Surgical treatment of premature sagittal synostosis

Pianetti, Geraldo

doi:10.1590/S0004-282X1997000300008

Abstracts

A series of 50 consecutive children with premature sagittal synostosis is reported. All were treated surgically; 43 were male, 47 were leukodermic and two are siblings. In the pre-operative examination, the head shape, skull measurements and radiologic findings were evaluated; 38 children were operated on before six months of age and 12 of them, between six and 12 months of age. The surgical technique used was a wide biparietal craniectomy. Blood transfusions were occasional, being necessary for only six (12%) children. The children were admitted at the day of surgery and discharged between the second and the third post-operative day. No local or general complications were observed and no one died. The aesthetic result was considered good. The altered skull measurements before surgery reached normalization as far as the end of the first year after the treatment. It may be concluded that wide biparietal craniectomy is a procedure of great effectiveness in the treatment of the premature fusion of the sagittal suture.

craniosynostosis; sagittal suture

É apresentada uma série de 50 crianças com fusão isolada e prematura da sutura sagital, tratadas cirurgicamente; 43 eram do sexo masculino, 47 leucodérmicas e duas irmãs. No pré-operatório foram avaliados o formato da cabeça, medidas do crânio e medidas radiológicas, 38 crianças foram operadas antes dos 6 meses de idade e 12 entre os 6 e 12 meses. A técnica cirúrgica usada foi a craniectomia parcial, ampla e biparietal. A transfusão sanguínea foi eventual, sendo necessária em somente 6 crianças (12%). As crianças foram admitidas no dia da cirurgia e receberam alta entre o segundo e terceiro dia após a cirurgia. Não foram observadas complicações locais ou gerais e não houve óbito. O resultado estético final foi considerado bom; as medidas do crânio, alteradas antes da cirurgia, se normalizaram até um ano após o tratamento. Conclui-se que a craniectomia parcial, ampla e biparietal é eficiente no tratamento da fusão isolada e prematura da sutura sagital, até o primeiro ano de vida.

craniossinostose; sutura sagital

Surgical treatment of premature sagittal synostosis

Tratamento cirúrgico da fusão prematura da sutura sagital

Geraldo Pianetti

Division of Neurosurgery, Hospital das Clínicas, Faculty of Medicine Federal University of Minas Gerais (UFMG), Hospital São Francisco de Assis, Belo Horizonte, Brazil: M.D., M.S.C., Associate Professor

ABSTRACT

A series of 50 consecutive children with premature sagittal synostosis is reported. All were treated surgically; 43 were male, 47 were leukodermic and two are siblings. In the pre-operative examination, the head shape, skull measurements and radiologic findings were evaluated; 38 children were operated on before six months of age and 12 of them, between six and 12 months of age. The surgical technique used was a wide biparietal craniectomy. Blood transfusions were occasional, being necessary for only six (12%) children. The children were admitted at the day of surgery and discharged between the second and the third post-operative day. No local or general complications were observed and no one died. The aesthetic result was considered good. The altered skull measurements before surgery reached normalization as far as the end of the first year after the treatment. It may be concluded that wide biparietal craniectomy is a procedure of great effectiveness in the treatment of the premature fusion of the sagittal suture.

Key words: craniosynostosis, sagittal suture.

RESUMO

É apresentada uma série de 50 crianças com fusão isolada e prematura da sutura sagital, tratadas cirurgicamente; 43 eram do sexo masculino, 47 leucodérmicas e duas irmãs. No pré-operatório foram avaliados o formato da cabeça, medidas do crânio e medidas radiológicas, 38 crianças foram operadas antes dos 6 meses de idade e 12 entre os 6 e 12 meses. A técnica cirúrgica usada foi a craniectomia parcial, ampla e biparietal. A transfusão sanguínea foi eventual, sendo necessária em somente 6 crianças (12%). As crianças foram admitidas no dia da cirurgia e receberam alta entre o segundo e terceiro dia após a cirurgia. Não foram observadas complicações locais ou gerais e não houve óbito. O resultado estético final foi considerado bom; as medidas do crânio, alteradas antes da cirurgia, se normalizaram até um ano após o tratamento. Conclui-se que a craniectomia parcial, ampla e biparietal é eficiente no tratamento da fusão isolada e prematura da sutura sagital, até o primeiro ano de vida.

Palavras-chave: craniossinostose, sutura sagital.

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

Aceite: 2-abril-1997.

Dr. Geraldo Pianetti - Rua dos Aimorés 2480/902 - 30140-072 Belo Horizonte MG - Brasil.

