Long-Term Morphological Evaluation of Conservatively Managed Patients With Single Suture Craniosynostosis
Notice bibliographique
Résumé
PURPOSE: Surgical treatment for single-suture craniosynostosis is controversial, with some authors casting doubt over its benefits for intracranial pressure1 and behavioral development.2 In this optic, cranioplasty is a purely aesthetic intervention wherein the benefits may not outweigh the risks. There is a paucity of literature objectively evaluating the long-term aesthetic results of unoperated children with craniosynostosis. Our purpose is to clarify the long-term evolution of the cranial deformity in patients with single suture craniosynostosis and thus facilitate decision-making for families faced with the prospect of surgical intervention for their child. MATERIALS AND METHODS: A retrospective chart review was conducted at our institution to identify unoperated patients with single-suture craniosynostosis followed with standardized photographs. Data on demographics, type of craniosynostosis, and cranial deformity were collected. Patient photos were then presented to surgeons trained in craniofacial assessment for evaluation of the severity of deformity on a 5-point Likert scale and candidacy for surgery over time. Laypeople also evaluated the severity of deformity over time and determined their readiness to accept corrective surgery if offered on a similar scale. RESULTS: Nine unoperated patients with metopic craniosynostosis and 11 with sagittal craniosynostosis were identified. Sixty-five percent of patients were male, mean age at initial presentation was 36.7 months, and mean photographic follow-up was 83.9 months. Craniofacial surgeons rated the initial deformity as moderate (median 3/5, interquartile range [IQR], 2) and would have offered surgery in 70.0% of cases. They found the deformity to be mild at long-term follow-up (4/5; IQR, 2), a significant improvement (P < 0.001). Surgeons stated that only 64.0% of cases would have needed surgery initially given their evolution and were willing to offer surgery at long-term follow-up in 48.0% of cases. Surgeons over 65 years of age were more likely to offer surgery initially (91.8% versus 33.3%, P < 0.0001) and at long-term follow-up (64.7% versus 11.1%; P < 0.001) than those 45–64. No differences were found in evolution of deformity or willingness to operate when accounting for affected suture. Lay evaluators found the initial deformity moderately acceptable (4/5; IQR, 1) but were very unwilling to accept surgery at presentation (1/5; IQR, 0). They found the deformity to be significantly more acceptable at last follow-up (median 5/5; IQR, 1; P < 0.001) and were equally unwilling to accept surgery at long-term follow-up (1/5; IQR, 0). No significant differences in opinion regarding severity of deformity, change in deformity or willingness to accept surgery were found when accounting for affected suture, participant sex, or parenthood. CONCLUSIONS: In the long-term, the cranial deformity associated with unoperated single suture craniosynostosis improves moderately in the eyes of craniofacial surgeons and laypeople alike. Older surgeons may favor surgery but up to 6.0% of children who undergo operative correction may have good aesthetic outcome without this. REFERENCES: 1. Bristol RE, Lekovic GP, Rekate HL. The effects of craniosynostosis on the brain with respect to intracranial pressure. Semin Pediatr Neurol; 2004;11:262–267. 2. Speltz ML, Collett BR, Wallace ER, et al. Behavioral adjustment of school-age children with and without single-suture craniosynostosis. Plast Reconstr Surg 2016;138:435–445.
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
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