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Triple square extended osteotomies for treatment of scaphocephaly (Renier’s “H” technique modification)

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Abstract

Scaphocephaly is the most common single suture craniosynostosis. Surgical technique has evolved from simple strip craniectomy over π-procedures and vertex craniectomies to extensive cranial remodeling which is preferred procedure nowadays. The purpose of this paper is to present our modification of Renier’s standard “H” technique and its preliminary results in detail. Eleven patients with scaphocephaly were surgically treated from January 2011 until January 2014. Only children with isolated sagittal synostosis were included in the study. Our modified Renier’s technique reduces the possibility of lesion of superior sagittal sinus, dividing parietal bone in three bone fragments, thus achieving shortening of the scull in AP diameter without detaching the bone from the superior sagittal sinus. The possibility for potential secondary stenosis is minimized using extended V-shaped osteotomies with rounding of the bone edges, as well as making wide neocoronal and neolambdoid sutures. Cosmetic results were estimated as very pleasing immediately after surgery by both the parents and the surgeons in all cases. The majority of patients presented in our study were categorized as Sloan Class 1. Improvement or normalization of the cranial index was accomplished in all patients. No revision surgeries were required during the follow-up. Triple square extended osteotomies technique is a fast, simple, and efficient surgical option for children with sagittal synostosis and can be safely applied in the first months of life in children even under weight of 6 kilos. Preliminary results are encouraging and deserve a longer follow-up and comparative surgical analysis to verify its usefulness in the future.

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Authors and Affiliations

  1. Clinic of Neurosurgery, Clinical Center of Serbia, Koste Todorovica 4, 11000, Belgrade, Serbia

    Mirko Micovic, Bojana Zivkovic, Vladimir Bascarevic, Radovan Mijalčić & Lukas Rasulic

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  1. Mirko Micovic
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  2. Bojana Zivkovic
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  3. Vladimir Bascarevic
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  4. Radovan Mijalčić
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  5. Lukas Rasulic
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Correspondence to Lukas Rasulic.

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Comments

Concezio di Rocco, Hannover, Germany

Sagittal synostosis is the simplest and the most common form of craniosynostosis and also the one the management of which is the most variable from extensive cranial remodeling to simple strip craniectomies carried out with minimal invasive techniques or endoscopy. In the present article, the authors describe their personal variant, which is a modification of the widely utilized Renier’s technique. They aim at reducing the risk of bleeding from tearing of the small veins draining into the superior sagittal sinus or, in exceptional cases, from its direct laceration, associated with the removal of the overlying early fused suture. The relatively low blood losses the authors report in their preliminary series appears to confirm the safety of their procedure.

Although nearly all the techniques utilized in the correction of sagittal cranisynostosis may be considered to be effective in improving the cranial index and the cosmetic appearance of the affected child, it is still questionable whether they really achieve an equivalent correction of the presumed altered physio-pathogenetic mechanisms at the base of the malformation. Indeed, if we consider the constriction of the flow in the superior sagittal sinus eventually brought about by the abnormal ossification process of the overlying fused cranial suture one of the possible factor leading to a constant or intermittent increased intracranial pressure, then the technique here considered should be reserved only to those cases in whom the course of the superior sagittal sinus is unequivocally demonstrated to be free of any bone compression.

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Micovic, M., Zivkovic, B., Bascarevic, V. et al. Triple square extended osteotomies for treatment of scaphocephaly (Renier’s “H” technique modification). Neurosurg Rev 39, 115–122 (2016). https://doi.org/10.1007/s10143-015-0661-z

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  • DOI: https://doi.org/10.1007/s10143-015-0661-z

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