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2024 Oral Abstract Award

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Cleft & Craniofacial Surgery

Patient and Therapy Factors Impacting Postoperative Helmet Therapy Efficacy in Patients with Craniosynostosis

(6) Patient and Therapy Factors Impacting Postoperative Helmet Therapy Efficacy in Patients With Craniosynostosis

Thursday, September 12, 2024

2:30 PM – 4:00 PM EDT

Poster Presenter(s)

Sasha Lasky, BS

Research Fellow
Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles
South Pasadena, California, United States

Co-Author(s)

Idean Roohani, BS

Research Fellow
Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles
Los Angeles, California, United States
Tayla Moshal, BS

Research Fellow
Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles
Los Angeles, California, United States
Marah Jolibois, MS (she/her/hers)

Research Fellow
Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles
Los Angeles, California, United States
AM

Artur Manasyan, BS

Medical Student
Keck School of Medicine of USC
Los Angeles, California, United States
EW

Erin Wolfe, MD

Plastic Surgery Resident
Division of Plastic and Maxillofacial Surgery, Keck School of Medicine of USC
Los Angeles, California, United States
NM

Naikhoba Munabi, MD, MPH

Plastic Surgery Fellow
Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles
Los Angeles, California, United States
Jeffrey A. Hammoudeh, DDS, MD

Plastic Surgeon Attending
Division of Plastic and Maxillofacial Surgery, Children’s Hospital Los Angeles
Los Angeles, California, United States
MU

Mark M. Urata, DDS, MD

Plastic Surgeon Attending
Division of Plastic and Maxillofacial Surgery, Children’s Hospital Los Angeles
Los Angeles, California, United States

Disclosure(s):

Sasha Lasky, BS: No financial relationships to disclose

Tayla Moshal, BS: No financial relationships to disclose

Abstract:

Introduction: Postoperative helmet therapy (PHT) is commonly utilized in patients with craniosynostosis to improve cranial shape and symmetry.1,2 This study aims to determine if PHT is effective in improving cranial measurements regardless of suture type and surgical approach. The secondary aim is to determine other factors that impact PHT efficacy.

Methods: Patients who underwent PHT between 2016 and 2022 were reviewed retrospectively. Patients with non-syndromic single-suture synostosis were included. Suture types with fewer than 3 cases were excluded. Surgical approaches included endoscopic strip craniectomy (ESC) or open cranial vault remodeling (CVR). Pre- and post-helmet measurements were assessed. Outcomes of interest included cephalic index (CI) and cranial vault asymmetry index (CVAI). Paired t-tests and ANOVA tests compared pre- and post-helmet measurements amongst suture types and patients undergoing ESC versus open CVR. Multivariate linear regression assessed contributors toward a greater change in CI and CVAI following PHT.

Results: Of 291 patients who underwent index synostosis-correcting surgery, 41 met inclusion criteria (20 unicoronal, 15 sagittal, 6 lambdoid). Twenty-nine patients underwent CVR (70.7%), and 12 underwent ESC (29.3%). Average follow-time was 1.8 ± 1.5 years. Comparing pre- and post-helmet measurements, PHT improved CI for patients with unicoronal (P < .001), sagittal (P = .005), and lambdoid synostosis (P = .014). PHT significantly improved CVAI for patients with unicoronal (p < 0.001) and sagittal synostosis (P = .029), however improvement for lambdoid synostosis was not significant (P = .106). In patients who underwent ESC, PHT significantly improved CI (P = .007) and CVAI (P = .039). In patients who underwent open CVR, PHT significantly improved CI (P < .001) and CVAI (P < .001). On multivariate regression, suture type and surgical approach were not associated with greater improvement in CI or CVAI (P > .05). A shorter time from surgery to starting PHT was associated with greater normalization of CI (β: -1.384, P = .008). A more abnormal CVAI before starting PHT was associated with greater overall improvement in CVAI (β: 0.342, p < 0.001).

Conclusions: PHT improved cranial shape and symmetry in patients regardless of suture type and surgical approach. PHT should be offered to patients with unicoronal, sagittal, and lambdoid synostosis and to patients who underwent either open CVR or ESC. Since less time from surgery to PHT was associated with greater improvements in CI, effective coordination between care teams and cranial orthotic device companies is encouraged.References1. Taheri Z, Babaee T, Moradi E, Hajiaghaei B, Mohammadi HR. Minimally invasive craniectomy and postoperative cranial remolding orthotic treatment in infants with craniosynostosis: A multicenter prospective study. World Neurosurg X. 2023;19:100207.2. Barone CM, Jimenez DF. Endoscopic craniectomy for early correction of craniosynostosis. Plast Reconstr Surg. 1999;104(7):1965-1973; discussion 1974-1975.

Comparison of Cephalic Index and Cranial Vault Asymmetry Index Before and After PHT Stratified Based on Suture Type

Comparison of Different Suture Types Percent Improvement in Head Symmetry and Proportion Anthropometrics after PHT

Calculations for Cephalic Index and Cranial Vault Asymmetry Index