Long-term anthropometric outcomes following surgery for isolated sagittal craniosynostosis

Deepak Agrawal M.B.B.S.1, M.Ch.1, Paul Steinbok M.B.B.S., F.R.C.S.(C)1, and D. Douglas Cochrane M.D., F.R.C.S.(C)1
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  • 1 Division of Pediatric Neurosurgery, Department of Pediatric Surgery, British Columbia’s Children’s Hospital, Children’s and Women’s Health Centre; and Division of Neurosurgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
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Object

A number of studies have shown good short-term cosmetic outcomes following surgery for isolated sagittal craniosynostosis. Whether the improvement in head shape persists in the longer term is less clear. The aim of this study was to investigate the long-term anthropometric outcomes following surgery for isolated sagittal craniosynostosis.

Methods

Records were retrospectively reviewed for children with isolated sagittal synostosis who underwent surgical revision between 1987 and 2000. Only children who underwent surgery before 8 months of age and for whom serial anthropometric data (skull width, skull length, and cephalic index) were available were included in the study. The operative procedure consisted of vertex and parietal craniectomies involving removal of the sagittal suture and a 1.5- to 2.5-cm piece of adjacent parietal bone on each side as well as bilateral parietal barrel-stave osteotomies.

Ninety cases satisfied the eligibility criteria. The mean age of the patients at surgery was 5 months (range 1.9–7.5 months). The mean preoperative cephalic index was 66.78. The follow-up period ranged from 1.8 to 167 months (mean 39.6 months). In 24 cases, the follow-up period was longer than 36 months. Eighteen (75%) and five (20.8%) of these 24 cases were followed up for longer than 5 and 10 years, respectively. The mean increase in cephalic index at the last follow up was 8.69% (p < 0.0001). The maximum improvement in the cephalic index occurred within 6 months of surgery, at which point it had improved by a mean of 11.1% (p < 0.0001). The cephalic index remained increased throughout the follow-up period, with a mean change of –1.84% (standard deviation, 4.28%; 99% confidence interval –3.33 to –0.37%) from the first postoperative to the final measurement.

Conclusions

Surgery for isolated sagittal craniosynostosis leads to a significant improvement in the cephalic index, which is most marked in the early postoperative period. Improvement in the cephalic index is still present after prolonged follow up.

Abbreviations used in this paper:

CI = confidence interval; SD = standard deviation.

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