Optimal duration of postoperative helmet therapy following endoscopic strip craniectomy for sagittal craniosynostosis

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OBJECTIVE

Many infants with sagittal craniosynostosis undergo effective surgical correction with endoscopic strip craniectomy (ESC) and postoperative helmet therapy (PHT). While PHT is essential to achieving optimal cosmesis following ESC, there has been little comprehensive analysis of the ideal PHT duration needed to attain this goal.

METHODS

The authors retrospectively reviewed the charts of infants undergoing ESC and PHT for sagittal synostosis at our institution between 2008 and 2015. Data collected included age at surgery, follow-up duration, and PHT duration. Cephalic index (CI) was evaluated preoperatively (CIpre), at its peak level (CImax), at termination of helmet therapy (CIoff), and at last follow-up (CIfinal). A multivariate regression analysis was performed to determine factors influencing CIfinal.

RESULTS

Thirty-one patients (27 male, 4 female) were treated in the studied time period. The median age at surgery was 2.7 months (range 1.6 to 3.2) and the median duration of PHT was 10.4 months (range 8.4 to 14.4). The mean CImax was 0.83 (SD 0.01), which was attained an average of 8.4 months (SD 1.2) following PHT initiation. At last follow-up, there was an average retraction of CIfinal among all patients to 0.78 (SD 0.01). Longer helmet duration after achieving CImax did not correlate with higher CIfinal values. While CImax was a significant predictor of CIfinal, neither age at surgery nor CIpre were found to be predictive of final outcome.

CONCLUSIONS

Patients undergoing ESC and PHT for sagittal synostosis reach a peak CI around 7 to 9 months after surgery. PHT beyond CImax does not improve final anthropometric outcomes. CIfinal is significantly dependent on CImax, but not on age, nor CIpre. These results imply that helmet removal at CImax may be appropriate for ESC patients, while helmeting beyond the peak does not change final outcome.

ABBREVIATIONS CI = cephalic index; CIfinal = CI at last follow-up; CImax = maximum/peak CI achieved; CIoff = CI at helmet removal; CIpre = preoperative CI; ESC = endoscopic strip craniectomy; PHT = postoperative helmet therapy.

Article Information

Correspondence Edward S. Ahn: Mayo Clinic, Rochester, MN. ahn.edward@mayo.edu.

INCLUDE WHEN CITING Published online August 31, 2018; DOI: 10.3171/2018.5.PEDS184.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

© AANS, except where prohibited by US copyright law.

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Figures

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    Serial laser imaging during the post-ESC helmeting period in a patient with sagittal synostosis. Serial lateral 3D laser images (lower row), calculated axial cranial depictions (top row), and corresponding CI measurements obtained preoperatively (A), 3 months postoperatively (B), and 12 months postoperatively (C), showing a retraction in CI from 0.82 to 0.80 between 3 and 12 months, but an overall improvement in CI from 0.70 to 0.80 during the helmeting period. Figure is available in color online only.

  • View in gallery

    Cephalic index (CI) trends in 31 patients undergoing ESC and PHT for sagittal synostosis. The average trend in CI in patients treated with PHT after ESC for sagittal synostosis demonstrates a peak around 8 months, followed by a steady retraction to final CI measurement, ending in the normal range (red line). The average CI in more than 300 normal babies (solid green line) and 95% normal range (dashed green lines) are shown for comparison.17 Numbers listed at the top indicate time points for the average values across groups: 1, CIpre; 2, CImax; 3, CIoff; and 4, CIfinal. Figure is available in color online only.

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