Regression of cephalic index following endoscopic repair of sagittal synostosis

Nicholas A. Pickersgill, Gary B. Skolnick, Sybill D. Naidoo, Matthew D. Smyth, Kamlesh B. Patel

Research output: Contribution to journalArticlepeer-review

16 Scopus citations


OBJECTIVE Metrics used to quantify preoperative severity and postoperative outcomes for patients with sagittal synostosis include cephalic index (CI), the well-known standard, and the recently described adjusted cephalic index (aCI), which accounts for altered euryon location. This study tracks the time course of these measures following endoscopic repair with orthotic helmet therapy. The authors hypothesize that CI and aCI show significant regression following endoscope-assisted repair. METHODS CT scans or 3D photographs of patients with nonsyndromic sagittal synostosis treated before 6 months of age by endoscope-assisted strip craniectomy and postoperative helmet therapy (n = 41) were reviewed retrospectively at three time points (preoperatively, 0–2 months after helmeting, and > 24 months postoperatively). The CI and aCI were measured at each time point. RESULTS Mean CI and aCI increased from 71.8 to 78.2 and 62.7 to 72.4, respectively, during helmet treatment (p < 0.001). At final follow-up, mean CI and aCI had regressed significantly from 78.2 to 76.5 and 72.4 to 69.7, respectively (p < 0.001). The CI regressed in 33 of 41 cases (80%) and aCI in 39 of 41 cases (95%). The authors observed a mean loss of 31% of improvement in aCI achieved through treatment. A strong, positive correlation existed between CI and aCI (R = 0.88). CONCLUSIONS Regression following endoscope-assisted strip craniectomy with postoperative helmet therapy commonly occurs in patients with sagittal synostosis. Future studies are required to determine whether duration of helmet therapy or modifications in helmet design affect regression.

Original languageEnglish
Pages (from-to)54-60
Number of pages7
JournalJournal of Neurosurgery: Pediatrics
Issue number1
StatePublished - Jan 2019


  • Cephalic index
  • Craniofacial
  • Endoscopic
  • Plastic surgery
  • Regression
  • Sagittal synostosis


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