title: Cranial Base and Posterior Cranial Vault Asymmetry After Open and Endoscopic Repair of Isolated Lambdoid Craniosynostosis.
abstract: BACKGROUND
  Previous studies have shown that open cranial vault remodeling does not fully address the endocranial deformity. This study aims to compare endoscopic-assisted suturectomy with postoperative molding helmet therapy to traditional open reconstruction by quantifying changes in cranial base morphology and posterior cranial vault asymmetry.
  
  
  METHODS
  Anthropometric measurements were made on pre- and 1-year postoperative three-dimensionally reconstructed computed tomography scans of 12 patients with unilateral lambdoid synostosis (8 open and 4 endoscopic-assisted). Cranial base asymmetry was analyzed using: posterior fossa deflection angle (PFA), petrous ridge angle (PRA), mastoid cant angle (MCA), and vertical and anterior-posterior (A-P) displacement of external acoustic meatus (EAM). Posterior cranial vault asymmetry was quantified by volumetric analysis.
  
  
  RESULTS
  Preoperatively, patients in the open and endoscopic groups were statistically equivalent in PFA, PRA, MCA, and A-P EAM displacement. At 1 year postoperatively, open and endoscopic patients were statistically equivalent in all measures. Mean postoperative PFA for the open and endoscopic groups was 6.6 and 6.4 degrees, PRA asymmetry was 6.4 and 7.6%, MCA was 4.0 and 3.2 degrees, vertical EAM displacement was -2.3 and -2.3 millimeters, and A-P EAM displacement was 6.8 and 7.8 millimeters, respectively. Mean volume asymmetry was significantly improved in both open and endoscopic groups, with no difference in postoperative asymmetry between the 2 groups (P = 0.934).
  
  
  CONCLUSIONS
  Patients treated with both open and endoscopic repair of lambdoid synostosis show persistent cranial base and posterior cranial vault asymmetry. The results of endoscopic-assisted suturectomy with postoperative molding helmet therapy are similar to those of open calvarial vault reconstruction.
authors.affiliation: *Division of Plastic and Reconstructive Surgery †Department of Neurosurgery, Washington University in St. Louis, St. Louis, MO.
authors.forename: Ema
authors.initials: E
authors.lastname: Zubovic
authors.forename: Albert S
authors.initials: AS
authors.lastname: Woo
authors.forename: Gary B
authors.initials: GB
authors.lastname: Skolnick
authors.forename: Sybill D
authors.initials: SD
authors.lastname: Naidoo
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Smyth
authors.forename: Kamlesh B
authors.initials: KB
authors.lastname: Patel
mesh_terms: D002508:Cephalometry / Q000379:methods; D002675:Child, Preschool; D003131:Combined Modality Therapy; D003393:Cranial Sutures / Q000601:surgery; D003398:Craniosynostoses / Q000473:pathology / Q000601:surgery*; D004424:Ear Canal / Q000473:pathology; D004724:Endoscopy / Q000379:methods*; D005500:Follow-Up Studies; D006260:Head Protective Devices; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods; D007223:Infant; D008416:Mastoid / Q000473:pathology; D009777:Occipital Bone / Q000473:pathology* / Q000601:surgery; D010294:Parietal Bone / Q000601:surgery; D010579:Petrous Bone / Q000473:pathology; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D019291:Skull Base / Q000473:pathology* / Q000601:surgery; D014057:Tomography, X-Ray Computed / Q000379:methods