Long-Term Morphological Evaluation of Conservatively Managed Patients With Single Suture Craniosynostosis
Bibliographic record
Abstract
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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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".