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Methods: IRB-approved retrospective review was performed of patients undergoing correction of sagittal synostosis from 1988 to 2012. Patients were excluded with prior outside intervention or diagnosis of syndromic or multisutural synostosis. Demographic, operative/post-operative data and outcomes were analyzed with chi-squared and Fisher’s exact test for categorical data and Wilcoxon rank-sum and Kruskal-Wallis rank for continuous data.
Results: Over 25 years, 300 patients were treated for sagittal synostosis and 186 met inclusion criteria. The majority of patients were male (n=144; 77%). Neurosurgery (NSU) treated 108 patients with strip craniectomy and mid-vault reconstruction at an average age of 0.3±0.2 years. Plastic surgery treated 78 patients with 24%(n=19) previously treated by NSU. Average age at intervention was 2.2±1.8 years with a mean 3.8±4.0 years follow-up. Primary reconstruction consisted of 31(40%) posterior vaults, 26(33%) anterior vaults, 11(14%) total vaults, and 6(8%) spring-assisted craniectomies. There were 10 surgical complications(13%); 6(8%) minor and 4(5%) major. In patients with ≥1 year follow-up(n=49), 28(57%) needed second operations with 13(27%) receiving planned two-stage reconstruction and 6(12%) receiving unplanned secondary intervention. At latest follow-up, 32(65%) patients were Whitaker class I, 12(25%) class III and 5(10%) class IV. Patients with prior NSU intervention had no statistical difference in outcomes. In patients with ≥5 years follow-up, more were class III(p=.001) and fewer class I(p=.038) compared to those with <5 years follow-up. A higher incidence of bitemporal constriction was noted in patients with ≥5 years follow-up(p=.004).
Conclusions: We characterize treatment modalities, report complication and reoperation rates and demonstrate a clear trend toward altered growth and/or recurrence over time. This may impact the way we counsel families and underscores the need to follow these patients to physical maturity.