1The Craniofacial Center, Dallas, TX, USA, 2Former Fellow, The Craniofacial Center, Dallas, TX, USA, 3Dallas Craniofacial Center, Dallas, TX, USA.
Background: Numerous publications have examined technique-specific results in treating sagittal synostosis, but there is 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-staged posterior remodeling) patients were retrospectively reviewed (43 excluded for multi-sutural involvement, incomplete records, or non-surgical treatment). The surgical technique did not vary per the age of the patient, and the correction resulted in an intact calvaria with no skull defects left unfilled. Long-term growth was assessed from anthropologic measurements taken from 3 - 11 years postoperatively (mean = 4.7 years). Results: The surgical age ranged from 2 months to 5 years (mean = 8 months) and hospital stay was < 3 days. Seven of the 89 patients were over 18-months of age; four were between 3 and 5-years old. Following the institution (2001) of preoperative erythropoietin administration, and use of a cell saver for blood recycling, the overall transfusion rate decreased from 92% to 21% of patients. There were no deaths, major complications, infections, or repeat-remodeling procedures performed. Postoperatively, the cephalic index was over-corrected. Subsequent growth of the cranial breadth, and length were 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: In this series of patients, treated for scaphocephaly resulting from sagittal craniosynostosis, posterior remodeling resulted in normalization of the cephalic index without the need for a secondary procedure. This study demonstrated abnormal skull growth following surgical correction, with a tendency for the calvaria to revert towards scaphocephaly. Based on these findings, surgeons treating sagittal synostosis may wish to expand their goals of treatment beyond normalization, to an over-correction of the abnormal skull shape.