Cranial bone structure in children with sagittal craniosynostosis: relationship with surgical outcomes

Publication date: Available online 27 June 2017
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Naiara Rodriguez-Florez, Amel Ibrahim, J.Ciaran Hutchinson, Alessandro Borghi, Greg James, Owen Arthurs, Patrizia Ferretti, David Dunaway, Silvia Schievano, N.U.Owase Jeelani
BackgroundWhilst spring-assisted cranioplasty has become a widespread technique to correct scaphocephaly in children with sagittal synostosis, predicting head shape changes induced by the gradual opening of the springs remains challenging. The aim of this study was to explore the role of cranial bone structure on surgical outcomes.MethodsPatients with isolated sagittal synostosis undergoing spring-assisted cranioplasty at GOSH (London, UK) were recruited (n=18, age: 3-8 months). Surgical outcome was assessed by the change in cephalic index measured on 3D head scans acquired before spring insertion and after their removal using a 3D handheld scanner. Parietal bone samples routinely discarded during spring-assisted cranioplasty were collected and scanned using micro-computed tomography. Based upon visual assessment of such scans, bone structure was classified into one- or three-layered, the latter indicating the existence of a diploё cavity. Bone average thickness, volume fraction and surface density were computed and correlated with changes in cephalic index.ResultsCephalic index increased for all patients (p<0.001), but individual improvement varied. While the patient age and treatment duration were not significantly correlated with changes in cephalic index, bone structural parameters were. The increase of cephalic index was smaller with increasing bone thickness (Pearson’s r =-0.79, p<0.001) and decreasing bone surface density (r=0.77, p<0.001), associated with the three-layered bone structure.ConclusionsVariation in parietal bone micro-structure was associated with the magnitude of head shape changes induced by spring-assisted cranioplasty. This suggests that bone structure analysis could be a valuable adjunct in designing surgical strategies that yield optimal patient-specific outcomes.



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