Outcomes Analysis of Minimal Access Cranial Vault Remodeling for Sagittal Craniosynostosis

Total cranial vault remodeling for sagittal synostosis has lower recurrence rates and improved esthetic outcomes compared to strip craniectomy. However, total vault remodeling typically requires a coronal incision and full exposure which is accompanied by increased blood loss and hospital stay.

Purpose: The aim of this study was to evaluate the safety, outcome, and degree of parental satisfaction of minimal access vault remodeling for the management of sagittal synostosis. Methods: Thirteen patients ages 3-11.5 mo with non-syndromic sagittal synostosis were treated with minimal access cranioplasty followed by helmet therapy. Surgical access was via a small 3-4 cm zigzag vertex incision. A lighted retractor and subgaleal dissection allowed safe visualization of strip craniectomy with protection of the sagittal sinus. Subgaleal barrel stave cuts and wedge excisions were made with special scissors to address associated scaphocephaly, frontal bossing and occipital bathrocephaly. Helmet therapy was started 1-3 weeks after surgery and continued for 1-4 mo (9.9 ± 4.5 weeks). Omega tracer scans were obtained postoperatively and at completion of helmet treatment. Cranial width, cranial length and cephalic- and symmetry ratios were used as objective measures of headshape. Parents were sent a questionnaire to obtain a subjective assessment of overall outcome. Results: Blood loss (240 ± 218 ml), transfusion volume (234.1 ± 201.5 ml), procedure duration (3.2 ± 1.7 hrs) and postoperative hospital stay (3 ± 0.7 days) were lower in the minimal access cranioplasty group as compared to national practices. Overall efficacy improved with increasing experience. One patient required re-operation for incomplete posterior release. Both the objective measures and the subjective parental evaluation of change in skull shape were significant. Conclusions: Minimal access cranial vault remodeling followed by helmet therapy is safe and efficacious for the management of sagittal synostosis. Compared to traditional open procedures, transfusion requirements are lower and hospital stay is shorter. Compared to endoscopic procedures, the approach is simpler and allows for improved visualization and surgical control.