학술논문
What to do with an incidental finding of a fused sagittal suture: a modified Delphi study.
Document Type
Academic Journal
Author
Chiang SN; 1Department of Surgery, Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, St. Louis, Missouri.; 2Department of Surgery, Division of Plastic and Reconstructive Surgery, University of California, Los Angeles, California.; Reckford J; 1Department of Surgery, Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, St. Louis, Missouri.; Alexander AL; 3Department of Neurosurgery, University of Colorado Anschutz School of Medicine, Aurora, Colorado.; Birgfeld CB; 4Department of Surgery, Division of Plastic Surgery, University of Washington School of Medicine, Seattle, Washington.; Bonfield CM; Departments of5Neurological Surgery and.; Couture DE; Departments of6Neurological Surgery and.; David LR; 7Plastic and Reconstructive Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina.; French B; 8Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Colorado Anschutz School of Medicine, Aurora, Colorado.; Gociman B; 9Department of Surgery, Division of Plastic Surgery, University of Utah School of Medicine, Salt Lake City, Utah.; Goldstein JA; Departments of10Plastic Surgery and.; Golinko MS; 11Plastic Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee.; Kestle JRW; 12Department of Neurosurgery, University of Utah School of Medicine, Salt Lake City, Utah.; Lee A; 13Department of Neurological Surgery, University of Washington School of Medicine, Seattle, Washington.; Magge SN; 14Department of Neurosurgery, University of Michigan Medical School, Ann Arbor, Michigan.; Pollack IF; 15Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.; Rottgers SA; 16Division of Plastic and Reconstructive Surgery, and.; Runyan CM; 7Plastic and Reconstructive Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina.; Smyth MD; 17Department of Neurosurgery, Johns Hopkins All Children's Hospital, St. Petersburg, Florida; and.; Wilkinson CC; 3Department of Neurosurgery, University of Colorado Anschutz School of Medicine, Aurora, Colorado.; Skolnick GB; 1Department of Surgery, Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, St. Louis, Missouri.; Strahle JM; 18Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri.; Patel KB; 1Department of Surgery, Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, St. Louis, Missouri.
Source
Publisher: American Association of Neurological Surgeons Country of Publication: United States NLM ID: 101463759 Publication Model: Electronic-Print Cited Medium: Internet ISSN: 1933-0715 (Electronic) Linking ISSN: 19330707 NLM ISO Abbreviation: J Neurosurg Pediatr Subsets: MEDLINE
Subject
Language
English
Abstract
Objective: As many as 5% of normocephalic children may have a prematurely fused sagittal suture, yet the clinical significance and best course of management of this finding remain unclear. Providers in the Synostosis Research Group were surveyed to create a multicenter consensus on an optimal treatment and monitoring algorithm for this condition.
Methods: A four-round modified Delphi method was utilized. The first two rounds consisted of anonymous surveys distributed to 10 neurosurgeons and 9 plastic surgeons with expertise in craniosynostosis across 9 institutions, and presented 3 patients (aged 3 years, 2 years, and 2 months) with incidentally discovered fused sagittal sutures, normal cephalic indices, and no parietal dysmorphology. Surgeons were queried about their preferred term for this entity and how best to manage these patients. Results were synthesized to create a treatment algorithm. The third and fourth feedback rounds consisted of open discussion of the algorithm until no further concerns arose.
Results: Most surgeons preferred the term "premature fusion of the sagittal suture" (93%). At the conclusion of the final round, all surgeons agreed to not operate on the 3- and 2-year-old patients unless symptoms of intracranial hypertension or papilledema were present. In contrast, 50% preferred to operate on the 2-month-old. However, all agreed to utilize shared decision-making, taking into account any concerns about future head shape and neurodevelopment. Panelists agreed that patients over 18 months of age without signs or symptoms suggesting elevated intracranial pressure (ICP) should not undergo surgical treatment.
Conclusions: Through the Delphi method, a consensus regarding management of premature fusion of the sagittal suture was obtained from a panel of North American craniofacial surgeons. Without signs or symptoms of ICP elevation, surgery is not recommended in patients over 18 months of age. However, for children younger than 18 months, surgery should be discussed with caregivers using a shared decision-making process.
Methods: A four-round modified Delphi method was utilized. The first two rounds consisted of anonymous surveys distributed to 10 neurosurgeons and 9 plastic surgeons with expertise in craniosynostosis across 9 institutions, and presented 3 patients (aged 3 years, 2 years, and 2 months) with incidentally discovered fused sagittal sutures, normal cephalic indices, and no parietal dysmorphology. Surgeons were queried about their preferred term for this entity and how best to manage these patients. Results were synthesized to create a treatment algorithm. The third and fourth feedback rounds consisted of open discussion of the algorithm until no further concerns arose.
Results: Most surgeons preferred the term "premature fusion of the sagittal suture" (93%). At the conclusion of the final round, all surgeons agreed to not operate on the 3- and 2-year-old patients unless symptoms of intracranial hypertension or papilledema were present. In contrast, 50% preferred to operate on the 2-month-old. However, all agreed to utilize shared decision-making, taking into account any concerns about future head shape and neurodevelopment. Panelists agreed that patients over 18 months of age without signs or symptoms suggesting elevated intracranial pressure (ICP) should not undergo surgical treatment.
Conclusions: Through the Delphi method, a consensus regarding management of premature fusion of the sagittal suture was obtained from a panel of North American craniofacial surgeons. Without signs or symptoms of ICP elevation, surgery is not recommended in patients over 18 months of age. However, for children younger than 18 months, surgery should be discussed with caregivers using a shared decision-making process.