Jukic, Alma

Objective To evaluate the incidence and characteristics of secondary synostosis following spring-mediated cranioplasty (SMC) for nonsyndromic sagittal craniosynostosis. Design Retrospective cohort study. Setting Single tertiary pediatric hospital. Patients/Participants Ten patients with isolated sagittal craniosynostosis who underwent primary SMC between 2021 and 2023. Patients with syndromic diagnoses or prior cranial surgery were excluded. Interventions SMC was performed using 2 to 3 stainless-steel springs following sagittal strip craniectomy. Springs were typically removed 3 to 4 months postoperatively. Follow-up included review of clinical photographs, radiographs, and operative records. Main Outcome Measures Change in cephalic index (CI) from preoperative to postoperative assessment and occurrence of secondary suture fusion, particularly coronal synostosis. Results Mean age at surgery was 4 months (range, 3-6 months). Mean CI improved from 68.5 to 79 following expansion. Three patients (30%) developed left unicoronal synostosis (UCS) during the perioperative period prior to spring removal. One patient required secondary coronal suturectomy for significant frontal asymmetry, while 2 were observed without intervention. Conclusions Secondary synostosis, particularly UCS, may represent an underrecognized sequela of SMC. Altered biomechanical forces or asymmetric cranial remodeling during distraction may contribute to this finding. Larger, multicenter studies with longitudinal imaging are warranted to determine incidence, risk factors, and preventive strategies.

Objective: Our objective is to examine which sociodemographic factors may influence the time of presentation of patients with craniosynostosis, which can impact perioperative outcomes. Design: Retrospective cohort study. Setting: Tertiary pediatric hospital. Patients, Participants: All patients with nonsyndromic sagittal synostosis who underwent surgery at a tertiary pediatric hospital from January 1, 2007 to January 2, 2024 were eligible for inclusion. Interventions: Comparing demographic variables between those undergoing early and late craniosynostosis repair. Main Outcome Measure(s): Demographic variables, social vulnerability index (SVI) and area deprivation index (ADI), median household income, education rate, and employment rates. Results: 77.5% (n = 234) of patients underwent minimally invasive repair. 22.5% (n = 68) underwent open cranial vault remodeling. Age at consultation differed significantly between those undergoing early repair compared to late repair (0.18 years v. 1.01 years, P < .0001). Patients undergoing late repair were more likely to be Hispanic (42.6% v. 24.4%, P = .0378), on public insurance (66.2% v. 45.3%, P = .0079), have lower parental education rates (24.78% vs. 31.64%, P = .0019), and lower median household income ($65 657 vs. $75 281, P = .0226). Interestingly, ADI scores and SVI scores did not significantly differ between groups. Conclusions: Patients who presented later for treatment of nonsyndromic sagittal synostosis had lower median household income, were more likely to be Hispanic, had lower parental education rates, and were more likely to be on public insurance compared to those who received early treatment.