phenomenon and a single operation is sufficient to treat most children. However, recent studies have indicated that “restenosis” of the sagittal suture often occurs rapidly after strip craniectomy, 1 , 2 , 19 in some cases associated with closure of other sutures, 9 , 19 and may be associated with development of symptomatic ICP elevation. Because most previous large series have focused predominantly on cosmetic outcome, the frequency with which secondary procedures are necessitated by growth restriction of the skull leading to increased ICP, rather than a suboptimal
Matthew A. Adamo and Ian F. Pollack
Rodrigo Navarro-Ramirez, Oded Rabau, Alisson Teles, Susan Ge, Abdulaziz Bin Shebreen, Neil Saran and Jean Ouellet
Early-onset scoliosis (EOS) correction techniques have evolved slowly over the past 40 years and still remain a challenge for the spine surgeon. Avoiding spinal fusion in these patients is key to decreasing morbidity and mortality in this population.
Current treatments for EOS include both conservative and surgical options. The authors present the modified Luqué technique that has been performed at their institution for the past decade. This modified technique relies on Luqué’s principle, but with newer “gliding” implants through a less disruptive approach. The goal of this technique is to delay fusion as long as possible, with the intent to prevent deformity progression while preserving maximal growth.
Normally, these patients will have definitive fusion surgery once they have reached skeletal maturity or as close as possible. Out of 23 patients until present (close to 4-year follow-up), the authors have not performed any revision due to implant failure. Three patients have undergone final fusion as the curve progressed (one patient, 4 years out, had final fusion at age 12 years; two other patients had final fusion at 3 years). These implants, which have the CE mark in Europe, are available in Canada via a special access process with Health Canada. The implants have not yet been submitted to the FDA, as they are waiting on clinical data out of Europe and Canada.
In the following video the authors describe the modified Luqué technique step-by-step.
The video can be found here: https://youtu.be/k0AuFa9lYXY.
Per Alberius and Göran Selvik
, craniostenosis may not be apparent until the child is more than 1 or 2 years old. In these patients, early routine examinations do not reveal any abnormalities associated with the calvarial sutures. Evidently, “late” premature suture fusion is possible, although the etiology is obscure. The compensatory reactions of nonfused cranial vault regions are also unclear, both in relation to duration of suture growth restriction and the following surgical intervention. The purpose of this investigation was to elucidate these intricate issues in the rabbit, using highly accurate
Justin S. Cetas, Morad Nasseri, Targol Saedi, Anna A. Kuang and Nathan R. Selden
data: Selden, Cetas, Saedi. Drafting the article: Selden, Cetas, Kuang. Critically revising the article: all authors. Reviewed submitted version of manuscript: all authors. Approved the final version of the manuscript on behalf of all authors: Selden. Study supervision: Selden. Acknowledgements The authors would like to thank Shirley McCartney, Ph.D., for editorial assistance and Andy Rekito, M.S., for graphics assistance. References 1 Adamo MA , Pollack IF : A single-center experience with symptomatic postoperative calvarial growth restriction
.E. Ghali , D.D.S., M.D. 3 2013 11 3 A364 A365 Copyright held by the American Association of Neurological Surgeons. You may not sell, republish, or systematically distribute any published materials without written permission from JNSPG. 2013 Introduction: Craniosynostosis is a congenital craniofacial disorder in which one or more cranial vault sutures closes in early infancy resulting in vault asymmetry, brain growth restriction, and developmental impairment can all occur with this disorder. This study was conducted to evaluate the treatment
Johnny B. Delashaw, John A. Persing, William C. Broaddus and John A. Jane
perpendicular to the fused suture. For example, multiple stereotyped deformities are seen in unilateral craniosynostosis ( Fig. 1 ). Virchow's guidelines 17 predict a deficit in growth in ipsilateral frontal and parietal bones perpendicular to the fused suture. He also implied that compensatory growth must occur at the remaining sutures to accommodate a growing brain. Virchow, however, did not establish a specific compensatory growth pattern that fully predicts the observed calvarial deformities. If the normal sutures could effectively accommodate for growth restriction
10.3171/2009.8.PEDS09345 2009.8.PEDS09345 Seizure control outcomes after resection of dysembryoplastic neuroepithelial tumor in 50 patients Edward F. Chang Catherine Christie Joseph E. Sullivan Paul A. Garcia Tarik Tihan Nalin Gupta Mitchel S. Berger Nicholas M. Barbaro 1 2010 5 1 123 130 10.3171/2009.8.PEDS09368 2009.8.PEDS09368 A single-center experience with symptomatic postoperative calvarial growth restriction after extended strip craniectomy for sagittal craniosynostosis Matthew A. Adamo Ian F. Pollack 1 2010 5 1 131 135 10.3171/2009.8.PEDS09227 2009
S. Alex Rottgers, Subash Lohani and Mark R. Proctor
normalize the relationship between the supraorbital rim and the cornea. 6 , 12–14 Advancements are more durable and safer when delayed until after the age of 6 months. 20 , 22 , 23 This delay, however, allows continued development of a turricephalic head shape, which is not treated effectively with an FOA, and exposes the patient to a longer period of cranial growth restriction. Many centers have sought treatment algorithms that allow for earlier intervention to relieve cranial growth restriction and mitigate the development of turricephaly, while preserving the
Mark M. Souweidane
months might appear logical. A clearer understanding of what surgical procedure was associated with an elevated ICP, however, is needed. Yet the confirmatory message cannot be ignored: the correction of sagittal synostosis mandates a long-term comprehensive longitudinal follow-up, even if the components of that surveillance are not clear. References 1 Adamo MA , Pollack IF : A single-center experience with symptomatic postoperative calvarial growth restriction after extended strip craniectomy for sagittal craniosynostosis . J Neurosurg Pediatr 5 : 131
Ian F. Pollack, H. Wolfgang Losken and Dennis J. Hurwitz
T he management of children with bilateral coronal synostosis constitutes a challenging problem because in many instances the cosmetic deformities result not only from the effect of frontoorbital retrusion, but also from a severe associated growth restriction of the posterior calvaria and compensatory changes in the surrounding cranial vault. The combination of anterior and posterior calvarial growth restriction produces a markedly foreshortened skull; because compensatory growth occurs laterally and upwardly, these patients characteristically exhibit a