1. Albright AL. Operative normalization of skull shape in sagittal synostosis. Neurosurgery 1985;17:329-331.
2. Anderson FM, Geiger L. Craniosynostosis: a survey of 204 cases. J Neurosurg 1965;2:229-240.
3. Barritt J, Brooksbank M, Simpson D. Scaphocephaly: aesthetic and psychosocial considerations. Dev Med Child Neurol 1981;23:183-191.
4. Czorny A, Chocron S, Forlodou P, Tisserant D, Striker M, Montaut J. Scaphocephalies: traitement et complications: à propôs de 115 cas. Neurochirurgie 1987;33:190-195.
5. Dandy WE. An operation for scaphocephaly. Arch Surg 1943;47:247-249.
6. Diament AJ. Um novo índice cefálico no primeiro ano de vida. Rev Paul Med 1968;72:303-305.
7. Duff TA, Mixter RC. Midline craniectomy for sagittal suture synostosis: comparative efficacy of two harries to calvarial reclosure. Surg Neurol 1991;35:350-354.
8. Epstein N, Epstein F, Newman G. Total vertex craniectomy for the treatment of scaphocephaly. Child's Brain 1982;9:309-316.
9. Faber HK, Towne EB. Early operation in premature cranial synostosis for the prevention of blindness and other sequelae. J Pediatr 1943;22:286-307.
10. Foltz EL, Loeser JD. Craniosynostosis. J Neurosurg 1975;43:48-56.
11. Greene CS, Winston KR. Treatment of scaphocephaly with sagittal craniectomy and biparietal morcellation. Neurosurgery 1988;23:196-202.
12. Hassler W, Zentner J. Radical osteoclastic craniectomy in sagittal synostosis. Neurosurgery 1990;27:539-543.
13. Hudgins RJ, Burstein FD, Boydston WR. Total calvarial reconstruction for sagittal synostosis in older infants and children. J Neurosurg 1993;78:199-204.
14. Ingraham FD, Alexander E, Matson DD. Clinical studies in craniosynostosis: analysis of fifty cases and description of a method of surgical treatment. Surgery 1948;24:518-541.
15. Jane JA,.Edgerton MT, Futrell JW, Park TS. Immediate correction of sagittal synostosis. J Neurosurg 1978;49:705-710.
16. Keener EB. Experimental observations on the use of rubber in the treatment of craniosynostosis. J Neurosurg 1958; 15:642-652.
17. Lane LC. Pioneer craniectomy for relief of mental imbecility due to premature sutural closure and microcephalus. J Am Med Assoc 1892;18:49-50.
18. Lannelongue M. De la craniectomie dans la microcephalic CR Acad Sciences 1890; 110:1382-1386.
19. Marsh JL, Jenny A, Galic M, Picker S, Vannier MW. Surgical management of sagittal synostosis. Neurosurg Clin North Am 1991;2:629-640.
20. McLaurin RL, Matson DD. Importance of early surgical treatment of craniosynostosis. Pediatrics 1952;10:637-652.
21. Olds MV, Storrs B, Walker ML. Surgical treatment of sagittal synostosis. Neurosurgery 1986;18:345-347.
22. Pawl PP, Sugar O. Zenker solution in the surgical treatment of craniosynostosis. J Neurosurg 1972;36:604-607.
23. Samra KA, Sorour O. Bilateral flap operation for craniosynostosis. J Neurosurg 1968;29:591-596.
24. Shillito J. A plea for early operation for craniosynostosis. Surg Neurol 1992;37:182-188.
25. Shillito J, Matson DD. Craniosynostosis: a review of 519 surgical patients. Pediatrics 1968;41:829-853.
26. Simmons DR, Peyton WT. Premature closure of the cranial sutures. J Pediatr 1947;31:528-547.
27. Sorour O. The four-flap operation: a new operation for treatment of craniosynostosis. J Neurosurg 1961;,18:86-90.
28. Stein SC, Schut L. Management of scaphocephaly. Surg Neurol 1977;7:153-155.
29. Venes JL, Sayers MP. Sagittal synostectomy. J Neurosurg 1976;44:390-392.
30. Vollmer DG, Jane JA, Park TS, Persing JA. Variants of sagittal synostosis: strategies for surgical corretion. J Neurosurg 1984;61:557-562.

Publication Dates

Publication in this collection
18 Oct 2010
Date of issue
Sept 1997

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. Albright AL. Operative normalization of skull shape in sagittal synostosis. Neurosurgery 1985;17:329-331.

