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The Michigan Technique of Scaphocephaly Surgical Repair in the Supine Position
John M. Mesa, M.D.1, Adam Oppenheimer, M.D.2, Frank Fang, M.D.2, Katherine Gast, M.D.2, Karin Muraszko, M.D.2, Steven R. Buchman, M.D.2.
1Univeristy of Michigan /University of Alabama at Birmingham, Ann Arbor / Birmingham, MI, USA, 2Univeristy of Michigan, Ann Arbor, MI, USA.

PURPOSE:
The majority of the cranial vault remodeling techniques for correction of scaphocephaly secondary to sagittal synostosis focus in the correction of the cephalic index and/or on reshaping of the posterior cranial vault, while in the prone position. The lack of ‘active’ correction of the anterior cranial vault synostotic changes often results on residual post-surgical bitemporal constriction and frontal bossing stigmata. The aim of this study is to present a new method of total cranial vault remodeling for correction of scaphocephaly, performed in the supine position, which focus in the reshaping of the anterior cranial vault, but also addresses the posterior cranial vault deformity: The Michigan Technique of Scaphocephaly Repair

METHODS:
An IRB approved retrospective analysis of patients with scaphocephaly secondary to non-syndromic sagittal synostosis that underwent total cranial vault remodeling at our institution between 1995 and 2009 was performed. All surgical procedures were performed in the supine position by the senior author (SRB) (Figure 1). Surgical repair consisted reshaping of the frontal bossing, bitemporal constriction, biparietal narrowing, posterior occipital bullet, and enlarged anterior-posterior diameter (Figure 2). Demographic information, peri-operative and follow up data was collected for analysis. Post-surgical appearance of the forehead was documented clinically and photographically.
RESULTS:
Our results showed that correction of scaphocephaly (total cranial vault remodeling) could be performed in the supine position (n=173). All patients presented an excellent correction of all the characteristics of scaphocephaly immediately intra-op (Figure 2). Blood transfusion was given to 81% of patients intra-operatively. Patients stayed initially in the ICU on average 1.32 day. The average hospital length of stay was 4.65 days. Three patients experience seizures (1.7%) and two wound infections (1.2%). Average follow up time was 4.16 years. There were no mortalities. All patients presented long lasting excellent aesthetic correction of the scaphocephaly (Figure 3). Two patients presented persistent cranial bone defects that required grafting (1.2%). No patient presented residual frontal bossing or bitemporal constriction that required re-operation.

CONCLUSION:
Our study demonstrates that the Michigan Technique of Scaphocephaly Repair in the supine position is safe, and allows obtaining an immediate and long lasting excellent reconstruction of the entire cranial vault with emphasis in the aesthetic correction of the anterior cranial vault deformities (frontal bossing and bitemporal constriction).


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