The reversal exchange technique of total calvarial reconstruction for sagittal synostosis

The role of total calvarial reconstruction in the treatment of sagittal syn ostosis remains controversial, especially in patients younger than 1 year o f age. The purpose of this study was to prospectively evaluate the efficacy of a single surgical technique for total calvarial reconstruction (the rev ersal exchange technique) in patients younger than 1 year of age who had a radiographically confirmed diagnosis of sagittal synostosis. Twenty-three c onsecutive patients underwent the reversal exchange technique of total calv arial reconstruction at a median age of 3 months (age range, 6 weeks to 10 months). Quantitative assessments were performed on the basis of preoperati ve and postoperative (minimum, 6 months) measurements of the cephalic index (cranial width/cranial length x 100) taken from three-dimensional computed tomography scans, which were obtained in 18 of 23 patients. Aesthetic asse ssments were performed on the basis of the grading of preoperative and post operative photographs, obtained in 17 of 23 patients, by three independent raters who were blinded as to the surgical technique. The mean preoperative cephalic index was 65.0, and the mean postoperative index was 76.4, yieldi ng a mean improvement of 11.4 (17.5 percent). By photographic evaluation, 1 2 of 17 patients (70.6 percent) were classified as having a normal head sha pe (grade 4) and five of 17 (29.4 percent) as having minor residual deformi ties (grade 3). No patients were identified as having significant residual deformities (grade 1 or 2). There were two intraoperative complications and one postoperative complication, none of which resulted in permanent morbid ity. It was concluded that the reversal exchange technique of total calvari al reconstruction provided significant improvement in head shape on the bas is of quantitative measurements (cephalic index) and independent evaluation s of aesthetic improvement.