Massachusetts Chapter of the American College of Surgeons

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Decision Making in Sagittal Synostosis
Christopher D. Hughes,MD MPH1; Olivia Langa,BA2; Laura Nuzzi,BA2; Steven J. Staffa,MS3; Mark Proctor,MD2; John G. Meara,MD DMD MBA2; Ingrid M. Ganske,MD MPA2
1Division of Plastic and Craniofacial Surgery, Connecticut Children's, Hartford, CT 2 Department of Plastic and Oral Surgery,Boston Children's Hospital, Boston, MA 3 Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital

Background: Surgical correction of craniosynostosis is undertaken to address concerns about potential elevated intracranial pressure and the cranial deformity. In nonsyndromic sagittal synostosis, approximately 15% of patients have elevated intracranial pressure. The decision to operate therefore likely reflects a combination of aesthetic goals, prevention of possible brain growth restriction over time, surgeon training and experience, and parental expectations. This study examines the clinical factors that influence surgical decision making in nonsyndromic sagittal synostosis. Methods:An online survey was sent to craniofacial and neurosurgeons presenting five theoretical patients with varying severities of sagittal synostosis. For each cephalic index severity, four separate clinical scenarios were presented to assess the influence of parental concern and developmental delay on the decision to operate.
Results: Fifty-six surveys were completed (response rate=28%). Participants were predominantly from North America (57%), had over ten years of experience (75%), and performed over 20 craniosynostosis procedures annually (50%). Thirty percent of respondents indicated they would operate regardless of head shape and without clinical and/or parental concern. Head shape was the greatest predictor of decision to operate (p<0.05).
Conclusion: There was a low rate of systemic and local complications with no bleeding complications. The rate of hypersensitivity reaction to cyanoacrylate glue was 23%. All patients were treated with a steroid course and anti-inflammatory medications without significant long-term complication. Overall, varicose vein interventions in the elderly are safe and effective in the outpatient, community setting.


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