Post-operative Helmet Therapy in Patients with Unilateral Coronal Craniosynostosis

Abstract

Statement of the problemOut of all the synostotic corrective surgeries, fronto-orbital advancement and cranial vault remodeling for patients with unilateral coronal synostosis is 1 of the hardest to maintain ideal correction without relapse.1,2 Over the course of 20 years operating on these patients, the senior author (MMU) has made multiple adjustments to compensate for this relapse, including overcorrection on the affected side, superior orbital rim grafting, additional points of fixation, periosteal release, and scalp expansion with galeal scoring to minimize tension of the closure. As a result of these interventions, researchers have seen a positive increase of on-table results. However, the researchers have continued to note relapse postoperatively. As such, MMU has started to implement postoperative helmet therapy (PHT) to help maintain the surgical correction, improve brachycephaly, and increase overall symmetry. Methods and materialsAn IRB-approved retrospective review of all patients who underwent FOA and CRV followed by PHT for isolated unilateral nonsyndromic coronal synostosis at an institution between April 2017 and April 2020 was performed. Patients with insufficient data, significant deformational plagiocephaly, and multi-suture craniosynostosis and those not treated at Cranial Technologies (Pasadena, CA) for PHT were excluded for consistency of measurements and outcomes. Data collected included age at surgery, age at helmet initiation, follow-up duration, and PHT duration. Anthropometric measurements were performed using a proprietary machine learning application (Landmarks3D, Cranial Technologies, Tempe, AZ). Anthropometric data were collected, including cranial index and cranial vault asymmetry index (CVAI) at initiation (int) of helmet therapy and at termination (final) of helmet therapy. ResultsEleven patients (4 male, 7 female) meeting criteria were treated in the studied time period. Six patients had right UCS and 5 patients had left UCS. The median age at surgery was 8.5 months (range 7 to 11). The median time from surgery to initiating helmet therapy after fittings and swelling reduction was 1.56 months (range 0.65 to 3.35). The median duration of PHT was 5.4 months (range 4.1 to 9.8). The mean CI int was 92.67 (SD 2.54). The mean CI final was 87.41 (SD 4.16). The mean CVAI int was 4.80 (SD 1.29). The mean CVAI final was 3.13 (SD 1.40). Outcomes dataIn patients with unilateral coronal synostosis, postoperative helmet therapy can minimize the amount of relapse often observed in this condition. ConclusionPostoperative helmet therapy for patients with unilateral coronal synostosis is a reasonable low-risk complement to fronto-orbital advancement and cranial vault remolding. Clinically, PHT appears to help minimize relapse and improve overall head symmetry. Further investigation and increased patient enrollment are required to determine the true benefits of PHT in this patient population.