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Published on: November 4, 2025
Sagittal craniosynostosis: surgical outcomes and long-term growth
Jeffrey A Fearon1, Emily B McLaughlin, John C Kolar
1Craniofacial Center, North Texas Hospital for Children, Dallas, Texas, USA. cranio700@aol.com
Insights
Surgical correction of sagittal synostosis in children led to abnormal long-term skull growth, with reduced cranial breadth and length. Surgeons should consider overcorrection to achieve optimal outcomes in treating scaphocephaly.
Area of Science:
- Pediatric Neurosurgery
- Craniofacial Surgery
- Developmental Biology
Background:
- Limited long-term outcome data exist for surgical treatments of sagittal synostosis.
- This study evaluates long-term cranial growth in a large cohort of children treated for sagittal craniosynostosis.
Purpose of the Study:
- To assess long-term cranial growth patterns after surgical correction of sagittal synostosis.
- To identify potential growth deficiencies or abnormalities post-intervention.
Main Methods:
- Retrospective review of 89 children surgically treated for sagittal synostosis (1990-2003).
- Single-stage posterior remodeling was the primary surgical technique.
- Long-term growth was assessed via anthropometric measurements 3-11 years post-surgery.
Main Results:
- Postoperative cephalic index was initially overcorrected.
- Cranial breadth and length growth were less than predicted, with greater deficiency in breadth.
- Diminished capacity for head circumference growth was observed (p < 0.001).
Conclusions:
- Surgical correction of sagittal synostosis resulted in abnormal skull growth patterns.
- Consideration of overcorrection may be beneficial to achieve normalized skull shape long-term.
Background:
Numerous publications have examined technique-specific results in treating sagittal synostosis, but there are scant data examining long-term outcomes. This retrospective study was designed to evaluate a large series of surgically repaired children with sagittal craniosynostosis and to examine long-term cranial growth following correction.
Methods:
From 1990 to 2003, 132 children with sagittal synostosis were evaluated and 89 surgically treated (single-stage posterior remodeling) patients were retrospectively reviewed (43 were excluded for multisutural involvement, incomplete records, or nonsurgical treatment). Long-term growth was assessed from anthropologic measurements taken from 3 to 11 years postoperatively (mean, 4.7 years).
Results:
The surgical age ranged from 2 months to 5 years (mean, 8 months), and the hospital stay was less than 3 days. There were no deaths, major complications, infections, or repeated remodeling procedures performed. Postoperatively, the cephalic index was overcorrected. Subsequent growth of the cranial breadth and length was less than predicted. Moreover, growth was more deficient in cranial breadth than length, resulting in a regression of the cephalic index over time (p < 0.01). Frontal breadth improved immediately postoperatively but did not subsequently narrow over time. Head circumference also showed a statistically significant diminished capacity for growth (p < 0.001).
Conclusions:
This study demonstrated abnormal skull growth in children following the surgical correction of scaphocephaly. On the basis of these findings, surgeons treating sagittal synostosis may wish to expand their goals of treatment beyond normalization to an overcorrection of the abnormal skull shape.
