Purpose: Few large series have been published examining treatment for the single sutural synostoses, and fewer have examined long-term outcomes. Families are typically counseled that following surgical correction, their child's growth should be normal. We recently published data showing that growth was not normal following sagittal synostosis correction, with a tendency towards recapitulation of the initial deformity. This current retrospective study was designed to evaluate a large series of surgically repaired children with the other single sutural synostoses, and to examine long-term cranial growth.

Methods: The records of 164 children with metopic, unilateral coronal, and unilateral lambdoid synostosis were retrospectively reviewed for outcomes. All patients were treated with a single stage open remodeling procedure. Long-term growth was assessed from anthropologic measurements taken up to 8 years postoperatively (mean > 4 years).

Results: Of 164 consecutive patients, complete records were available for 132 operative procedures. The surgical age ranged from 2.5 months to 8 years (mean <15 months), with 36 patients over 12-months of age. Following the institution of preoperative erythropoietin administration and use of a cell saver for blood recycling (2001), the overall transfusion rate decreased from 74% to 17% of patients, and the average hospitalization was < 2.5 days. There were no deaths or major complications, and there was only 1 non-surgically treated infection (0.7%). Five patients underwent secondary remodeling procedures (<4%). Early postoperative anthropologic measurements verified initial correction, but subsequent measurements revealed that not all growth indices were normal. These findings included: children with trigonocephaly demonstrated less than predicted bifrontal growth following an initial over-correction (p<0.05) and the more severely affected children with plagiocephaly had significantly less (p<0.05) growth in head circumference.

Conclusions: In this series of children born with single sutural synostoses, surgical treatment resulted in normalization of cranial indices with low reoperative rates and exceptionally few complications. However, building on the results of our earlier sagittal synostosis study, we found that growth is not normal following surgical correction of metopic, unilateral coronal and unilateral lambdoid synostoses, with a tendency for the calvaria to revert towards the primary deformity. Impaired growth may be greater with the midline sutural synostoses (sagittal and metopic), and the degree of growth inhibition may correlate with the initial presenting severity. Based on these findings, surgeons treating single sutural craniosynostosis should expand their treatment goals beyond normalization, to an over-correction of the abnormal skull shape.