CC BY-NC-ND 4.0 · Asian J Neurosurg 2024; 19(04): 610-617
DOI: 10.1055/s-0044-1791228
Review Article

The Role of Helmet Therapy in Craniosynostosis: A Systematic Review

1   Department of Neurosurgery, Aga Khan University Hospital, Karachi, Pakistan
,
Ayesha Sohail
1   Department of Neurosurgery, Aga Khan University Hospital, Karachi, Pakistan
,
Gohar Javed
1   Department of Neurosurgery, Aga Khan University Hospital, Karachi, Pakistan
,
Syeda Sana Samar
2   Department of Neurosurgery, Jinnah Sindh Medical University, Karachi, Pakistan
› Author Affiliations
Funding None.

Abstract

The aim of this study was to determine the impact of helmet therapy (HT) as a treatment for craniosynostosis, with a focus on the outcomes of skull morphology, reoperation rate, complications of HT, and quality of life of patients who receive it. A systematic literature review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The review utilized the PICO format: Does HT following strip craniectomy (SC) improve outcomes (outcome) compared to SC alone (comparison) in patients undergoing craniosynostosis correction (intervention)? Searches were performed from January 1, 2000 to December 31, 2022, using PubMed, Cochrane Library, and Ovid Medline databases. Study quality was evaluated using the National Heart, Lung, and Blood Institute (NHLBI) quality assessment scale. Fourteen studies meeting the inclusion criteria were identified. Among these, 438 patients underwent SC-HT, while 104 patients underwent SC without HT. The preoperative cephalic indices for sagittal craniosynostosis in the HT and non-HT groups were 66.8 and 67.8, respectively, which improved postoperatively to 75 and 76.2, respectively. Limited long-term follow-up hindered a definitive assessment of reoperation rates. Complication rates related to HT were low at approximately 2.9%, primarily consisting of skin irritation. Parental satisfaction was high, correlating with a strong compliance rate. Existing literature does not demonstrate a clear superiority between SC with or without HT for treating nonsyndromic sagittal craniosynostosis. Outcomes appear comparable, but evidence is constrained by the predominance of single-center retrospective studies with limited methodological rigor. There is a pressing need for international multicenter trials to furnish more robust and generalizable findings.

Authors' Contributions

F.S. contributed to conception of the study and writing of the manuscript draft, data collection and screening, and data analysis and interpretation, and gave final approval of the version to be published. A.S. contributed to data collection and screening and analysis and interpretation of data, and gave final approval of the version to be published. G.J. contributed to conception and design of the manuscript, critical revision of the manuscript, and analysis and interpretation of data, and gave final approval of the version to be published. S.S.S. contributed to revision of the manuscript draft and gave final approval of the version to be published.


