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Houston Cranio Facial

Sagittal Craniosynostosis

The most common form of craniosynostosis is premature fusion of the sagittal suture causing an elongated boat shaped skull known as scaphocephaly or dolichocephaly. Sagittal craniosynostosis can occur 1 in 2000 to 1 in 5000 live births and accounts for about half of all craniosynostosis cases. The suture involved is located on the top of the skull beginning at the soft spot or anterior fontanel and ends at the back of the skull where the posterior fontanel is located.

The treatment of sagittal craniosynostosis is surgery. There are two approaches to the correction with risks and benefits of each. We recommend that parents review all their options prior to deciding on what is best for their child’s condition. Our extensively trained craniofacial and plastic surgeon, Dr. Eric Payne, performs both operations, strip craniectomy and cranial vault remodeling, with a pediatric neurosurgeon.

Strip Craniectomy- Also referred to as minimally invasive or limited incision with or without the use of an endoscope that must be performed before the infant is 6 months old. The affected suture is cut out of the skull along with about 3 cm on both sides for a total width of bone removed measuring 6 cm or 2.4 inches. Four more cuts are made, two on each side in a wedge shape just in front and behind the ears. This allows the side of the head to expand outward from the top. A helmet is then used after surgery for 3 – 6 months to correct the head shape. The advantages as well as the benefits are as followed: the surgery requires a small incision, a shorter operation, and less blood loss. The disadvantages are the following: there is a risk of missed bleeding or Dural tear due to limited view, the bone defects require a second operation, and there is a second surgery later in life if skull is not fully corrected.

Cranial Vault Remodeling – The goals of cranial vault remodeling involve three dimensional correction of the scaphocephaly skull deformity. Understanding that the skull is narrow when viewed from above, and too long when viewed from the side. The other issue involves the posterior height of the back of the skull. Therefore the surgical goals are to widen the skull, reduce the length, and raise the height of the posterior aspect of the skull. This is typically done with one operation involving the posterior skull. A standard wavy-line incision starting above each ear and extending over the head like a headband is used.