Effectiveness of a limited invasive scalp approach in the correction of sagittal craniosynostosis.
BACKGROUND
Several surgical techniques have been proposed for the correction of sagittal craniosynostosis. Extensive procedures seem to ensure the most stable long-term results and are more indicated in the older age group. Mini-invasive approaches are particularly useful in the very young infant as they are associated with a minor surgical risk. Furthermore, they are weighted by a minor cosmetic impact related to a less extended surgical scar.


METHODS
Data of the last 94 consecutively operated on scaphocephalic patients have been reviewed to verify the effectiveness of a personal limited-invasive approach based on four to six short linear scalp incisions vs the traditional bicoronal skin flap. The patients have been divided in two groups: (1) the control group (2000-2002): 45 children, operated on by means of a traditional bicoronal skin incision, and (2) the study group (2002-2004): 49 children, treated through four to six linear scalp incisions. The patients' variables were comparable. The results were evaluated in terms of duration of the surgical procedure, estimated blood loss (EBL), transfusion risk, postoperative complication rate, length of hospital stay, and postoperative cephalic index and cosmetic outcome as perceived by the patients' families.


RESULTS
No significant differences between the two groups were found about the early and the long-term surgical results; however, about one third of the subjects of the control group complained about the visibility of the surgical scar. In the study group, a significant reduction in the duration of the operation (p < 0.0001), postoperative hospital stay (p < 0.0001), EBL (p = 0.011), transfusion risk (p = 0.018), and complication rate (p = 0.016) was observed.


CONCLUSIONS
The current trend in the management of scaphocephaly is to favor simplified surgical procedures to be performed in the younger ages prevalently. The technique here presented allows achieving a stable long-term cranial reshaping, even when performed in the very young patient. The technique can be utilized also in older subjects with results comparable to those of more extensive surgical procedures. This less invasive technique is weighted by minor complication rates and minor impact of the surgical scar.
Massimi
Luca
L
Pediatrc Neurosurgery, Catholic University Medical School, Rome, Italy. lmassimi@email.it
Tamburrini
Gianpiero
G
Caldarelli
Massimo
M
Di Rocco
Concezio
C
D000367:Age Factors; D002508:Cephalometry; D003393:Cranial Sutures / Q000002:abnormalities / Q000601:surgery*; D019465:Craniofacial Abnormalities / Q000150:complications / Q000601:surgery*; D003398:Craniosynostoses / Q000150:complications / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D019637:Orthopedic Procedures / Q000379:methods*; D017060:Patient Satisfaction; D016896:Treatment Outcome