The Temporal Region in Unilateral Coronal Craniosynostosis: Fronto-orbital Advancement Versus Endoscopy-Assisted Strip Craniectomy

Abstract

Objective: To compare postoperative temporal expansion in patients treated with fronto-orbital advancement or endoscopy-assisted craniectomy with cranial orthotic therapy.

Design: This is a retrospective, multicenter cohort study of patients with unilateral coronal craniosynostosis (UCS).

Setting: Computed tomographic (CT) scans were drawn from UCS patients treated at Boston Children's Hospital or St Louis Children's Hospital.

Patients: The study included 56 patients with UCS after fronto-orbital advancement (n = 32) or endoscopic repair (n = 24) and 10 age-matched controls.

Intervention: Fronto-orbital advancement entails a craniotomy of the frontal bone and superior orbital rim followed by reshaping and forward advancement. Endoscopic repair is the release of the synostotic suture and guidance of further growth of the cranium using a molding orthotic.

Main outcome measures: Measures included posterior temporal width, anterior temporal width, orbital width, and anterior cranial fossa area taken preoperatively and 1 year postoperatively. Linear regression was performed to assess 1 year postoperative improvement in symmetry; covariates included preoperative symmetry and type of surgery.

Results: Both treatments showed improvement in orbital width and anterior cranial fossa area symmetry 1 year postoperatively ( P < .001), but no significant improvement in posterior or anterior temporal width symmetry. Linear regression revealed no difference between the 2 procedures in any of the 4 measurements (.096 ≤ P ≤ .898).

Conclusions: Fronto-orbital advancement and endoscopic repair show equivalent outcomes 1 year postoperatively in all 3 width measurements and anterior cranial fossa area. Neither procedure produced significant improvement in temporal width.

Keywords: endoscopic; fronto-orbital advancement; temporal; unilateral coronal craniosynostosis.

Figure 1.

Three-dimensional volume renderings from computed tomographic (CT) scans of a patient with (A) right unilateral coronal synostosis preoperatively (top row) and 1 year postoperatively (bottom row) after fronto-orbital advancement and (B) left unilateral coronal synostosis preoperatively (top row) and 1 year postoperatively (bottom row) after endoscopic repair. Neosuture formation and/or persistent craniectomy gap are common after endoscopic repair in patients with unilateral coronal craniosynostosis (UCS; Sauerhammer et al., 2014).

Figure 2.

Three-dimensional volume renderings from a preoperative computed tomographic (CT) scan of a patient with unilateral coronal craniosynostosis (UCS). (A) A red spot denotes the location of each osseous landmark. Blue arrows denote width measurements. SZ signifies the superior-most point of the sphenozygomatic suture; ZF signifies the zygomaticofrontal suture. All osseous landmarks were measured on the exterior of the skull, as shown in the images on the left. The midline was established along the cranial base from the sella turcica to the anterior end of the cribriform plate (right). (B) The anterior cranial fossa is shown in red on the synostotic side and blue on the nonsynostotic side. The boundaries of the anterior cranial fossa were defined as the edge of the lesser sphenoid wing posteriorly and the cross-sectional surface of the frontal bone anteriorly.