title: Results of early surgery for sagittal suture synostosis: long-term follow-up and the occurrence of raised intracranial pressure.
abstract: OBJECTIVE
  Numerous techniques are used to correct sagittal synostosis. Although cosmetic results and operative complications are well documented, little is known about functional outcome. In our institution, the technique for extended strip craniectomy evolved over time. This study compares cosmetic results, complications, and signs of raised intracranial pressure (ICP) between the variants of the extended strip craniectomy.
  
  
  METHODS
  Seventy-nine consecutive patients undergoing early extended strip craniectomy for scaphocephaly (2002-2008) were included. Four techniques were used: A, a simple bilateral parietal flap with out-fracturing of the bone flap; B, C, and D included remodeling of the parietal flap by adding triangular cuts and bending or suturing the resulting fingers. In technique D, the sagittal strip was rotated and fixed between the parietal flaps. Data on head circumference (HC), skull X-ray, and fundoscopy were collected prospectively.
  
  
  RESULTS
  For all patients, the average cranial index (CI) was 74 after 3 months and 72 after 2 years. Although technique D resulted in the best initial improvement, there was no significant percentage increase in CI after 24 months between the four techniques. Postoperatively, 9 % of the patients developed papilledema, 42 % developed a fontanel bulge, and 57 % had diminished HC. Four patients were reoperated on because of raised ICP.
  
  
  CONCLUSIONS
  Postoperative CI is mainly determined by preoperative CI and hardly affected by type of extended strip craniectomy. Signs of raised ICP occurred more frequently than expected, therefore structural follow-up is required to detect such signs. Technique and timing of surgery should aim at creating sufficient intracranial volume.
authors: Department of Neurosurgery, Dutch Craniofacial Centre Erasmus MC, Sophia Children's Hospital, Rotterdam, The Netherlands. m.l.c.vanveelen@erasmusmc.nl
authors: Marie-Lise C
authors: ML
authors: van Veelen
authors: Oscar H J
authors: OH
authors: Eelkman Rooda
authors: Tim
authors: T
authors: de Jong
authors: Ruben
authors: R
authors: Dammers
authors: Leon N A
authors: LN
authors: van Adrichem
authors: Irene M J
authors: IM
authors: Mathijssen
mesh_terms: D002648:Child; D002675:Child, Preschool; D003393:Cranial Sutures / Q000601:surgery; D003398:Craniosynostoses / Q000601:surgery*; D003399:Craniotomy / Q000009:adverse effects*; D005260:Female; D006801:Humans; D019586:Intracranial Hypertension / Q000209:etiology*; D008137:Longitudinal Studies; D008297:Male; D011183:Postoperative Complications / Q000503:physiopathology*; D012189:Retrospective Studies; D013997:Time Factors; D014057:Tomography, X-Ray Computed