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ISCFS 2019 Abstract Supplement

S7A-14 SESSION 7A: SAGITTAL SYNOSTOSIS 10 YEARS REVIEW OF « H CRANIECTOMY » TECHNIQUE FOR SAGITTAL SYNOSTOSIS IN 436 PATIENTS,EVALUATION OF SURGICAL ASPECTS, AESTHETIC AND COGNITIVE OUTCOME

Paternoster, G.1,*; Haber, S.1; James, S.1; Khonsari, H.2; Di Rocco, F.1; Renier, D.1; Arnaud, E.1

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Plastic and Reconstructive Surgery - Global Open: August 2019 - Volume 7 - Issue 8S-2 - p 74-75
doi: 10.1097/01.GOX.0000583180.22812.0c
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Introduction: “H craniectomy” – open approach with partial craniectomy- represents one of the principal surgical techniques for scaphocephaly treatment. Several variations of this technique and mini invasive approaches have been proposed in the last years to improve the outcomes and reduce the complications.

Methods: Between 2008 and 2018, 567 patients underwent H craniectomy for scaphocephaly correction in a single center (Necker Hospital, Paris). 476 patients had sufficient data available and were included. The following parameters were assessed: removal of coronal sutures, cranial index (pre-operative and late post-operative), associated closure of metopic suture during surgery, late postoperative fusion of coronal sutures and presence of copper-beaten skull. The aesthetic outcome was evaluated by one single surgeon using the Whitaker scale. Cognitiveissues were recorded (attention, memory, language, school performance) as well as the incidence of headaches.

Results: 64% of patients were operated on beforetheage 6 months;30.5% were operated on between age 6 months and 1 yearof age; 5.5% were operatedonafter 1 yearof age. Mean follow-uptimewas 5.6 years (0.2–10.4). Mean cranial index was 70.5 preoperatively and 72.9 postoperatively. 17.3% of patients presented with copper-beaten skullon late follow-up. 58.4% presented with a radiologic fusion of the coronal sutures at late follow-up. 19% presented with an insufficient aesthetic result (Whitaker III or IV). 2.1% had papillary edema at some point during their follow-up. 27.7% reported headaches at some point of their follow-up. As to the cognitive outcomes, 75% had no reported problems at alland5.4% presented with cognitive or language impairment requiring professional assistance. 7 (1.5%) patients neededsurgical revision.The comparison between the classic technique and the surgical variant where coronal sutures were removed did not show any statistically significant differences in cognitive (p=0.633), aesthetic (p=0.782) or radiologic (p=0.461) outcomes.

Conclusion: This is the largest long-term retrospective outcome study aiming to evaluate the H craniectomy technique: H craniectomy is a safe and effective procedure. Removal of coronal sutures did not change the incidence of secondary coronal fusion, aestheticand functional outcomes. Further investigations based on multivariate models are in process in order to screen for parameters with predictive values for various aspects the outcome of H craniectomy.

Copyright © 2019 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons. All rights reserved.