title: Treatment of scaphocephaly with combined vertex craniectomy and bilateral microbarrel staving.
abstract: BACKGROUND
  Surgical techniques for the treatment of scaphocephaly continue to evolve; however, there is still no accepted criterion standard. Until recently, the Alder Hey supraregional craniofacial department's experience was principally with combined wide-vertex suturectomy and biparietal barrel stave osteotomies.
  
  
  OBJECTIVE
  To determine whether the technique of wide-vertex suturectomy and biparietal barrel stave osteotomies improves the cephalic index (CI) in scaphocephalic patients and determine whether age at surgery influences outcomes.
  
  
  METHODS
  A literature review was undertaken to confirm recognized outcome measures. Patients who had surgery between 2000 and 2006 were enrolled in the audit. Prospective database review allowed preoperative and postoperative data collection at 6 weeks, 6 months, and 2 years. Statistical analysis was performed with Statview V.5.0.1 (Adept Scientific, Letchworth, UK).
  
  
  RESULTS
  Of 73 children referred to the unit with scaphocephaly, 66 underwent surgery. Of these 66 children, 54 were boys and 12 girls. Mean age at surgery was 11.1 months, with a mode of 6 months and a median of 8 months (range, 4-56 mo). Mean change in CI from the preoperative value was significant at 6 weeks (P < 0.0001) and 6 months (P < 0.0001) after surgery. Early correction of scaphocephaly (≤ 9 mo) was associated with a normal CI at 6 weeks after surgery (P = 0.03).
  
  
  CONCLUSIONS
  Wide-vertex suturectomy with biparietal barrel stave osteotomies are effective at increasing the CI in children with scaphocephaly. Early correction is associated with an improved CI in the short term, but long-term outcomes are unclear and require further follow-up studies.
authors.affiliation: Supraregional Department of Pediatric Craniofacial Surgery, Royal Liverpool Children's Hospital Alder Hey, Liverpool, UK.
authors.forename: Jothy
authors.initials: J
authors.lastname: Kandasamy
authors.forename: Keith
authors.initials: K
authors.lastname: Anderson
authors.forename: Jonathan
authors.initials: J
authors.lastname: Dunne
authors.forename: Joan
authors.initials: J
authors.lastname: Grogan
authors.forename: Christian
authors.initials: C
authors.lastname: Duncan
authors.forename: Ajay
authors.initials: A
authors.lastname: Sinha
authors.forename: Paul
authors.initials: P
authors.lastname: May
mesh_terms: D000367:Age Factors; D002675:Child, Preschool; D003393:Cranial Sutures / Q000601:surgery; D003398:Craniosynostoses / Q000601:surgery*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D010027:Osteotomy / Q000379:methods; D011446:Prospective Studies; D012886:Skull / Q000002:abnormalities / Q000601:surgery; D016896:Treatment Outcome