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Outcomes In Pediatric Craniofacial Surgery: Children Undergoing Corrective Surgery For Single Suture Synostosis Display Head Growth On A Unique Curve
Richard Slama, BA1, Franziska Huettner, MD, PhD2, Peter D. Ray, MD1, Jeffrey P. Blount, MD3, John H. Grant, III, MD1, Danuta I. Dynda, MD4.
1University of Alabama at Birmingham (UAB), Birmingham, AL, USA, 2Cleveland Clinic, Cleveland, OH, USA, 3University of Alabama at Birmingham (UAB) / Children's of Alabama / Section of Pediatric Neurosurgery, Birmingham, AL, USA, 4University of Illinois, College of Medicine, Peoria, IL, USA.

PURPOSE:
The head circumference (H.C.) of children with surgically corrected craniosynostosis is currently monitored using standard growth charts based on age and sex. These charts are derived from a selection of “healthy children” living under conditions most favorable to obtain “full genetic growth potential”.WHO [4] Generalizing craniosynostosis patients to the normal growth curves may be inaccurate and could lead to sub-optimal care by failing to identify children who may have fallen off the H.C. curve unique to their specific craniosynostosis. This study aims to establish diagnosis specific H.C. growth curves for children who have undergone craniosynostosis surgery.
METHODS:
A single surgeon, IRB approved, retrospective chart review identified 429 craniofacial cases at Children’s of Alabama between 1997 and 2012. Of the 429 charts reviewed, 275 underwent correction of synostosis. Of these, 222 patients qualified for the study and 187 full charts were available for review. Our study population was comprised of: 46 unilateral coronal, 26 metopic, and 115 sagittal synostosis patients. Age in months (X-axis) vs. H.C. in centimeters (Y-axis) were plotted separately for pre-operative and post-operative visits. A logarithmic trend line was added to the pre-operative vs. post-operative measurements after which all data points and trend lines were compared with The Center for Disease Control H.C. Growth Charts.
RESULTS:
Both male and female sagittal synostosis patients had preoperative H.C. that approached the 90th percentile. H.C. remain relatively unchanged by surgery falling between the 75th and 90th percentiles. Preoperatively female unilateral coronal synostosis patients have a H.C. between the 25th and 50th percentile. After surgery, H.C. is at the 50th percentile and remains stable. Finally, male metopic craniosynostosis patients fell on the 50th percentile pre-operatively and corrected to the 75th percentile.
CONCLUSION:
Children with craniosynostosis have head circumference growth that is unique to their condition and reflects a distinct subset of the general population. Because of these diagnosis-specific trends, we believe that monitoring craniosynostosis patients with the standard CDC H.C. curves may lead to suboptimal care with possible neurodevelopmental sequelae. The development of head circumference growth curves for each type of craniosynostosis may therefore help maximize the care of these patients and prevent neurodevelopmental sequelae.
Male Sagittal Craniosynostosis

Female Sagittal Craniosynostosis

Female Unilateral Coronal Craniosynostosis

Male Metopic Craniosynostosis


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