Cases reported "Craniosynostoses"

Filter by keywords:



Filtering documents. Please wait...

1/54. Unilateral coronal synostosis treated by internal forehead distraction.

    A 1-year-old infant with left hemicoronal synostosis was treated by distraction osteogenesis of the craniofacial skeleton using an internal distraction device. Surgery was performed through a coronal incision. The frontal bone and upper half of both orbits were first osteotomized en bloc after minimal epidural dissection of the supraorbital area and no epidural dissection around the coronal osteotomy site. The lateral one fourth of the frontal bone, including the right lateral half of the orbit, was left intact. The internal distraction device was fixed in the left temporal area. A 0.5-mm per day rate of distraction was performed up to an elongation of 17 mm after a 5-day latency period. The distraction device was removed after a consolidation period of 2 months. The results obtained were satisfactory, with symmetry of the forehead, orbit, and nose achieved without complications. The merits of this procedure are no extradural dead space after the operation (which prevents infection), shortened operative time, reduced blood loss, filling in the bone gap created by advancement with new bone, acceptable cosmesis by the parents during distraction, and no fixation device left after the second operation.
- - - - - - - - - -
ranking = 1
keywords = operative
(Clic here for more details about this article)

2/54. Early experience with poly L-lactic acid bioabsorbable fixation system for paediatric craniosynostosis surgery. Report of 3 cases.

    OBJECTIVE: The authors describe early experience in the use of bioabsorbable fixation devices for cranial reconstruction of paediatric craniosynostosis patients. methods: Three patients, individually respectively presenting sagittal synostosis, metopic synostosis, and clover leaf skull deformity, underwent cranial reconstruction using poly L-lactic acid (PLLA) plates and screws. The patients ranged in age from 2 to 10 months at the time of surgery. The postoperative clinical follow-up ranged from 16 to 18 months. All patients showed satisfactory wound healing without signs of infection or local inflammation. The plates provided satisfactory fixation and were not palpable through the skin after 16 to 18 postoperative months. CONCLUSION: Our experience demonstrated the efficacy of PLLA bioabsorbable plates and screws for cranial reconstruction in cases of infant craniosynostosis. prospective studies and longer follow-up of a larger number of patients is desirable for confirmation of these findings.
- - - - - - - - - -
ranking = 2
keywords = operative
(Clic here for more details about this article)

3/54. Monobloc and midface distraction osteogenesis in pediatric patients with severe syndromal craniosynostosis.

    We present 2 children with severe syndromal craniosynostosis who were in need of urgent midface advancement surgery due to recurrent ocular dislocations (Pfeiffer's syndrome type II) or severe upper respiratory obstruction (Crouzon's syndrome). They were operated using distraction osteogenesis, with gradual midface or monobloc advancements. In the Pfeiffer patient, a maxillary distraction of 25 mm achieved effective cessation of ocular dislocations, whereas a 23-mm monobloc advancement in the Crouzon patient achieved cessation of nocturnal arterial desaturations. No major postoperative complications were recorded. Distraction osteogenesis has become a versatile and safe technique that allows for large skeletal advancements.
- - - - - - - - - -
ranking = 1
keywords = operative
(Clic here for more details about this article)

4/54. Application of the distraction technique to scaphocephaly.

    The case of a 1-year-old boy who underwent correction of a scaphocephalic deformity using distraction devices is described. Double pi-shaped osteotomies were cut. Bilateral temporal bone flaps were gradually expanded, and the frontal bone was pulled back simultaneously. The patient showed a good skull contour 2 years postoperatively. Although previous distractions were aimed only at expansion of the cranium, we used the distraction technique to successfully shorten the cranial vault in the anteroposterior direction. This case demonstrates that the osteotomized bone flaps can be moved in various directions. This feature of the distraction technique may contribute greatly toward meticulous reconstruction of the cranial vault.
- - - - - - - - - -
ranking = 1
keywords = operative
(Clic here for more details about this article)

5/54. The reversal exchange technique of total calvarial reconstruction for sagittal synostosis.

