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The Management of Nonsyndromic, Isolated Sagittal Synostosis

Chummun, Shaheel FRCS(Plast); McLean, Neil R. MD, FRCS(Plast); Flapper, Walter J. FRACS(Plast), MASurg; David, David J. FRACS, FRCST(Hon)

Journal of Craniofacial Surgery: March 2016 - Volume 27 - Issue 2 - p 299–304
doi: 10.1097/SCS.0000000000002363
Original Articles

Aim: Isolated sagittal synostosis is the commonest form of craniosynostosis. The reasons for surgery are to normalize the head shape and to increase the cranial volume, thus reducing the risk of raised intracranial pressure and allowing for normal brain development. It has been suggested that sagittal synostosis may impair neuropsychological development. This systematic review appraised the literature on the management of sagittal synostosis.

Methods: A literature search was performed with the assistance of a professional librarian. Studies selected had to satisfy the criteria set by PICO (patients, intervention, comparison, and outcome). Cranial index and neuropsychological outcome were used as outcome measures. MINORS was used to assess the methodological quality of the selected articles. A score of 75% was deemed to be of satisfactory quality, and the quality of the evidence from the selected studies was graded using the GRADE system.

Results: One hundred forty-eight articles were initially identified. Only 6 articles fulfilled the PICO criteria and scored a minimum of 75% on MINORS. Four studies compared 1 technique to another with documented cranial indices. Two studies compared 1 group to another and assessed the neuropsychological development. According to GRADE, the quality of evidence was deemed to be very low.

Conclusions: This systematic review assessed cranial index and neuropsychological outcome following surgery for isolated, nonsyndromic sagittal synostosis. The quality of the evidence in the published literature was noted to be of very low quality. There is a need for better-designed, prospective studies to guide surgeons involved in management of sagittal synostosis.

Australian Craniofacial Unit, Women's and Children's Hospital, Adelaide, Australia.

Address correspondence and reprint requests to Shaheel Chummun, FRCS(Plast), Australian Craniofacial Unit, Women's and Children's Hospital, Adelaide, SA5006, Australia; E-mail:

Received 17 July, 2015

Accepted 1 November, 2015

The authors report no conflicts of interest.

© 2016 by Mutaz B. Habal, MD.