Sagittal craniosynostosis: Surgical outcomes and long-term growth

Background: Numerous publications have examined technique-specific results in treating sagittal synostosis, but there are scant data examining long-term outcomes. This retrospective study was designed to evaluate a large series of surgically repaired children with sagittal craniosynostosis and to examine long-term cranial growth following correction. Methods: From 1990 to 2003, 132 children with sagittal synostosis were evaluated and 89 surgically treated (single-stage posterior remodeling) patients were retrospectively reviewed (43 were excluded for multisutural involvement, incomplete records, or nonsurgical treatment). Long-term growth was assessed from anthropologic measurements taken from 3 to 11 years postoperatively (mean, 4.7 years). Results: The surgical age ranged from 2 months to 5 years (mean, 8 months), and the hospital stay was less than 3 days. There were no deaths, major complications, infections, or repeated remodeling procedures performed. Postoperatively, the cephalic index was overcorrected. Subsequent growth of the cranial breadth and length was less than predicted. Moreover, growth was more deficient in cranial breadth than length, resulting in a regression of the cephalic index over time (p < 0.01). Frontal breadth improved immediately postoperatively but did not subsequently narrow over time. Head circumference also showed a statistically significant diminished capacity for growth (p < 0.001). Conclusions: This study demonstrated abnormal skull growth in children following the surgical correction of scaphocephaly. On the basis of these findings, surgeons treating sagittal synostosis may wish to expand their goals of treatment beyond normalization to an overcorrection of the abnormal skull shape.