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  • Neosuture Formation After Endoscope-Assisted Craniosynostosis Repair

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    Afshin Saleh MD, MS; Katherine Carol Ott BS; Gary Skolnick BS; Dennis Nguyen; Sybill Naidoo PhD RN CPNP; Alex A Kane; Albert Woo MD; Kamlesh Patel MD; Matthew D. Smyth MD

    Study Design:

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    Meeting: Congress of Neurological Surgeons 2016 Annual Meeting

    Introduction: Continued fusion and synostosis of unaffected sutures has been noted after both traditional calvarial vault remodeling and endoscopic-assisted synostosis repair. Agrawal and colleagues identified reformation of the sagittal suture after strip craniectomy in 17% of their cases. In the largest ever studied cohort we have also observed neosuture formation in patients after endoscope-assisted strip craniectomy and molding helmet therapy. The aim of this study is to identify the rate of neosuture formation in patients with endoscope-assisted craniosynostosis repair and to describe any effect it may have on cranial modeling post repair.

    Methods: We retrospectively reviewed 166 cases of non-syndromic craniosynostosis that underwent endoscopic-assisted repair between 2006 and 2014. Pre- and one year post-operative head computed tomography (CT) scans were evaluated and the rate of neosuture formation was calculated. Three-dimensional reconstructions of the CT data were used to measure cephalic index (ratio of head width and length) of patients with sagittal synostosis. Regression analysis was used to calculate significant differences between patients with and without neosuture accounting for age at surgery and pre-operative CI.

    Results: Review of 96 patients revealed some degree of neosuture development occurred in 23 patients (23.9%): 16 sagittal, 2 bilateral coronal, 4 unilateral coronal and 1 lambdoid synostosis. Complete neosuture formation was seen in 14 of those 23 patients (9 of 16 sagittal, 1 of 2 bilateral coronal, 3 of 4 unilateral coronal, 1 of 1 lambdoid). Mean pre- and postoperative cephalic index in the complete sagittal neosuture group was 67.4% and 75.5% and in the non-neosuture group 69.8% and 74.4%, respectively. There was no statistically significant difference in the cephalic index between neosuture and fused suture groups prior or 17 months post-operatively in patients with sagittal synostosis

    Conclusions: Neosuture development can occur after endoscope-assisted strip craniectomy and molding helmet therapy for patients with craniosynostosis. While we did not detect a significant difference in calvarial shape post-operatively in the group with sagittal synostosis, the relevance of neosuture formation remains to be determined. Further studies are required to discover long-term outcomes comparing patients with and without neosuture formation

    Patient Care: This study focuses on a never before described phenomenon of formation of neosuture after endoscope-assisted repair of craniosynostosis in sagittal and other types of synostosis. Furthermore, it raises the question of whether neosuture formation can have an effect on cranial shape after synostosis release and helmet therapy.

    Learning Objectives: We described formation of neosutures after endoscope-assisted strip craniectomy and molding helmet therapy in treating patients with craniosynostosis. Furthermore, cranial index was used as a measurement for cranial shape. No statistically significant change was noted comparing patients who developed neosuture post-operatively vs those who did not.

    References: 1.Seruya M, Tan SY, Wray AC, et al. Total cranial vault remodeling for isolated sagittal synostosis: part I. Postoperative cranial suture patency. Plastic and reconstructive surgery 2013;132:602e-10e. 2.Yarbrough CK, Smyth MD, Holekamp TF, et al. Delayed synostoses of uninvolved sutures after surgical treatment of nonsyndromic craniosynostosis. The Journal of craniofacial surgery 2014;25:119-23 3.Agrawal D, Steinbok P, Cochrane DD. Reformation of the sagittal suture following surgery for isolated sagittal craniosynostosis. Journal of neurosurgery 2006;105:115-7.

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