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Effects of Open and Endoscopic Surgery on Skull Growth and Calvarial Vault Volumes in Sagittal Synostosis

Ghenbot, Rahel G. BME*; Patel, Kamlesh B. MD*; Skolnick, Gary B. BA*; Naidoo, Sybill D. PhD, RN*; Smyth, Matthew D. MD; Woo, Albert S. MD*

Journal of Craniofacial Surgery: January 2015 - Volume 26 - Issue 1 - p 161–164
doi: 10.1097/SCS.0000000000001236
Original Articles
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Background There have been conflicting reports on how sagittal synostosis affects cranial vault volume (CVV) and which surgical approach best normalizes skull volume. In this study, we compared CVV and cranial index (CI) of children with sagittal synostosis (before and after surgery) with those of control subjects. We also compared the effect of repair type on surgical outcome.

Methods Computed tomography scans of 32 children with sagittal synostosis and 61 age- and sex-matched control subjects were evaluated using previously validated segmentation software for CVV and CI. Sixteen cases underwent open surgery, and 16 underwent endoscopic surgery. Twenty-seven cases had both preoperative and postoperative scans.

Results Age of subjects at computed tomography scan ranged from 1 to 9 months preoperatively and 15 to 25 months postoperatively. Mean age difference between cases and matched control subjects was 5 days. The mean CVV of cases preoperatively was nonsignificantly (17 mL) smaller than that of control subjects (P = 0.51). The mean CVV of postoperative children was nonsignificantly (24 mL) larger than that of control subjects (P = 0.51). Adjusting for age and sex, there was no significant difference in CVV between open and endoscopic cases postoperatively (β = 48 mL, P = 0.31). The mean CI increased 12% in both groups. There was no significant difference in mean postoperative CI (P = 0.18) between the 2 groups.

Conclusions Preoperatively, children with sagittal synostosis have no significant difference in CVV compared with control subjects. Type of surgery does not seem to affect CI and CVV 1 year postoperatively. Both open and endoscopic procedures result in CVVs similar to control subjects.

From the *Division of Plastic and Reconstructive Surgery, Cleft Palate-Craniofacial Institute, and †Department of Neurosurgery, Washington University School of Medicine, St Louis, Missouri.

Received February 12, 2014.

Accepted for publication July 23, 2014.

Address correspondence and reprint requests to Albert S. Woo, MD, Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, 660 South Euclid Ave, Campus Box 8238, St Louis, MO 63110; E-mail: wooa@wustl.edu

Research reported in this publication was supported by the Washington University Institute of Clinical and Translational Sciences grant UL1 TR000448 from the National Center for Advancing Translational Sciences of the National Institutes of Health (NIH), the Children’s Discovery Institute, and Kirk Smith and Greg Reiker of the Electronic Radiology Laboratory for work under NIH grant R43-NS67726. It was also supported by the St Louis Children’s Hospital Foundation–Children’s Surgical Sciences Institute.

The authors report no conflicts of interest.

The content is solely the responsibility of the authors and does not necessarily represent the official view of the NIH.

© 2015 by Mutaz B. Habal, MD.