S4A-12 SESSION 4A: GENERALITIES IN CRANIOSYNOSTOSIS – PART I THE EFFICACY OF OUR NOVEL SUTURECTOMY TECHNIQUE WITH ABSORBABLE PLATES IN EARLY SURGERY FOR CRANIOSYNOSTOSIS

Abstract

Introduction: Surgical procedures for craniosynostosis patients with severe intracranial hypertension include suturectomy, cranial distraction and conventional cranial reconstruction. Suturectomy has been performed in children younger than 3 months of age with insufficient bone strength. Conventional suturectomy is generally ineffective, because bone formation occurs rapidly in the grooves, resulting in recurrent elevation of intracranial pressure and severe deformity. Therefore, the surgical effects should be extended by preventing bone formation during the early postoperative period to correct the severe deformity and subsequently achieve sufficient bone formation and strength. This study examined the efficacy of our newly developed suturectomy technique using an absorbable plate. We present our novel method and the postoperative follow-up. Methods: Our new method was indicated for craniosynostosis cases younger than 3 months of age who had severe intracranial hypertension, scaphocephaly, or plagiocephaly between 2011 and 2018. All patients underwent suturectomy. Suture lines that indicate premature fusion were incised at a width of approximately 7–10 mm to insert the absorbable plates. The bone stumps on both sides of the grooves were covered with absorbable sheet-type plates. Evaluation was conducted primarily with three-dimensional computed tomography and clinical photographs, and the preoperative and postoperative cephalic index were analyzed. Results: Twenty-three patients who underwent surgery were evaluated. The cranial shape was brachycephaly in five, scaphocephaly in four, oxycephaly in five, clover-leaf deformity in three, and plagiocephaly in four. There were eleven syndromic (1 Crouzon, 4 Apert, 3 Pfeiffer and 3 Saethre-Chotzen syndromes) and twelve non-syndromic patients. The patients’ mean age at the time of surgery was 43.5 days (12 to 76), and the mean follow-up period was 44.2 months (7 months to 7 years). The postoperative cephalic index improved in all patients. Secondary surgery was not required in five of eleven syndromic and in all non-syndromic patients. There were no major complications. Conclusion: Placement of an absorbable plate during strip craniectomy can prevent bone formation during the early postoperative period and promote bone formation after plate absorption. Even in patients who underwent distraction osteogenesis, the planning of the procedure was relatively easy because improvement in cranial shape had been achieved. In particular, some syndromic craniosynostosis patients were able to avoid additional surgery. Also, good outcomes were obtained without adjunctive therapy, such as helmet therapy. The present approach is less invasive and expected to be highly effective.