Treatment of scaphocephaly with combined vertex craniectomy and bilateral microbarrel staving

Surgical techniques for the treatment of scaphocephaly continue to evolve; however, there is still no accepted criterion standard. Until recently, the Alder Hey supraregional craniofacial department's experience was principally with combined wide-vertex suturectomy and biparietal barrel stave osteotomies.

To determine whether the technique of wide-vertex suturectomy and biparietal barrel stave osteotomies improves the cephalic index (CI) in scaphocephalic patients and determine whether age at surgery influences outcomes.

A literature review was undertaken to confirm recognized outcome measures. Patients who had surgery between 2000 and 2006 were enrolled in the audit. Prospective database review allowed preoperative and postoperative data collection at 6 weeks, 6 months, and 2 years. Statistical analysis was performed with Statview V.5.0.1 (Adept Scientific, Letchworth, UK).

Of 73 children referred to the unit with scaphocephaly, 66 underwent surgery. Of these 66 children, 54 were boys and 12 girls. Mean age at surgery was 11.1 months, with a mode of 6 months and a median of 8 months (range, 4-56 mo). Mean change in CI from the preoperative value was significant at 6 weeks (P < 0.0001) and 6 months (P < 0.0001) after surgery. Early correction of scaphocephaly (≤ 9 mo) was associated with a normal CI at 6 weeks after surgery (P = 0.03).

Wide-vertex suturectomy with biparietal barrel stave osteotomies are effective at increasing the CI in children with scaphocephaly. Early correction is associated with an improved CI in the short term, but long-term outcomes are unclear and require further follow-up studies.