Dong Ha Park and Soo Han Yoon
Although distraction osteogenesis (DO) requires a secondary procedure in the surgical correction of craniosynostosis, it is relatively simple, requires less transfusion, results in a shorter intensive care unit stay, and is quite safe. Because of these positive factors, various DO techniques have been developed. However, there is disagreement regarding the superiority of DO. The authors reported on a new DO technique, transsutural DO (TSDO), 6 years ago that was performed in 23 patients over a period of 6 months, and it continues to be used at the present time. In this paper the authors report the results of TSDO performed in 285 patients with craniosynostosis over a period of 6 years at a single institution.
TSDO consists of a simple suturectomy of the pathological suture followed by direct distraction of the suturectomy site only. Types of TSDO conducted included sagittal TSDO in 95 patients, bicoronal in 14, unilateral coronal in 57, lambdoid in 26, metopic in 13, multiple in 19, syndromic in 33, and secondary in 28. The mean age (± SD) of the patients was 19.4 ± 23.0 months, and mean follow-up was 39.5 ± 21.0 months.
The mean operating time was 115 ± 43 minutes, and mean anesthesia time was 218 ± 56 minutes. The mean transfusion volume of red blood cell components was 48 ± 58 ml, and mean transfusion volume of fresh-frozen plasma was 19 ± 35 ml. Total transfusion volume was significantly less in infants younger than 12 months of age and in children with lower lumbar puncture pressures (p < 0.05). Complications included 1 (0.4%) death from postoperative acute pneumonia after a distractor removal operation and 23 (8%) surgical morbidities comprising 10 revisions (3.5%) and 13 early removals of distracters (4.6%).
TSDO is a simple, effective, and safe method to use for treating all types of craniosynostosis. Some morbidity was experienced in this study, but it may be attributed to the learning curve of the technique.
Jaiho Chung, Sook Young Sim and Soo Han Yoon
Habitual sleeping positions in infants can produce/ occipital plagiocephaly, which causes strabismus as well as skull and facial asymmetry. This condition can be managed using a hard helmet, but maintaining an infant in such a device is often intolerable. The authors studied whether the shape of a young canine skull could reform while inside a soft helmet and whether intracranial volume would be preserved by the compensatory growth of the skull.
The authors tracked the head sizes of 14 1-week-old beagles who wore long, soft helmets (study group) and seven beagles who did not (control group). From these measurements, the intracranial volume in each beagle was calculated. All crania were also studied radiologically by using plain skull radiography, computerized tomography (CT), and magnetic resonance (MR) imaging.
The crania of all 14 beagles who wore soft helmets quickly adapted, resulting in a narrow, long head only 2 weeks into the experiment. This configuration continued to develop throughout the 7-week experimental period. At 8 weeks of age, animals in the study group showed no significantly different alteration in calculated intracranial volumes (p > 0.05). It is interesting that the helmet-treated animals initially underwent a paradoxical increase in intracranial volume growth. No structural difference in their brains was evident from CT or MR imaging findings, nor was there any functional disability.
Intracranial volume can be preserved by the compensatory growth of the skull during successful remodeling of the developing skull achieved using a soft helmet.
Sook Young Sim, Yong Sam Shin, Kyung Gi Cho, Sun Yong Kim, Se Hyuk Kim, Young Hwan Ahn, Soo Han Yoon and Ki Hong Cho
The clinical features of blood blister–like aneurysms (BBAs) that arise at nonbranching sites of the internal carotid artery (ICA) differ from those of saccular aneurysms. In this study, the authors attempt to describe optimal treatments for BBAs, which have yet to be clearly established.
Ten of 483 patients with aneurysmal subarachnoid hemorrhage who had been seen at the authors’ institution between March 2001 and June 2005 had intraoperatively confirmed BBAs at nonbranching sites of the ICA. All ten patients were women between the ages of 37 and 64 years (mean age 49.3 years); five had a history of hypertension. The BBAs were localized to the right side of the ICA in seven cases. All patients were successfully treated; clipping was undertaken in six, clipping combined with wrapping in three, and trapping in one. These methods were used in conjunction with various other surgical techniques such as brain relaxation by draining cerebrospinal fluid, anterior clinoidectomy, exposing the cervical ICA, gentle subpial dissection (for aneurysms that adhered to the frontal lobe), complete trapping of the ICA before clipping, and protecting the brain. Clip slippage occurred at the end of dural closing in two cases; the aneurysm was completely obliterated using multiple clips combined with ICA stenosis in one of these cases and ICA trapping with good collateral flow in the other. An excellent clinical outcome was achieved in eight patients, whereas two patients were disabled from massive vasospasm. The authors retrospectively reviewed radiological and surgical data in all cases to determine which treatment methods produced a favorable outcome.
Blood blister–like aneurysms located at nonbranching sites of the ICA are difficult to treat. Preoperative awareness and careful consideration of these lesions during surgery can prevent poor clinical outcomes.
2010 AANS Annual Meeting Philadelphia, Pennsylvania May 1–5, 2010