Evaluation of Head Height After Endoscopic Strip Craniectomy and Orthotic Therapy for Sagittal Craniosynostosis

Background: Achievement of normal head shape is one of the primary goals of all treatment modalities for craniosynostosis, in addition to maintenance of normal intracranial pressure and allowing normal brain development. Pre- and postoperative quantification of head shape in sagittal craniosynostosis has largely relied on cephalic index (width divided by anterior-posterior length of skull). However, many infants with sagittal craniosynostosis have a head that is short in addition to long and narrow. Height is not captured by the cephalic index. Methods: Patients who underwent endoscopic repair of sagittal craniosynostosis between 2016 and 2019 with available pre- and 1-year postoperative head computed tomography (CT) scans were identified. Age-matched controls with available CT scans were used for comparison. Twenty-one patients with sagittal craniosynostosis who underwent endoscopic repair, 10 preoperative, and 10 postoperative age-matched controls were identified. CT scans were measured with Analyze 12.0 software using soft tissue windows. Head height was defined as the vertical distance from the opisthocranion to the top of the head along a line crossing the tragus. Results: Patients with sagittal craniosynostosis had a shorter head height (mean 6.01 cm) than age-matched controls (mean 6.94 cm, P =.0003), and, after endoscopic repair and helmeting, the head height (mean 8.05 cm) was similar to age matched controls (mean 8.22 cm, P =.515). Conclusions: This head height measurement quantifies the third dimension of abnormal head shape in sagittal craniosynostosis. Additionally, it is adequately corrected in endoscopic repair with helmeting.