Related Experiment Video
Updated: Jul 16, 2026
Minimally Invasive Thumb-sized Pterional Craniotomy for Surgical Clip Ligation of Unruptured Anterior Circulation Aneurysms
Published on: August 11, 2015
The "clamshell" craniotomy technique in treating sagittal craniosynostosis in older children
Matthew D Smyth1, Marissa J Tenenbaum, Christian B Kaufman
1Department of Neurological Surgery and Division of Plastic Surgery, St. Louis Children's Hospital, Washington University, St. Louis, Missouri 63110, USA. smythm@nsurg.wustl.edu
Insights
This study presents a new surgical method for older children with sagittal craniosynostosis, improving skull shape with minimal complications. The technique offers excellent early outcomes for calvarial reconstruction.
Area of Science:
- Neurosurgery
- Craniofacial Surgery
- Pediatric Surgery
Background:
- Sagittal craniosynostosis is typically diagnosed and treated in infancy.
- Some children present later with untreated sagittal craniosynostosis, requiring specialized intervention.
- Delayed diagnosis necessitates effective surgical techniques for older children.
Purpose of the Study:
- To describe a novel single-stage operative technique for calvarial reconstruction in older children with untreated sagittal craniosynostosis.
- To evaluate the safety and efficacy of this new surgical approach.
- To assess outcomes and complications associated with the procedure.
Main Methods:
- A cohort of eight patients underwent a novel single-stage calvarial reconstruction.
- The procedure involved bifrontal craniotomy, multiple midline parietooccipital osteotomies, and recontouring with bioabsorbable plates.
- Cranial indices, operative data, and follow-up assessments were used to evaluate outcomes.
Main Results:
- The mean cranial index significantly improved from 65.6% to 71.3% (p = 0.001).
- Mean operative time was 5.13 hours with a mean blood loss of 425 ml (33.5% of estimated circulating volume).
- No acute or delayed complications were observed, with high patient and family satisfaction at a mean 12-month follow-up.
Conclusions:
- Aggressive calvarial reconstruction using multiple interleaving osteotomies effectively addresses biparietal narrowing.
- Combined with bifrontal reconstruction, this technique yields excellent early outcomes.
- The procedure is associated with acceptable intraoperative blood loss and a low complication rate.
Object:
Although most patients with sagittal craniosynostosis are recognized and treated in infancy, some children are not referred to craniofacial centers until later in childhood. In this paper the authors describe a novel operative technique for calvarial reconstruction in older children with previously untreated sagittal craniosynostosis.
Methods:
The authors report a clinical series of eight patients who were treated using novel single-stage calvarial reconstruction, and they assess the complications and outcomes. The patient is placed supine for the procedure, which consists of a coronal incision, bifrontal craniotomy without orbital osteotomy, and multiple interlocking midline parietooccipital osteotomies and recontouring. Fixation is achieved using a bioabsorbable plate system. Cranial indices were calculated from measurements obtained before and after the reconstructive procedures. Preoperative, intraoperative, and postoperative photographs and three-dimensional computed tomography scans are presented for review. Between November 2003 and April 2005, the authors treated seven boys (age range approximately 1-10 years, mean age 4.2 years) with uncorrected sagittal craniosynostosis and one with bicoronal and sagittal synostosis. The mean operating time was 5.13 hours (range 4.3-8 hours), with a mean blood loss of 425 ml (range 200-800 ml). As a percentage of the estimated circulating blood volume, the mean operative blood loss was 33.5% (range 17-57%). The mean hospital stay was 4.9 days. The cranial index significantly improved from a mean of 65.6 to 71.3% (p = 0.001). No acute or delayed complications have been noted. Follow-up examinations performed at an average of 12 months (range 1-17 months) have confirmed early patient and family satisfaction.
Conclusions:
An approach of aggressive calvarial reconstruction with multiple interleaving osteotomies crossing the midline achieves improvements in biparietal narrowing. Combined with a bifrontal reconstruction, early outcomes are excellent, with an acceptable amount of intraoperative blood loss and no significant complications.
