Assessment of Minimally Invasive Surgical Techniques for Sagittal Craniosynostosis: A Multicenter Time Series Study

Background: Minimally invasive strip craniectomy is a well-established treatment for sagittal craniosynostosis; however, the temporality of change in head shape has not been assessed. In this study, the authors performed head shape analysis to compare time-series–based clinical outcomes among 3 different surgical techniques across 3 academic centers for the treatment of sagittal craniosynostosis. Methods: Retrospective, longitudinal 3-dimensional (3D) images were collected from patients who underwent surgery for the correction of sagittal craniosynostosis for up to 5 years postoperation. The surgical methods studied include spring-assisted craniectomy, narrow-strip craniectomy plus orthotic helmet therapy, and wide-strip craniectomy with biparietal and bitemporal barrel stave wedge osteotomies plus orthotic helmet therapy. Postoperative 3D images were binned into 6 age groups. Cranial index measurements were calculated on 3D images. The 3D whole-head composite images were generated for each procedure to visually represent longitudinal outcomes. Results: The median (interquartile range) cranial index measurements at 3- to 5-years postoperative follow-up were 75.9 (73.1 to 78.6) for spring-assisted, 75.9 (75.4 to 78.5) for narrow-strip, and 79.4 (76.4 to 81.9) for wide-strip procedures. The wide-strip cranial index was significantly different from the spring-assisted and narrow-strip groups (P < 0.001). Concerning 3D analysis, patients receiving spring-assisted procedures showed normalization of frontal bossing and skull height compared with age-matched controls, whereas patients receiving wide-strip procedures showed greater correction of occipital bulleting. Patients receiving narrow-strip procedures had intermediate results between these outcomes. Conclusions: There was no statistically significant regression in longitudinal cranial index measurements across the 3 techniques aimed at treating sagittal craniosynostosis. Longitudinal comparison of 3D head shape outcome demonstrated satisfactory correction of scaphocephalic deformity across all 3 surgical groups.