ORIGINAL ARTICLES   

Chirurgia 2003 August;16(4):143-6

Copyright © 2003 EDIZIONI MINERVA MEDICA

language: Italian

Sagittal craniosynostosis: a new technique to reduce the impact of the surgical procedure

Di Rocco C., Tamburrini G., Massimi L., Caldarelli M.

Aim. Sagittal synostosis can be surgically corrected by different surgical procedures; all of them, however, present a small but not negligible surgical risk and a significant cosmetic impact owing to the extension and visibility of the surgical scar. In this paper, personal preliminary experience using 6 short linear incisions in place of the traditional biparietal or linear incisions, is reported. This procedure seems to decrease the severity of the surgical procedure (minor blood loss, better control of clinical conditions during surgery, shorter hospital stay) as well as the psychological impact of the surgical scar.
Methods. Between January 1980 and December 2002, 388 children have been operated on for a sagittal craniosynostosis at the Pediatric Neurosurgical Unit of the Catholic University Medical School, Rome. A bicoronal scalp incision has been used in 378 cases; in 10 children, operated on between October 2001 and December 2002, 6 short (3-4 cm) linear incisions have been used; 2 of these incisions have been made in proximity of the coronal suture and under the temporal muscle bilaterally; 2 have been made bilaterally parallel to the anterior ones, at the level of the lambdoid suture, and the last 2 incisions have been made along the midline, one across the anterior fontanel and the other at the level of the posterior third of the sagittal suture.
Results. In spite of the low number of patients, our results suggest that, with this technique, it is possible to obtain a good correction of sagittal synostosis; final results are similar to those obtained with traditional approaches. This kind of procedure has also allowed a more stable control of perioperative hemodynamic conditions; indeed only 2 patients (20%) needed intraoperative blood transfusion due to a significant reduction of Hb values (HB< 6 g/dl). Only 1 patient needed a postoperative blood transfusion. Post-operative course was more rapid, in our experience, if compared with traditional techniques (mean post-operative stay: 4.9 days vs 7.9 days).
Periorbital subgaleal collections, which were constantly found in children operated on using a bicoronal incision, were observed in only 2 of the 10 patients treated with this new technique.
Conclusion. In conclusion, the operative procedure proposed seems to be a valid alternative to the traditional and more extended approaches for the treatment of patients with sagittal craniosynostosis and should be particularly considered in children who are operated in the first months of life and therefore more sensitive to rapid hemodynamic modifications.