Modified total cranial vault remodeling technique for scaphocephaly repair

Altaib, Mohamed Giuma (2015-12)

Thesis (MMed)--Stellenbosch University, 2015.

Thesis

ENGLSIH ABSTRACT: Introduction: Sagittal synostosis or scaphocephaly is the most common isolated single-suture synostosis that accounts for 40% to 60% of all craniosynostosis cases which affects 1 out of 2000 live births. The craniofacial unit at Tygerberg Academic Hospital modified the technique of total vault remodeling by lag screw fixation of onlay bone segments in the temperoparietal region to: a) improve the stability of the reconstruction; b) to increase the biparietal distance; c) to reduce operation time; and lastly d) to avoid secondary procedures for the removal of titanium plates. The aim of this study was to evaluate the surgical outcomes of the modified total cranial vault remodeling procedure for the management of sagittal synostosis. Method: A retrospective study was employed to investigate the surgical outcomes of the modified total cranial vault remodeling technique for non-syndromic scaphocephaly repair by use of medical records of eight pediatric patients operated over thirty-two months from October 2011 to May 2014. The sample comprised three boys and five girls with an age range of 4 months to 5 years and 7 months. The head circumference was measured pre- and post-operatively and the parents’ satisfaction recorded. The surgical duration of the modified procedure and the patients’ blood transfusion volume was compared to the unit’s traditional approach. Results: The head circumference of all patients increased on the percentiles of the head circumference-for-age growth chart. Pre-operatively a mean of 47 cm and post-operatively a mean of 50.94 cm were measured. Parents were generally satisfied with the aesthetic outcomes of the surgery. The average volume for intraoperative blood transfusion was 230 ml compared to 763 ml for the conventional method. The average surgical time decreased from 5.5 hours with the conventional method to 3.4 hours with the modified technique. Conclusion: The modification of the cranial vault remodeling increased the head circumference, yielded good parental satisfaction, decreased the surgery time and intraoperative blood transfusion volume with complications comparable to the traditional method.

AFRIKAANSE OPSOMMING: Inleiding: Sagittale sinostose of skafosefalie is die mees algemene geïsoleerde enkel-hegting sinostose. Dit is verantwoordelik vir 40-60% van alle kraniosinostose gevalle, en beinvloed 1 uit 2000 lewende geboortes. Die kraniofasiale eenheid by Tygerberg Akademiese Hospitaal het die tegniek van die totale skedeldak hermodellering verander deur skroeffiksasie van oorvleuel been segmente in die temperoparietal streek gewysig om: a) die stabiliteit van die rekonstruksie te verbeter; b) die biparietale afstand te verhoog ; c) vermindering van operasie tydsduur en laastens, en d) die vermyding van sekondêre prosedures vir die verwydering van titanium plate. Die doel van hierdie studie was om die chirurgiese uitkomste van die gewysigde totale kraniale skedeldak hermodellering prosedure te evalueer in die hantering van sagittale sinostose. Metode: 'n Retrospektiewe studie is ingestel om die chirurgiese uitkomste van die gewysigde totale kraniale skedeldak hermodellering tegniek vir nie-sindromiese skafosefalie herstel te ondersoek deur die gebruik van mediese rekords van agt pediatriese pasiënte. Hierdie pasiente is geopereer oor ʼn tydperk van 32 maande vanaf Oktober 2011 tot Mei 2014. Die studie bestaan uit drie seuns en vyf meisies met 'n ouderdomsvariasie van 4 -67 maande. Die kopomtrek is pre en postoperatief gemeet en die ouers se tevredenheid met die prosedure was bepaal. Die duur van die chirurgiese gewysigde prosedure en bloedoortapping volume van die pasiënte is vergelyk met die tradisionele benadering. Resultate: Die kopomtrek van alle pasiënte het vermeerder op die persentiele van die kop omtrek-vir-ouderdom groeikaart. Pre-operatief is 'n gemiddeld van 47 cm en post-operatief 'n gemiddeld van 50.94 cm gemeet. Ouers was oor die algemeen tevrede met die estetiese uitkoms van die operasie. Die gemiddelde volume vir intraoperatiewe bloedoortapping was 230 ml in vergelyking met 763 ml vir die konvensionele metode. Die gemiddelde chirurgiese duur het verminder vanaf 5.5 uur (die tradisionele metode) to 3,4 uur met die gewysigde tegniek. Gevolgtrekking: Die wysiging van die kraniale skedeldak hermodellering verhoog die kopomtrek. Dit lewer goeie ouerlike tevredenheid, en dit verminder die operasie tyd en intraoperatiewe bloedoortapping volume met komplikasies vergelykbaar met die tradisionele metode.

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