Utility of Pre-Operative Helmet Molding Therapy in Patients with Isolated Sagittal Craniosynostosis
Zachary D. Zapatero1, Steven K. Slawinski2, Mychajlo S. Kosyk1, Christopher L. Kalmar1, Liana Cheung1, Anna R. Carlson1, Jordan W. Swanson1, Jesse A. Taylor1, Scott P. Bartlett1
1The Children's Hospital of Philadelphia , Philadelphia, PA, 2Boston Orthotics & Prosthetics, Philadelphia, PA
Purpose The use of helmet molding therapy to correct abnormal cranial morphology was first described in 1979 to treat plagiocephaly associated with congenital torticollis. The idea of using pre-operative helmet molding therapy to improve cranial index (CI) in patients with isolated sagittal synostosis was introduced in 2011. The purpose of this study was to review our institution's experience using helmet molding therapy in children with isolated non-syndromic sagittal craniosynostosis prior to placement of cranial springs and provide objective measurements of craniometric changes to help determine its role in treatment.
Methods: Patients who underwent pre-operative helmet molding therapy for sagittal craniosynostosis were retrospectively reviewed. Three-dimensional surface tomography scans were acquired using a Polhemus FastScan Handheld Class I Laser Scanner (Polhemus, Vermont, United States). The raw images were processed using Rodin4DScan software (Rodin 4D, Merignac, France) to create a solid object and place the head in the Frankfort horizontal. The scan exported to the Rodin4D Neo software to measure head circumference, cranial width, cranial length, cranial index, and cranial vault asymmetry. Head circumference percentiles were calculated according to CDC growth charts. Pre- and post-helmeting elements were compared using appropriate statistics. Result Seventeen patients underwent orthotic helmeting therapy prior to spring mediated cranial vault expansion. Patients spent a median of 48 days [IQR 32, 57] in pre-operative orthotic helmeting therapy. There were increases in both cranial width and length post-helmeting (median: 107.5 mm [IQR 104.8, 110.4] vs 115.6 mm [IQR 114.5, 119.3]; p<0.001) (median: 152.8 mm [IQR 149.2, 154.9] vs 156.8 mm [IQR 155.0, 161.5]; p<0.001), respectively. There was a greater increase in cranial width (p=0.015). Consequently, patients' cranial index improved after pre-operative helmeting (median: 0.702 [IQR 0.693, 0.717] vs 0.739 [0.711, 0.752]; p<0.001). There was no evidence of growth restriction from helmeting (pre-helmeting HC: median 96.8 percentile [IQR 90.6, 99.9] vs Post-helmeting HC: 98.7 percentile [IQR 94.7, 99.8]; p=0.109). Patients had evidence of a mild degree of cranial vault asymmetry that improved after helmeting (pre-helmeting: median 2.4 mm [IQR 1.3, 3.4] vs post-helmeting: 1.6 mm [IQR 0.6, 2.3]; p=0.049).
Conclusion: Pre-operative orthotic helmeting in patients with non-syndromic isolated sagittal craniosynostosis can be used to improve CI and correct cranial vault asymmetry prior to surgical correction. Significant benefits can be achieved in shorter pre-operative helmeting durations than previously reported with no evidence of cranial growth restriction, which supports its feasibility and utility in children undergoing spring mediated cranial vault expansion.
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