[2] 2. Anderson FM, Geiger L. Craniosynostosis: a survey of 204 cases. J Neurosurg 1965;2:229-240.

[3] 3. Barritt J, Brooksbank M, Simpson D. Scaphocephaly: aesthetic and psychosocial considerations. Dev Med Child Neurol 1981;23:183-191.

[4] 4. Czorny A, Chocron S, Forlodou P, Tisserant D, Striker M, Montaut J. Scaphocephalies: traitement et complications: à propôs de 115 cas. Neurochirurgie 1987;33:190-195.

[5] 5. Dandy WE. An operation for scaphocephaly. Arch Surg 1943;47:247-249.

[6] 6. Diament AJ. Um novo índice cefálico no primeiro ano de vida. Rev Paul Med 1968;72:303-305.

[7] 7. Duff TA, Mixter RC. Midline craniectomy for sagittal suture synostosis: comparative efficacy of two harries to calvarial reclosure. Surg Neurol 1991;35:350-354.

[8] 8. Epstein N, Epstein F, Newman G. Total vertex craniectomy for the treatment of scaphocephaly. Child's Brain 1982;9:309-316.

[9] 9. Faber HK, Towne EB. Early operation in premature cranial synostosis for the prevention of blindness and other sequelae. J Pediatr 1943;22:286-307.

[10] 10. Foltz EL, Loeser JD. Craniosynostosis. J Neurosurg 1975;43:48-56.

[11] 11. Greene CS, Winston KR. Treatment of scaphocephaly with sagittal craniectomy and biparietal morcellation. Neurosurgery 1988;23:196-202.

[12] 12. Hassler W, Zentner J. Radical osteoclastic craniectomy in sagittal synostosis. Neurosurgery 1990;27:539-543.

[13] 13. Hudgins RJ, Burstein FD, Boydston WR. Total calvarial reconstruction for sagittal synostosis in older infants and children. J Neurosurg 1993;78:199-204.

[14] 14. Ingraham FD, Alexander E, Matson DD. Clinical studies in craniosynostosis: analysis of fifty cases and description of a method of surgical treatment. Surgery 1948;24:518-541.

[15] 15. Jane JA,.Edgerton MT, Futrell JW, Park TS. Immediate correction of sagittal synostosis. J Neurosurg 1978;49:705-710.

[16] 16. Keener EB. Experimental observations on the use of rubber in the treatment of craniosynostosis. J Neurosurg 1958; 15:642-652.

[17] 17. Lane LC. Pioneer craniectomy for relief of mental imbecility due to premature sutural closure and microcephalus. J Am Med Assoc 1892;18:49-50.

[18] 18. Lannelongue M. De la craniectomie dans la microcephalic CR Acad Sciences 1890; 110:1382-1386.

[19] 19. Marsh JL, Jenny A, Galic M, Picker S, Vannier MW. Surgical management of sagittal synostosis. Neurosurg Clin North Am 1991;2:629-640.

[20] 20. McLaurin RL, Matson DD. Importance of early surgical treatment of craniosynostosis. Pediatrics 1952;10:637-652.

[21] 21. Olds MV, Storrs B, Walker ML. Surgical treatment of sagittal synostosis. Neurosurgery 1986;18:345-347.

[22] 22. Pawl PP, Sugar O. Zenker solution in the surgical treatment of craniosynostosis. J Neurosurg 1972;36:604-607.

[23] 23. Samra KA, Sorour O. Bilateral flap operation for craniosynostosis. J Neurosurg 1968;29:591-596.

[24] 24. Shillito J. A plea for early operation for craniosynostosis. Surg Neurol 1992;37:182-188.

[25] 25. Shillito J, Matson DD. Craniosynostosis: a review of 519 surgical patients. Pediatrics 1968;41:829-853.

[26] 26. Simmons DR, Peyton WT. Premature closure of the cranial sutures. J Pediatr 1947;31:528-547.

[27] 27. Sorour O. The four-flap operation: a new operation for treatment of craniosynostosis. J Neurosurg 1961;,18:86-90.

[28] 28. Stein SC, Schut L. Management of scaphocephaly. Surg Neurol 1977;7:153-155.

[29] 29. Venes JL, Sayers MP. Sagittal synostectomy. J Neurosurg 1976;44:390-392.

[30] 30. Vollmer DG, Jane JA, Park TS, Persing JA. Variants of sagittal synostosis: strategies for surgical corretion. J Neurosurg 1984;61:557-562.