Supplementary Material



Publication History

Article published online:
30 September 2024

© 2024. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Kabbani H, Raghuveer TS. Craniosynostosis. Am Fam Physician 2004; 69 (12) 2863-2870
  • 2 Arts S, Delye H, van Lindert EJ. Intraoperative and postoperative complications in the surgical treatment of craniosynostosis: minimally invasive versus open surgical procedures. J Neurosurg Pediatr 2018; 21 (02) 112-118
  • 3 Riordan CP, Zurakowski D, Meier PM. et al. Minimally invasive endoscopic surgery for infantile craniosynostosis: a longitudinal cohort study. J Pediatr 2020; 216: 142-149.e2
  • 4 Mehta VA, Bettegowda C, Jallo GI, Ahn ES. The evolution of surgical management for craniosynostosis. Neurosurg Focus 2010; 29 (06) E5
  • 5 Yan H, Abel TJ, Alotaibi NM. et al. A systematic review of endoscopic versus open treatment of craniosynostosis. Part 2: the nonsagittal single sutures. J Neurosurg Pediatr 2018; 22 (04) 361-368
  • 6 Lee HQ, Hutson JM, Wray AC. et al. Analysis of morbidity and mortality in surgical management of craniosynostosis. J Craniofac Surg 2012; 23 (05) 1256-1261
  • 7 Seymour-Dempsey K, Baumgartner JE, Teichgraeber JF, Xia JJ, Waller AL, Gateno J. Molding helmet therapy in the management of sagittal synostosis. J Craniofac Surg 2002; 13 (05) 631-635
  • 8 Checklist P. PRISMA: Transparent Reporting of Systematic Reviews and Meta-Analyses. Accessed September 19, 2024 at: https://www.prisma-statement.org/
  • 9 National Heart, Lung, and Blood Institute. Study Quality Assessment Tools. Bethesda, MD: National Heart, Lung, and Blood Institute;; 2021
  • 10 Baumgartner JE, Teichgraeber JF, Waller AL, Grantcherova E, Gateno J, Xia JJ. Microscopic approach to craniosynostosis. J Craniofac Surg 2005; 16 (06) 997-1005
  • 11 Jimenez DF, Barone CM. Early treatment of coronal synostosis with endoscopy-assisted craniectomy and postoperative cranial orthosis therapy: 16-year experience. J Neurosurg Pediatr 2013; 12 (03) 207-219
  • 12 Erşahin Y. Endoscope-assisted repair of metopic synostosis. Childs Nerv Syst 2013; 29 (12) 2195-2199
  • 13 Gociman B, Agko M, Blagg R, Garlick J, Kestle JR, Siddiqi F. Endoscopic-assisted correction of metopic synostosis. J Craniofac Surg 2013; 24 (03) 763-768
  • 14 Lajthia O, Rogers GF, Tsering D, Keating RF, Magge SN. Quantitative outcomes of endoscopic strip craniectomy for metopic craniosynostosis in children with severe trigonocephaly. Childs Nerv Syst 2021; 37 (02) 573-579
  • 15 Delye HHK, Arts S, Borstlap WA. et al. Endoscopically assisted craniosynostosis surgery (EACS): the craniofacial team Nijmegen experience. J Craniomaxillofac Surg 2016; 44 (08) 1029-1036
  • 16 Persad A, Aronyk K, Beaudoin W, Mehta V. Long-term 3D CT follow-up after endoscopic sagittal craniosynostosis repair. J Neurosurg Pediatr 2019; 25 (03) 291-297
  • 17 Hwang JH, Yang J, Kim KH. et al. Combined unilateral coronal-lambdoid suture synostosis: surgical outcome of suturectomy and postoperative helmet therapy. Childs Nerv Syst 2021; 37 (01) 277-286
  • 18 Jimenez DF, Barone CM. Early treatment of anterior calvarial craniosynostosis using endoscopic-assisted minimally invasive techniques. Childs Nerv Syst 2007; 23 (12) 1411-1419
  • 19 Sauerhammer TM, Seruya M, Ropper AE, Oh AK, Proctor MR, Rogers GF. Craniectomy gap patency and neosuture formation following endoscopic suturectomy for unilateral coronal craniosynostosis. Plast Reconstr Surg 2014; 134 (01) 81e-91e
  • 20 Schouman T, Vinchon M, Ruhin-Coupet B, Pellerin P, Dhellemmes P. Isolated bilateral coronal synostosis: early treatment by peri-fronto-orbital craniectomy. J Craniofac Surg 2008; 19 (01) 40-44
  • 21 Gociman B, Marengo J, Ying J, Kestle JR, Siddiqi F. Minimally invasive strip craniectomy for sagittal synostosis. J Craniofac Surg 2012; 23 (03) 825-828
  • 22 Murray DJ, Kelleher MO, McGillivary A, Allcutt D, Earley MJ. Sagittal synostosis: a review of 53 cases of sagittal suturectomy in one unit. J Plast Reconstr Aesthet Surg 2007; 60 (09) 991-997
  • 23 Bonfield CM, Lee PS, Adamo MA, Pollack IF. Surgical treatment of sagittal synostosis by extended strip craniectomy: cranial index, nasofrontal angle, reoperation rate, and a review of the literature. J Craniomaxillofac Surg 2014; 42 (07) 1095-1101