title: Comparison of Traditional versus Normative Cephalic Index in Patients with Sagittal Synostosis: Measure of Scaphocephaly and Postoperative Outcome.
abstract: BACKGROUND
  Preoperative severity and postoperative success for patients with sagittal synostosis are measured by cephalic index, but this metric does not describe the appropriateness of euryon location. The authors hypothesize that cephalic index in patients with sagittal synostosis is an inaccurate measure of scaphocephaly.
  
  
  METHODS
  Preoperative and 1-year postoperative cranial computed tomographic scans of children with sagittal synostosis treated before 6 months of age by either total calvarial reconstruction or endoscope-assisted craniectomy and helmet therapy (n = 10 for each) were reviewed retrospectively. The location of euryons in age-matched controls was measured as a fraction of the glabella-opisthocranion distance (horizontal point of maximum width) and as the fraction of the nasion-vertex vertical distance (vertical point of maximum width). Cephalic index at this ideal location (normative cephalic index) and traditional cephalic index were determined in all patients.
  
  
  RESULTS
  Ideal euryon location from preoperative controls was 56 percent by the horizontal point of maximum width and 56 percent by the vertical point of maximum width. Normative cephalic index (0.60) was significantly less than traditional cephalic index (0.66) in patients preoperatively (p < 0.001) and remained smaller postoperatively (0.68 versus 0.73) for patients who underwent open reconstruction (p < 0.001). Patients treated endoscopically also had a smaller normative cephalic index (0.71) than traditional cephalic index (0.76) postoperatively (p < 0.001).
  
  
  CONCLUSIONS
  Anterocaudal displacement of euryon in patients with sagittal synostosis influences cephalic index. Normative cephalic index, assessed at ideal euryon location, is a more accurate measure of preoperative severity and postoperative outcome.
  
  
  METHODS
  Diagnostic, III.
authors.affiliation: St. Louis, Mo. From the Division of Plastic and Reconstructive Surgery and the Department of Neurosurgery, Washington University in St. Louis.
authors.forename: Lucas A
authors.initials: LA
authors.lastname: Dvoracek
authors.forename: Gary B
authors.initials: GB
authors.lastname: Skolnick
authors.forename: Dennis C
authors.initials: DC
authors.lastname: Nguyen
authors.forename: Sybill D
authors.initials: SD
authors.lastname: Naidoo
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Smyth
authors.forename: Albert S
authors.initials: AS
authors.lastname: Woo
authors.forename: Kamlesh B
authors.initials: KB
authors.lastname: Patel
mesh_terms: D016022:Case-Control Studies; D002508:Cephalometry / Q000379:methods*; D002675:Child, Preschool; D003398:Craniosynostoses / Q000000981:diagnostic imaging / Q000601:surgery*; D003399:Craniotomy; D005260:Female; D006801:Humans; D007223:Infant; D016014:Linear Models; D008297:Male; D011184:Postoperative Period; D057234:Preoperative Period; D019651:Plastic Surgery Procedures / Q000379:methods; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome