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Cranial Base and Posterior Cranial Vault Asymmetry After Open and Endoscopic Repair of Isolated Lambdoid Craniosynostosis

Zubovic, Ema BA*; Woo, Albert S. MD*; Skolnick, Gary B. BS*; Naidoo, Sybill D. PhD, CPNP*; Smyth, Matthew D. MD; Patel, Kamlesh B. MD*

Journal of Craniofacial Surgery: July 2015 - Volume 26 - Issue 5 - p 1568–1573
doi: 10.1097/SCS.0000000000001891
Original Articles

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.

*Division of Plastic and Reconstructive Surgery

Department of Neurosurgery, Washington University in St. Louis, St. Louis, MO.

Address correspondence and reprint requests to Kamlesh B. Patel, Department of Plastic and Reconstructive Surgery, Washington University in Saint Louis, 660 South Euclid Ave, Campus Box 8238, St. Louis, MO 63110; E-mail:

Received 17 July, 2014

Accepted 18 April, 2015

This research was supported by the Washington University Institute of Clinical and Translational Sciences grants UL1 TR000448 and TL1 TR000449 from the National Center for Advancing Translational Sciences. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

Presented at the American Cleft Palate-Craniofacial Association (ACPA) Annual Meeting, Indianapolis, IN, March 24–29, 2014.

The authors report no conflicts of interest.

© 2015 by Mutaz B. Habal, MD.