RESUMO
BACKGROUND AND OBJECTIVES: Surgical correction of nonsyndromic craniosynostosis (NSC) aims to restore cranial shape. Reossification of bone defects is paramount for the best aesthetic prognosis. However, the literature on the quantitative evaluation of bone defects after NSC surgery is scarce. This study aimed to quantify and analyze the surface area of bone defects after NSC surgery and establish a threshold value for predicting persistent defects. METHODS: We conducted a systematic review and a prospective study of 28 children undergoing surgical treatment for NSC. We analyzed 426 defects on the first computed tomography scan (1 year postoperative) and 132 defects on the second computed tomography scan (4.6 years postoperative). Statistical analysis was performed using Spearman's rank correlation coefficient, Mann-Whitney-Wilcoxon rank-sum test, and Youden's J statistic. RESULTS: Our systematic review identified three studies reporting on bone defects' surface area and reossification rate. In our study, we found no statistically significant differences in the number or size of defects between sex or type of NSC. The threshold value for the surface area of bone defects above which there was a higher probability of persistent defects was 0.19 cm2 (Youden point), with an 89.47 % probability of persistence. Defects with a surface area below 0.19 cm2 had a considerably lower probability, only 15.07%, of persistence over time. CONCLUSION: Our study provides valuable quantitative data for managing bone defects after NSC surgery. Defects with a surface area above 0.19 cm2 should be monitored with radiological imaging because of the risk of persistence. Our findings highlight the importance of developing robust and reproducible methods for the quantitative analysis of bone defects after NSC surgery.
RESUMO
BACKGROUND: Sophysa SM8 is widely used by neurosurgeons in France. Published studies report shunt malfunction rates in adults between 18% and 29%. However, these studies included multiple valve types and thus entailed a serious confounding factor. OBJECTIVE: To ascertain the incidence the Sophysa SM8 cerebrospinal fluid (CSF) shunt malfunctions in adults. METHODS: We present a retrospective series of adult patients who underwent CSF shunt placement between 2000 and 2013 with Sophysa SM8. RESULTS: In total, 599 patients (329 males and 270 females) were included. The mean age at surgery was 64.15 years (19-90) (SD 16.17; median 68.0). The causes of hydrocephalus were normal pressure hydrocephalus (49%), traumatic hemorrhages (26.5%), tumors (15.7%), cerebral aqueduct stenoses (3%), and arachnoid cysts (2%). The mean follow-up was 3.9 years (0-16) (SD 4.10; median 3 years). The rate of complications was 22.04% (132 of 599). Most frequent causes of complications were disconnection (25%), migration (12.9%), overdrainage (9.1%), and proximal obstruction (6.8%). In 17 cases (12.9%), no failure was diagnosed during revision. Seven infections (5.3%) were reported. The mean delay for the first revision was 1.70 years (0-13.93) (SD 2.67, median 0.35). The risk of shunt failure was 36% at 10 years. Seventeen percent of revisions occurred during the first year after shunt placement. CONCLUSION: Disconnections are a very frequent complication of Sophysa SM8 valve. They are related to the 2-connector system of this valve. Based on these results, we recommend using 1-piece valves.