Methods

Follow-ups included skull radiograms preoperatively and 3 and 15 months postoperatively, which were analyzed by craniometry according to Haas, long-term anthropometry, and clinical follow-up till mean age of 7.6 and 7.4 years. Analysis included the following: time course of cephalic indexes (CI), sizes of distances (breadth, length, height) and modulus, and mean deviation of distances and modulus from the normal age- and sex-dependent values; evaluation of re-ossification of the operative defects covered by M-L C.

Results

CI in SS is normalized in early follow-up with stabilization thereafter; CI of DB is gradually normalized till late follow-up. Remodeling occurs in both disorders by active and passive mechanisms: increased growth of distances with preoperative minus and decreased growth of distances with surplus. The latter mechanism adds more to the postoperative remodeling. M-LC leads to concentric and final complete re-ossification of the defects.

Discussion

Significant remodeling of the skull vault is observed in both disorders by the demonstrated time course and mechanisms. M-LC does not hinder early remodeling and guarantees re-ossification of the defects.

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Acknowledgments

Prof. St. Berger MD, Head of Department of Pediatric Surgery of University Hospital Inselspital, Bern; Chr. Steffen, Dr. H. Tschäppeler MD, former Head, and Dr. R. Wolf MD, Head of Pediatric Radiology of University Institute of Diagnostic, Interventional and Pediatric Radiology; Dr. B. Liniger MD, Consultant of Craniofacial Anomalies, Department of Pediatric Surgery; Dr. V. Oesch MD, Head of Pediatric Surgery, Children’s Hospital Aarau.

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Correspondence to Chr. Steffen.

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No financial support or benefits were given to the author from any source related to the scientific work reported in this article.

The author got the permission to perform the study “Visualization of Skull Remodeling and Re-ossification after Reconstructive Surgery and M-LC in Sagittal Synostosis and Severe Posterior DB (VSRRRSSDB)” and to publish it from the Cantonal Commission of Ethics Berne of Swiss Ethics on May 2, 2017.

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Kaiser, G.L., Steffen, C. Visualization of skull remodeling and re-ossification after reconstructive surgery and mosaic-like cranioplasty in sagittal synostosis and deformational brachycephaly1. Childs Nerv Syst 36, 1489–1498 (2020). https://doi.org/10.1007/s00381-020-04511-y

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Keywords

  • Scaphocephy/postural brachycephaly
  • Surgery
  • X-ray craniometry/anthropometry
  • Long-term skull transformation