Sagittal craniosynostosis outcome assessment for two methods and timings of intervention

A retrospective quantitative analysis of 40 infants who underwent surgery f or sagittal craniosynostosis was conducted to determine whether any differe nce in outcome, with respect to cranial index (cranial width/cranial length x 100), could be associated with either the age at surgery or the extent o f the operation. Children less than or equal to 13 months old at surgery an d for whom there were archived computed tomography digital data precoperati vely , perioperatively, and 1 year postoperatively were studied. For statis tical analysis, the operation was classified as either extended strip crani ectomy or subtotal calvarectomy, and the age at operation was either less t han or equal to 4 months or >4 months. Twenty-eight patients underwent exte nded strip craniectomy at a mean age of 5.1 months. Their mean cranial inde x preoperatively was 67 versus 71 at 1 year postoperatively (p < 0.0001). O f extended strip craniectomy patients, 15 were operated on at age less than or equal to 4 months (mean = 2.9 months) and 13 at age >4 months (mean = 7 .6 months). Mean cranial indices for age at operation groups did not achiev e age-appropriate normal range values 1 year post operatively for either gr oup, and there was no significant difference between the mean percentages o f improvement achieved (P = 0.143). Twelve patients underwent subtotal calv arectomy at a mean age of 5.2 months. Their mean cranial index preoperative ly was 66 versus 74 at 1 year postoperatively (p < 0.0001). The mean crania l index in this group reached age-appropriate normal range values 1 year po stoperatively, The percentage improvement in cranial index 1 year after sub total calvarectomy was greater than after extended strip craniectomy (P = 0 .003). Extended strip craniectomy for sagittal craniosynostosis does not achieve n ormal cranial width:length proportions, even when performed before 1 months of age. Subtotal calvarectomy for sagittal craniosynostosis does achieve n ormal cranial width:length proportions in the majority: of the children, at least when pet-formed within the first 13 months of life.