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American Association of Plastic Surgeons
27. Sagittal Craniosynostosis: Surgical Outcomes and Long-term Growth
Jeffrey A. Fearon, MD1, Emily B. McLaughlin, MD2, John C. Kolar, PhD3.
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.

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