204. Comparison Of Clinical And Parental Satisfaction Outcomes Of Strip Craniectomy With Postoperative Helmet Versus Spring-mediated Remodeling In Sagittal Craniosynostosis

Authors: Luke George Foley Smith, MD; Varun Shah, BS; Helen Duenas, MS; Anne Graver; Lance Governale, MD; Gregory Pearson, MD; Annie Drapeau, MD, MSc (Columbus, OH)

Introduction:

We sought to compare outcomes and parental satisfaction between two minimally invasive approaches for sagittal craniosynostosis: strip craniectomy with spring-mediated skull remodeling (SMSR) and strip craniectomy with post-operative helmet (SCH).

Methods:

Perioperative and outcome data for SMSR or SCH patients from 9/20/2010–8/27/2018 were retrospectively reviewed. A phone survey was administered to parents of children who underwent SMRS or SCH to measure their satisfaction using a Likert scale (four questions).  

Results:

A total of 62 children were treated for sagittal craniosynostosis by either SMSR (n = 45) or SCH (n = 17). The SCH group had a lower estimated blood loss (EBL) (27 mL vs 47.06 mL, p = 0.021) and age at surgery (13.0 weeks vs 19.8 weeks) than the SMSR group. There was no significant difference in total anesthesia time. Three patients underwent early springs removal due to trauma or dislodgement, all of whom converted to helmeting. Mean follow-up time was 32.3 months (n = 15, range 15-85) in the SCH group and 29.6 months in the SMSR group (n = 44, 8-61, p = 0.990). Two patients in the SCH group converted to open cranial vault reconstruction. There was no difference in head circumference percentile between the groups at follow-up.

Thirty parents were contacted for the satisfaction survey (8 SCH, 22 SMSR). Average satisfaction was 3.86/4.0 in the SCH group and 3.45/4.0 in the SMSR group. No parents in the SCH group would change to SMSR while 13.7% would have changed to SCH in the SMSR group.

Conclusion:

Complication rates were similar in both groups except for EBL. Three patients required early springs removal. These results will better educate parents on the complications of both procedures and satisfaction outcomes. Further information is needed to determine ideal age at time of surgery for either procedure.