SURGICAL-MANAGEMENT OF SAGITTAL SYNOSTOSIS - A COMPARATIVE-ANALYSIS OF STRIP CRANIECTOMY AND CALVARIAL VAULT REMODELING

Although surgical treatment of sagittal synostosis has become normativ e, the procedure of choice is still debated. This retrospective analys is, during a 10-year period (1986-1995) at Children's Hospital Los Ang eles, compares the more conservative strip craniectomy (SC) procedure with a more extensive occipital reduction-biparietal widening calvaria l vault remodeling (CVR) technique for the management of sagittal syno stosis. SC was performed in 72 patients (61%) and CVR in 46 (39%). Pat ients undergoing CVR were older (mean 5.3 vs. 3.0 months, p < 0.01), t he procedure time longer(mean 126 min vs. 72 min, p < 0.01), intraoper ative blood loss greater (mean 243 vs. 54 cm(3), p < 0.01), and the fr equency of intraoperative blood transfusion increased (100 vs. 38%, p < 0.01; mean volume 357 vs. 51 cm(3), p < 0.01) compared to patients u ndergoing SC. No significant intraoperative complications occurred in either group. The total time of hospitalization was similar (mean 4.4 vs. 3.8 days, p = 0.02). No neurological, hematological, or transfusio n-related complications or deaths were encountered in either group. Co smetic outcomes were significantly better in the CVR group with 79% ra ted as excellent compared to 41% in the SC group (p < 0.01). Fifty-nin e percent of the SC patients manifested bony defects at last follow-up visit. Two SC patients required reoperation for poor cosmetic outcome s; CVR was successfully employed in both cases. These findings demonst rate that CVR is superior to SC in providing immediate and lasting cor rection of calvarial deformities secondary to sagittal synostosis. The optimal age at time of surgery is <6 months; however, CVR can be util ized throughout infancy, while SC becomes progressively less effective after 6 months of age. No significant complications were observed in either group, despite the increased operative manipulation and greater incidence of blood transfusion in the CVR patients.