title: Surgical treatment of sagittal synostosis by extended strip craniectomy: cranial index, nasofrontal angle, reoperation rate, and a review of the literature.
abstract: BACKGROUND
  Sagittal synostosis is the most common non-syndromic single suture craniosynostosis. Different techniques of surgical correction, including extended strip craniectomy (ESC), have been used to treat this condition. The aim of this study is to evaluate radiologic changes and rate of symptomatic restenosis after ESC in a large group of patients less than 12 months of age with non-syndromic sagittal synostosis.
  
  
  METHODS
  A retrospective study of patients from 1990 to 2012 was performed comparing cranial index (CI) and nasofrontal angle (NFA) before and after surgical correction by ESC. Also, the frequency of subsequent reoperations for symptomatic restricted head growth was determined.
  
  
  RESULTS
  A total of 238 patients underwent ESC. Follow-up information was available for 182 patients. The average age at the time of the operation was 4.5 months and the mean duration of follow-up was 49.6 months. The average post procedure radiologic follow-up (22 patients) was 40.7 months.
  
  
  CONCLUSIONS
  The mean CI increased from 0.68 to 0.75 (p < 0.001) after ESC. Also, mean NFA increased from 127 to 133° (p < 0.001). Five patients (2.7%) required a second operation due to symptomatic cranial growth restriction. Reoperation occurred at an average of 26.5 months after the initial procedure. The most common symptom reported was headache. ESC is effective in treating non-syndromic sagittal synostosis. It significantly improved NFA without the need for direct frontal bone resection or frontal orbital osteotomy and significantly increased CI without adjunctive helmet treatment. Patients should be followed for at least 5 years after surgical correction as symptomatic restenosis, although rare, can occur.
authors: Department of Neurosurgery, University of Pittsburgh Medical Center, 200 Lothrop Street, Suite B400, Pittsburgh, PA 15213, USA. Electronic address: bonfieldcm@upmc.edu.
authors: Christopher M
authors: CM
authors: Bonfield
authors: Department of Neurosurgery, University of Pittsburgh Medical Center, 200 Lothrop Street, Suite B400, Pittsburgh, PA 15213, USA.
authors: Philip S
authors: PS
authors: Lee
authors: Department of Neurosurgery, Albany Medical Center, Albany, NY, USA.
authors: Matthew A
authors: MA
authors: Adamo
authors: Department of Neurosurgery, University of Pittsburgh Medical Center, 200 Lothrop Street, Suite B400, Pittsburgh, PA 15213, USA.
authors: Ian F
authors: IF
authors: Pollack
mesh_terms: D002508:Cephalometry / Q000379:methods; D003398:Craniosynostoses / Q000601:surgery*; D003399:Craniotomy / Q000379:methods*; D005500:Follow-Up Studies; D005624:Frontal Bone / Q000473:pathology*; D006261:Headache / Q000601:surgery; D006801:Humans; D007223:Infant; D019586:Intracranial Hypertension / Q000601:surgery; D008279:Magnetic Resonance Imaging / Q000379:methods; D009295:Nasal Bone / Q000473:pathology*; D010294:Parietal Bone / Q000002:abnormalities / Q000601:surgery; D019651:Plastic Surgery Procedures / Q000379:methods*; D012086:Reoperation; D012189:Retrospective Studies; D012886:Skull / Q000254:growth & development; D014057:Tomography, X-Ray Computed / Q000379:methods
keywords: Craniosynostosis; Extended strip craniectomy; Pediatric; Sagittal