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James E. Baumgartner, Kelly Seymour-Dempsey, John F. Teichgraeber, James J. Xia, Amy L. Waller and Jaime Gateno

S caphocephaly is a common craniofacial abnormality that results from craniosynostosis of the sagittal suture. There are children, however, who present with nonsynostotic scaphocephaly, so-called sticky sagittal suture. These children exhibit the same abnormal head growth as those with sagittal synostosis, although CT scanning demonstrates a patent sagittal suture. They have no history of prematurity or lateral head positioning. Moreover, if the cranial deformity in these patients is left untreated, it progresses to the same clinical manifestation of sagittal

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R. Shane Tubbs, George Salter, Scott Elton, Paul A. Grabb and W. Jerry Oakes

T he anatomical relationship that exists between the SSS and the sagittal suture has not been sufficiently studied. Often, the surgeon assumes that the sagittal suture externally marks the SSS along the former's course between the coronal and lambdoid sutures. This study was undertaken to examine this relationship in cadaveric specimens. Materials and Methods Thirty formalin-fixed adult cadavers were dissected to elucidate the relationship between the SSS and the sagittal suture. There were 18 male and 12 female cadavers; the age range at death was 60 to

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Deepak Agrawal, Paul Steinbok and D. Douglas Cochrane

, with or without occipital or frontal remodeling. Most techniques used in infants do not create a fixed construct of the cranial vault, but rely on the immediate widening of the skull with release of the sagittal suture, supplemented by further remodeling with rapid brain growth or by external pressure with an orthosis for a good result. The basis of the management of isolated sagittal craniosynostosis is that it typically occurs as an isolated entity in an otherwise healthy child, 1 with operative intervention usually being offered to improve cosmesis. It has been

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Leonardo Rangel-Castilla, Steven W. Hwang, Andrew Jea, William E. Whitehead, Daniel J. Curry, Thomas G. Luerssen and Robert C. Dauser

craniosynostosis. 3 , 6 Few cases of nonsyndromic multiple-suture craniosynostosis, or newly appearing secondary synostosis, have been reported, but most fused sutures are diagnosed concurrently, and plans for reconstruction include all deformities. 3 We report on a patient in whom sagittal suture synostosis was diagnosed and confirmed by CT scanning and in whom a unilateral coronal suture synostosis subsequently developed. Case Report Examination This 2-month-old girl was born at 35 weeks' gestation. She had a concomitant history of multiple congenital

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David F. Jimenez and Constance M. Barone

Object

The purpose of this study was to assess the efficacy, safety, associated complications, and outcome in patients with sagittal suture craniosynostosis in whom endoscopy-assisted wide-vertex craniotomy and “barrel-stave” osteotomy were performed.

Methods

During a 4-year period, 59 patients with sagittal suture synostosis underwent endoscopy-assisted wide-vertex craniectomies, barrel stave–like osteotomies, and postoperatively were fitted with custom-made molding helmets. Data on operative time, blood loss, transfusion rates, hospital length of stay, complications, and hospital charges were collected prospectively. The mean patient age at the time of surgery was 3.7 months. The average blood loss was 31.8 ml; and only one patient required an intraoperative blood transfusion. Nine patients received transfusions of donor blood postoperatively. The mean operative time was 50 minutes, and all but three patients were discharged from the hospital the morning following surgery. There were no intraoperative complications. Normocephaly as well as normal cephalic indices were observed at latest follow up.

Conclusions

The authors conclude that early treatment of infants with sagittal suture craniosynostosis by using minimally invasive, endoscopy-assisted wide-vertex craniectomies provides excellent results and a significantly lower morbidity rate than traditional calvarial vault reconstructive procedures.

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Han Yan, Taylor J. Abel, Naif M. Alotaibi, Melanie Anderson, Toba N. Niazi, Alexander G. Weil, Aria Fallah, John H. Phillips, Christopher R. Forrest, Abhaya V. Kulkarni, James M. Drake and George M. Ibrahim

usage that have not been studied. The long-term efficacy and costs require ongoing research. Strengths and Limitations Strengths of this study include an extensive search of the current literature, strict adherence to PRISMA guidelines, and quality of evidence analysis by EPHPP protocol. Currently, there exists no randomized controlled trial comparing the surgical approaches of endoscopic and open sagittal suture repair. Given the data suggesting absence of equipoise between the two techniques, it is unlikely that such a trial would be conducted. Ultimately, the

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David F. Jimenez, Constance M. Barone, Maria E. McGee, Cathy C. Cartwright and C. Lynette Baker

patients with sagittal suture synostosis in whom endoscopy-assisted wide-vertex craniectomies were performed with bitemporal and biparietal barrel stave osteotomies. Postoperatively custom-made cranial molding helmets were placed to achieve and maintain normocephaly. The results of using endoscopic techniques in the management of sagittal synostosis are presented. We present follow-up data after the original introduction of the technique several years ago. 20 Clinical Material and Methods Patient Population One hundred thirty-nine consecutive children in whom

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Fangxiang Chen, Tsinsue Chen and Peter Nakaji

laterally from the sagittal suture. Therefore, the traditional method can lead to an inaccurate estimate of the entry point. When image guidance is used, adjustments may be made on preoperative image planning by using a trajectory view to compensate for this difference. However, when such technology is unavailable, this seemingly slight inaccuracy could become substantially magnified further along the trajectory, thereby risking injury to critical structures adjacent to the projected path. In such cases, a calculated degree of offset between the coronal suture and a

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Tatiana Protzenko Cervante, Eric Arnaud, Francis Brunelle and Federico Di Rocco

of the SSS. Generally, the SSS is considered to be under the sagittal suture, which is considered an external landmark of SSS between the bregma and the lambda. 14 However, some authors have questioned this anatomical relationship, 6 , 16 , 19 and further studies are needed. The aim of the present study is 3-fold: 1) to study the position of the SSS in relation to the sagittal suture in 50 patients with UCS; 2) to compare this anatomical relationship between patients with UCS and 50 control children without craniosynostosis; and 3) to study the presence of

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Gregory H. Jenkins, Nicola R. Smith and P. Daniel McNeely

sagittal suture and closure of the anterior and posterior fontanels. There was frontal bossing, and her cranial index was 0.70. F ig . 1. Preoperative skull radiographs, anteroposterior (left) and lateral (right) projections, demonstrating sagittal craniosynostosis and patency of the coronal and lambdoid sutures. F ig . 2. Preoperative photographs of the 3-month-old girl with isolated sagittal suture craniosynostosis. Note the scaphocephaly and frontal bossing. First Operation At 3 months of age, she underwent a successful, uncomplicated