Student Johns Hopkins School of Medicine Baltimore, Maryland, United States
Introduction: Sagittal craniosynostosis is the most common form of craniosynostosis and can be treated using a variety of open or endoscopic approaches. Existing approaches have varying degrees of effectiveness. Open approaches, whether performed early or late, can be associated with significant blood loss and the need for transfusion. Endoscope-assisted approaches are minimally invasive but require several months of postoperative helmet therapy to remodel the skull. Implantation of springs or distractors require a second operation for removal of the devices. Here we present an alternative technique for early correction of sagittal craniosynostosis combining sagittal synostectomy with tension band sutures to remodel the skull without need for transfusion or helmet therapy.
Methods: We retrospectively reviewed the medical records of all patients treated for sagittal craniosynostosis using a modified synostectomy with tension band sutures at a single tertiary care institution. The sutures place tension on the bone, shortening the anteroposterior diameter of the skull and forcing it to regenerate from the dura in a more rounded fashion. Data on patient demographics, operative factors, and post-operative course were collected.
Results: Twenty-seven patients were identified as having undergone the novel procedure. The median pre-operative cephalic index was 68 and improved to 76 immediately post-operatively. Median blood loss was 10 mL while operative duration was 115 minutes. No blood transfusions were needed. One small dural laceration was encountered that was promptly repaired. There were no post-operative complications. Patients presenting for follow-up visits through 3-year follow-up showed continued improvement in head shape and cephalic index.
Conclusion : A modified sagittal craniectomy with tension band sutures to remodel the skull is effective in correcting sagittal craniosynostosis. The technique can be performed with minimal blood loss and reduces transfusion risk, operative time, and overall morbidity compared to traditional open approaches while avoiding the need for helmet therapy necessitated by endoscopic approaches.
