gms | German Medical Science

Objective: Since more than a decade endoscopic minimal invasive cranioplasty in sagittal synostosis is an established surgical technique. Adjuvant helmet therapy is considered necessary to achieve normalization of the skull shape. The authors investigated their results with minimal invasive suturectomy without endoscopic assistance and no adjuvant helmet therapy.

Methods: We prospectively investigated consecutive patients with sagittal synostosis that have been operated with standard open cranioplasty or with minimal invasive procedure and compared both methods regarding outcome and clinical course. Open surgery was performed around 6th months age, minimal invasive at 3rd month. Instead of helmet therapy active occipital positioning was administered.

Results: 119 patients (28 female, 91 male) with sagittal synostosis have been operated between 2009 and 2015. Age was 2–15 months. In all patients 3D scans with morphometric measurements (head circumference, cephalic index, skull volume) prior and 6 and/or 12 months postoperatively and a final deformity assessment have been performed. In 31 patients all 3 datasets were available (11 standard, 20 minimal invasive). No statistical differences between the 2 groups could be found. The average preoperative and 12 months values were: skull volume: open 1229 and 1665 mm3, minimal invasive 879 and 1499 mm3; head circumference: open 45,9 and 49,1 cm, minimal invasive 42,4 and 48,3 cm; cephalic index: open 71,7 and 77,4, minimal invasive 70,1 and 76,5. Assessment of head shape by surgeons and families found in open surgery very good results in 1, good in 9 and fair in 1. One helmet therapy became necessary. The minimal invasive group had 6 very good, 10 good and 1 fair results. One child required recranioplasty due to relaps. In both groups no complications occurred, blood transfusion rate was slighty lower in the minimal invasive group.

Conclusion: Minimal invasive suturectomy in sagittal synostosis at early age without helmet therapy normalizes skull deformity. No differences could be found compared to standard open cranioplasty.