Effects of open and endoscopic surgery on skull growth and calvarial vault volumes in sagittal synostosis

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.