    The role of total calvarial reconstruction in the treatment of sagittal synostosis remains controversial, especially in patients younger than 1 year of age. The purpose of this study was to prospectively evaluate the efficacy of a single surgical technique for total calvarial reconstruction (the reversal exchange technique) in patients younger than 1 year of age who had a radiographically confirmed diagnosis of sagittal synostosis. Twenty-three consecutive patients underwent the reversal exchange technique of total calvarial reconstruction at a median age of 3 months (age range, 6 weeks to 10 months). Quantitative assessments were performed on the basis of preoperative and postoperative (minimum, 6 months) measurements of the cephalic index (cranial width/cranial length x 100) taken from three-dimensional computed tomography scans, which were obtained in 18 of 23 patients. Aesthetic assessments were performed on the basis of the grading of preoperative and postoperative photographs, obtained in 17 of 23 patients, by three independent raters who were blinded as to the surgical technique. The mean preoperative cephalic index was 65.0, and the mean postoperative index was 76.4, yielding a mean improvement of 11.4 (17.5 percent). By photographic evaluation, 12 of 17 patients (70.6 percent) were classified as having a normal head shape (grade 4) and five of 17 (29.4 percent) as having minor residual deformities (grade 3). No patients were identified as having significant residual deformities (grades 1 or 2). There were two intraoperative complications and one postoperative complication, none of which resulted in permanent morbidity. It was concluded that the reversal exchange technique of total calvarial reconstruction provided significant improvement in head shape on the basis of quantitative measurements (cephalic index) and independent evaluations of aesthetic improvement.
- - - - - - - - - -
ranking = 8
keywords = operative
(Clic here for more details about this article)

6/54. Surgical correction of scaphocephaly: experiences with a new procedure and follow-up investigations.

    INTRODUCTION: Simple resection of the sagittal suture and the use of alloplastic material or extensive skull resections have long been proven to be unsatisfactory in the treatment of sagittal synostosis. In contrast to these experiences, the immediate correction of skull shape seems to yield the best results without significant morbidity. patients: Thirty-six scaphocephalic infants with an average age of 6.5 (3.5-14) months underwent operation by our craniofacial team since 1994. methods: Wide resection of the sagittal suture was used in combination with a bone-strip resection along the coronal and lambdoid sutures. Occasionally partial resection and reshaping of the frontal or occipital bone was necessary to correct an extremely bulging skull. The cranial growth and shape was monitored by anthropometric skull measurements in the last 20 patients. RESULTS: Except in two cases, in which the dura mater was minimally injured intraoperatively, no complications occurred in any patient. Craniofacial oedema always occurred but disappeared after 72 h. The immediate correction of the skull shape was successful in all cases and was completed within 6 months postoperatively. There was no iatrogenic bone defect one year after surgery. Postoperative skull shape and growth was normal. CONCLUSION: These procedures seem to be effective in the treatment of scaphocephalus. Further normalization of skull shape is achieved by unrestricted postoperative brain growth.
- - - - - - - - - -
ranking = 4
keywords = operative
(Clic here for more details about this article)

7/54. Results of cranial vault reshaping.

    This study was designed to assess the outcome of cranial vault reshaping for correction of deformity of the skull and the upper face. A retrospective review of all children who underwent cranial vault reshaping by a single team of surgeons between 1993 and 1996 was performed. There were 10 children in the series. The age at surgery ranged from 6 to 62 months (mean age, 25 months). Five children in the series had untreated sagittal craniosynostosis with scaphocephaly, two had pansynostosis resulting in cloverleaf skull deformity, and three had turricephaly after shunt treatment of hydrocephalus. There was no operative mortality. blood loss ranged from 250 to 1,500 ml (mean, 422 ml). All patients needed transfusion. There were two major complications resulting from increased intracranial pressure, but both patients recovered completely with no neurological sequelae. titanium plates and screws were used in all patients, but were removed in two when they became palpable. The 5 children with sagittal craniosynostosis had a normal head shape. The 2 children with cloverleaf skull have improved head shape with persistent increased bitemporal width and round faces. The 3 children with turricephaly after shunting have marked improvement with mild persistent deformity. This study shows that cranial vault reshaping is safe and can lead to a long-term normal head shape in children with late correction of sagittal craniosynostosis. Children with more severe anomalies, particularly syndromic patients, can be improved but will have persistent mild deformity.
- - - - - - - - - -
ranking = 1
keywords = operative
(Clic here for more details about this article)

8/54. On the assets of CAD planning for craniosynostosis surgery.

