title: Pancraniosynostosis following endoscopic-assisted strip craniectomy for sagittal suture craniosynostosis in the setting of poor compliance with follow-up: a case report.
abstract: BACKGROUND
  There is limited craniofacial literature on the complications of helmet therapy and controversy regarding the effects of inadequate orthotic helmet therapy. The authors present a case of inadvertently prolonged orthotic helmet therapy after endoscopic strip craniectomy for isolated sagittal synostosis.
  
  
  METHODS
  A two-month-old Caucasian baby underwent uncomplicated endoscopic-assisted strip craniectomy to treat synostosis of the sagittal suture and was fitted for an orthotic helmet two weeks postoperatively. He presented to the craniofacial clinic eight weeks postoperatively with occipital flattening and increased posterior vault height, so the helmet was refitted. During the next 18 months, the helmet was used inconsistently without follow-up. Upon re-presentation, the patient had developed pansynostosis, requiring a subsequent open total cranial vault reconstruction for correction for this secondary deformity.
  
  
  CONCLUSIONS
  Although it remains unclear whether postoperative development of pansynostosis is the result of prolonged helmeting or the consequence of progressive synostotic disease, this report highlights the importance of parent education and judicious scheduled follow-up for the avoidance of potential helmet therapy complications.
authors.affiliation: Department of Neurosurgery, Primary Children's Hospital, University of Utah, 100 Mario Capecchi Drive, Salt Lake City, UT, 84132, USA. walavan.sivakumar@hsc.utah.edu.
authors.forename: Walavan
authors.initials: W
authors.lastname: Sivakumar
authors.affiliation: Department of Plastic Surgery, University of Utah Hospital, 30 North 1900 East, Suite 3B400, Salt Lake City, UT 84132, USA. isak.goodwin@hsc.utah.edu.
authors.forename: Isak
authors.initials: I
authors.lastname: Goodwin
authors.affiliation: Department of Plastic Surgery, University of Utah Hospital, 30 North 1900 East, Suite 3B400, Salt Lake City, UT 84132, USA. ross.blagg@hsc.utah.edu.
authors.forename: Ross
authors.initials: R
authors.lastname: Blagg
authors.affiliation: Department of Plastic Surgery, University of Utah Hospital, 30 North 1900 East, Suite 3B400, Salt Lake City, UT 84132, USA. dana.johns@hsc.utah.edu.
authors.forename: Dana
authors.initials: D
authors.lastname: Johns
authors.affiliation: Department of Neurosurgery, Primary Children's Hospital, University of Utah, 100 Mario Capecchi Drive, Salt Lake City, UT, 84132, USA. jay.riva-cambrin@hsc.utah.edu.
authors.forename: Jay
authors.initials: J
authors.lastname: Riva-Cambrin
authors.affiliation: Department of Plastic Surgery, University of Utah Hospital, 30 North 1900 East, Suite 3B400, Salt Lake City, UT 84132, USA. faizi.siddiqi@hsc.utah.edu.
authors.forename: Faizi
authors.initials: F
authors.lastname: Siddiqi
authors.affiliation: Department of Plastic Surgery, University of Utah Hospital, 30 North 1900 East, Suite 3B400, Salt Lake City, UT 84132, USA. barbu.gociman@hsc.utah.edu.
authors.forename: Barbu
authors.initials: B
authors.lastname: Gociman
mesh_terms: D003393:Cranial Sutures / Q000503:physiopathology*; D003398:Craniosynostoses / Q000503:physiopathology* / Q000601:surgery*; D006260:Head Protective Devices / Q000009:adverse effects*; D006801:Humans; D007223:Infant; D008297:Male; D044583:Neuroendoscopy; D019635:Neurosurgical Procedures / Q000379:methods*; D010349:Patient Compliance; D012086:Reoperation; D014057:Tomography, X-Ray Computed