gms | German Medical Science

Objective: The premature closure of the sagittal suture is a condition that may need operative correction, mainly for cosmetic and psychological reasons. We developed some modifications of the surgical technique in an attempt to further improve cosmetic results.

Methods: Since 1985, 400 surgical procedures in 379 patients with sagittal synostosis have been performed in our department. Depending on the different age at the operation we applied different therapeutical strategies:

During the first six months of life we performed a wide vertex craniectomy. This was modified with a morcellation technique at operations performed in the second half of the first year of life. More recently, an additional tilting of the forehead was done in selected cases. Starting 4 days after the operation the head was wrapped for 4-8 weeks in order to assist the remodeling of the cranial shape.

Patients older than 11 months were subjected to an extended cranial vault reconstruction.

Over the time we changed fixation techniques from wire sutures to non-resorbable and resorbable plates and finally to simple resorbable sutures in all procedures requiring reposition of bone segments.

Results: During the 22-year period 278 simple vertex craniectomies, 34 craniectomies with additional tilting of the forehead, 15 morcellation procedures and 73 cranial vault reconstructions were performed. The more radical surgical techniques resulted in an improved correction of the bulging forehead, the bregma height, and the parietal width and height although biometric parameters did not necessarily mirror the improved clinical aspect. The major drawback of these modifications, an increased blood loss, did not result in a higher complication rate.

Conclusions: Our currently applied modifications towards a more radical approach have turned out to be effective means to improve cosmetic results of surgery for scaphocephaly at the expense of a small, yet tolerable increment of surgical risk.