Correction of Sagittal Synostosis Using Foreshortening and Lateral Expansion of the Cranium Activated by Gravity: Surgical Technique and Postoperative Evolution

Background: The authors present a technique for correction of sagittal synostosis addressing the transverse constriction and providing foreshortening of the skull without the use of hardware. The design of the osteotomies combined with strict postoperative supine positioning allows foreshortening of the skull, with concomitant expansion. Methods: Twenty-two patients were operated on using the foreshortening and lateral expansion activated by gravity technique. Postoperative follow-up included clinical evaluation and three-dimensional computed tomographic scanning at 4 to 6 weeks, 1 year, and yearly afterward. These scans were analyzed using three-dimensional surface analysis software, according to a protocol the authors describe in this article. Results: The cephalic index improved from 66.4 preoperatively to 74.5 at 1 year postoperatively (normal, 72 to 87). Transverse growth continued to be the dominant vector of growth up to 1 year (until ossification-bridging of the vertex craniectomy). Beyond 1 year, the main area of transverse growth was overlying the temporal suture, producing a distinctive temporal bossing in patients. The parietal areas showed mini-mal growth afterward. Growth was mainly occipital between 1 and 3 years of age, and frontal afterward, up to 5 years of age. A low frontal bossing also occurred in some of our patients and resolved spontaneously. Conclusions: The authors have described a technique for correction of scaphocephaly that avoids the use of hardware, with acceptable operative times and transfusion needs. Postoperative improvement in shape is satisfactory. Analysis of the three-dimensional scans of these patients shows abnormal skull growth patterns up to 5 years of age.