Absorbable sutures for the achievement of stable osteosynthesis in surgery for craniosynostosis.

AIM OF THE STUDY: The goal of the present study was to analyse the exclusive use of absorbable suture material (Vicryl) in the fixation of transposed bone segments in cranial vault reshaping without modification of the osteotomy design. CLINICAL RATIONALE FOR THE STUDY: In the surgical correction of craniosynostosis, bone fixation using osteosynthesis is a key step. Absorbable osteosynthesis is a widespread tool in cranial vault remodelling, but only a limited number of studies have described the use of absorbable sutures in the treatment of patients with craniosynostosis. MATERIALS AND METHODS: In 72 children with various types of craniosynostosis, up to 24 months of age, osteosynthesis was conducted exclusively with Vicryl sutures. All patients were evaluated for the stability of postoperative results, and foreign body reactions were examined as part of the routine clinical and radiological follow-up ranging from 1 to 36 months. RESULTS: All examined children exhibited stable postoperative conditions with immediate stability of all remodelled cranial vaults. 2D and 3D radiological examinations demonstrated good bony union in all cases. Significant foreign body reactions were not observed and bone healing was noted at all sites. CONCLUSION AND CLINICAL IMPLICATIONS: The exclusive application of absorbable suture material enables stable and cost-effective osteosynthesis in craniofacial surgery without altering the osteotomy design.

Intrathecal baclofen in mucopolysaccharidosis type II (Hunter syndrome): case report.

PURPOSE: Intrathecal baclofen administration is commonly used in the treatment of children's spasticity. In general, candidates for baclofen pump are patients with spastic form of cerebral palsy. Intrathecal baclofen in the treatment of spasticity due to a metabolic disorder is rarely reported. METHODS: Authors report on an 11-year-old boy with mucopolysaccharidosis type II (Hunter syndrome) with progressive stiffness and contractures followed by profound loss of joint movement range and tiptoe walking pattern. Patient was indicated for baclofen test with subsequent pump insertion and continuous intrathecal baclofen administration. RESULTS: Postoperatively, patient was gradually set to current baclofen dose of 250 µg/day. At mentioned dose, we observed not only increased active and passive range of movements and facilitation in fine motor skills, but also better walking pattern. CONCLUSIONS: Despite intrathecal baclofen administration in patients with spasticity related to mucopolysaccharidosis type II is not widely reported, we consider it as feasible treatment. To emphasize, enzyme replacement therapy is the primary treatment, and improvement is attributed to both enzyme substitution and intrathecal baclofen therapy.

Anthropometry of craniosynostosis.

BACKGROUND: Anthropometry is becoming a popular method for diagnostics of various diseases in pediatric clinical practice. The aim of this study was to assess the growth changes in craniofacial parameters in patients with craniosynostosis and positional plagiocephaly. METHODS: Inclusion criteria for the study were presence of craniostenosis or positional plagiocephaly in a patient with at least three anthropometric evaluations at our department. Studied patients were aged from 1.0 month to 2.5 years with median age at the first and last anthropometric evaluation as 1.83 and 25.27 months, respectively. Further anthropometric results in patients older than 2.5 years were excluded from the study. Statistical significance was tested by the Mann-Whitney test. RESULTS: The studied group consisted of 70.5% male patients. The type of craniosynostosis was represented by scaphocephaly in 44.1%, by trigonocephaly in 45.6% and by coronal craniosynostosis in 10.3% of the cases. Cranial index was proven as a suitable parameter for evaluating differences in the trend of growth in craniosynostosis (p<0.001) and also for evaluating post-operative results. Significance was found in width of the head (p=0.038) for scaphocephaly and in length of the head for trigonocephaly (p=0.001) in surgically treated patients. Trend of cranial growth in operated patients copied the curve of the norm but in higher or lower values which depends on the type of prematurely closed suture. CONCLUSION: Longitudinal anthropometric follow-up is an objective and measurable method that can accurately non-invasively and non-expensively assess skull growth in pediatric patients with cranial deformity.