    SkullWiz is a computer-aided design program that transforms computer tomographic data of the neurocranium into a mathematical model that can be interactively manipulated to plan craniosynostosis surgery. Proper planning of this type of surgery involves reference to the underlying viscerocranium and to normal neurocranial dimensions, simulation of all basic surgical actions (closed and open osteotomy, translation, rotation, bending, removal, burring), and reference to the mechanical properties of calvarial bone at a given age. With SkullWiz, infinite trials are possible to develop a surgical plan that combines minimal action with maximum morphologic result. In contrast, physical models, e.g., foam milled or stereolitographic, provide just a single (or double, after gluing) opportunity to visualize three-dimensional morphology and simulate a treatment plan, without reference support. Validation of SkullWiz is difficult due to parameter variability. Its assets are therefore graphically exemplified in two common types of nonsyndromatic single-suture craniosynostosis-trigonocephaly and anterior plagiocephaly. SkullWiz is one of the most accurate planning tools currently available for craniosynostosis surgery. Accurate transfer of the planning by aluminium templates results in efficient and precise surgery by avoiding per-operative "chipping and fitting."
- - - - - - - - - -
ranking = 1
keywords = operative
(Clic here for more details about this article)

9/54. hyponatremia in the postoperative craniofacial pediatric patient population: a connection to cerebral salt wasting syndrome and management of the disorder.

    hyponatremia after cranial vault remodeling has been noted in a pediatric patient population. If left untreated, the patients may develop a clinical hypoosmotic condition that can lead to cerebral edema, increased intracranial pressure, and eventually, to central nervous system and circulatory compromise. The hyponatremia has traditionally been attributed to the syndrome of inappropriate secretion of antidiuretic hormone (SIADH); however, in our patients the treatment has been resuscitation with normal saline as opposed to fluid restriction (the accepted treatment of SIADH), thus placing the diagnosis of SIADH in question. patients who developed hyponatremia after intracranial injury or surgery were, until recently, grouped together as having SIADH. However, there are diagnosis and treatment differences between SIADH and another distinct but poorly understood disorder that is designated cerebral salt wasting syndrome (CSW). CSW is associated with increased urine output and increased urine sodium concentration and volume contraction, and it is frequently seen after a central nervous system trauma. We therefore developed a prospective study to evaluate the cause of the sodium imbalance.Ten consecutive pediatric patients who underwent intracranial surgery for various craniosynostotic disorders were postoperatively monitored in the pediatric intensive care unit for hemodynamic, respiratory, and fluid management. The first four patients were evaluated for electrolyte changes and overall fluid balance to determine the consistency with which these changes occurred. The remaining six patients had daily (including preoperative) measurement of serum electrolytes, urine electrolytes, urine osmolarity, serum antidiuretic hormone (ADH), aldosterone, and atrial natriuretic hormone (ANH). All patients received normal saline intravenous replacement fluid in the postoperative period.All of the patients developed a transient hyponatremia postoperatively, despite normal saline resuscitation. serum sodium levels as low as 128 to 133 mEq per liter (normal, 137 to 145 mEq per liter) were documented in the patients. All patients had increased urine outputs through the fourth postoperative day (>1 cc/kg/h). The six patients who were measured had an increased ANH level, with a peak value as high as 277 pg/ml (normal, 25 to 77 pg/ml). ADH levels were low or normal in all but one patient, who had a marked increase in ADH and ANH. aldosterone levels were variable. On the basis of these results, all but one patient showed evidence of CSW characterized by increased urine output, normal or increased urine sodium, low serum sodium, and increased ANH levels. The other patient had similar clinical findings consistent with CSW but also had an increase in ADH, thus giving a mixed laboratory picture of SIADH and CSW.The association of CSW to cranial vault remodeling has previously been ignored. This study should prompt reevaluation of the broad grouping of SIADH as the cause of all hyponatremic episodes in our postoperative patient population. An etiologic role has been given to ANH and to other, as yet undiscovered, central nervous system natriuretic factors. All of the patients studied required normal saline resuscitation, a treatment approach that is contrary to the usual management of SIADH. These findings should dictate a change in the postoperative care for these patients. After cranial vault remodeling, patients should prophylactically receive normal saline, rather than a more hypotonic solution, to avoid sodium balance problems.
- - - - - - - - - -
ranking = 11
keywords = operative
(Clic here for more details about this article)

10/54. Calvarial vault remodeling for sagittal synostosis.

    Sagittal synostosis is the most common form of craniosynostosis (i.e., premature fusion of cranial sutures). Sagittal synostosis, which is the premature fusion of the sagittal suture, occurs in 56% to 58% of all reported cases of craniosynostosis. This article describes calvarial vault remodeling, the procedure of choice at Children's Hospital los angeles for surgical intervention to correct sagittal synostosis. Perioperative interventions to minimize patients' risks and maximize benefits are explained. A case study is presented to describe the experience of one patient and his family members.
- - - - - - - - - -
ranking = 1
keywords = operative
(Clic here for more details about this article)
| Next ->


Leave a message about 'Craniosynostoses'


We do not evaluate or guarantee the accuracy of any content in this site. Click here for the full disclaimer.