Multiple methods have been described for the correction of sagittal craniosynostosis. Since 1993, we have used a modified surgical technique in 22 consecutive cases that includes: complete resection of the closed suture, parieto-occipital osteotomies, reshaping of the cut bones, and creation of bilateral trap-door mechanism which allows unimpeded transverse brain growth. This method can be modified to include frontal and occipital osteotomies if necessary.

Follow-up of at least 6 months is available in all cases. Representative perioperative photographs and radiographs of standard and extreme cases are presented. Most patients were operated in infancy. Clinical examination and computed tomography scans taken preoperatively and postoperatively confirm normalization of cranial index. One patient required reoperation for raised intracranial pressure. There were no deaths. One intravenous wound healed without surgery. No patients required subsequent cranioplasties or device removal. Helmets were not used for cranial shaping. Average hospitalization was three days.

Conclusions: (1) The surgical literature insufficiently documents both recurrence and morbidity of sagittal craniosynostosis, (2) The risks of exsanguinating hemorrhage, recurrence of craniosynostosis, and persistent abnormal head shape demand a surgical strategy favoring safety and reliability, and (3) the construction of a trap-door mechanism has simplified the goal of restoration of normal cranial shape.