Total cranial vault remodeling for isolated sagittal synostosis: part I. Postoperative cranial suture patency.
BACKGROUND
Total vault reconstruction addresses all phenotypic aspects of scaphocephaly. The clinical implications of remodeling across open cranial sutures, however, remain unclear. The purpose of this study was to assess patency of unaffected sutures following total vault remodeling for isolated sagittal synostosis.


METHODS
The authors reviewed routine postoperative computed tomographic scans of patients who underwent total vault remodeling for isolated sagittal synostosis between 2004 and 2008. Sutural patency was scored by a single reviewer as follows: 0 = closed, 1 = partial, and 2 = open. Individual suture scores were tallied for a total sutural patency score. Computed tomographic scans were stratified by postoperative time and craniofacial surgeon.


RESULTS
Forty-two patients met the inclusion criteria. Individual sutural closure rates were 42.6, 38.3, 74.5, and 74.5 percent for right coronal, left coronal, right lambdoidal, and left lambdoidal sutures, respectively. Lambdoidal sutures had a significantly higher rate of closure than coronal sutures (OR(Closure), 4.3; 95 percent CI, 2.3 to 8.0; p < 0.001); lambdoidal patency significantly changed over time (χ2 = 9.9, p = 0.04). Across craniofacial surgeons, coronal and lambdoidal patency were equivalent. The total sutural patency score did not significantly correlate with postoperative time, surgical age, preoperative cephalic index, or craniofacial surgeon.


CONCLUSIONS
Total vault remodeling for isolated sagittal synostosis results in a high degree of secondary craniosynostosis. Lambdoidal sutures are especially prone to closure, with their patency diminishing over time. At this time, radiographic fusion of adjacent sutures following surgery has not been related to any difference in head shape.


METHODS
Therapeutic, IV.
Melbourne, Victoria, Australia From the Department of Plastic and Maxillofacial Surgery and the Department of Neurosurgery, Royal Children's Hospital Melbourne; and the Department of Paediatrics, University of Melbourne.
Mitchel
M
Seruya
Shu Yi
SY
Tan
Alison C
AC
Wray
Anthony J
AJ
Penington
Andrew L
AL
Greensmith
Anthony D
AD
Holmes
David K
DK
Chong
D002675:Child, Preschool; D003393:Cranial Sutures / Q000000981:diagnostic imaging / Q000254:growth & development* / Q000601:surgery*; D003398:Craniosynostoses / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D011184:Postoperative Period; D019651:Plastic Surgery Procedures; D012189:Retrospective Studies; D012886:Skull / Q000000981:diagnostic imaging / Q000254:growth & development / Q000601:surgery; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome