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Updated: May 30, 2026
Midface Hypoplasia and Cranial Base Morphology in Syndromic Craniosynostosis: A Comparative Analysis Study Using a Predictive Regression Model
Published on: November 4, 2025
Cranial vault remodeling for sagittal craniosynostosis in older children
S Alex Rottgers1, Peter D Kim, Anand Raj Kumar
1Children's Hospital of Pittsburgh of UPMC, PA, USA.
Insights
Treating sagittal synostosis after one year of age in children is associated with higher rates of intracranial hypertension (ICH). However, surgical remodeling offers improved head shape and minimal risk of cranial defects with proper bone grafting.
Area of Science:
- Neurosurgery
- Pediatric Surgery
- Craniofacial Surgery
Background:
- Sagittal synostosis is the most common craniosynostosis, typically treated in infants.
- Optimal surgical management for patients over 1 year old remains unclear.
- Late surgical intervention requires understanding risks like intracranial hypertension and cranial defects.
Purpose of the Study:
- To evaluate outcomes of surgical treatment for sagittal synostosis in patients over 1 year of age.
- To determine the incidence of intracranial hypertension (ICH) in this older cohort.
- To assess the risk of nonhealing cranial defects and the need for revision surgeries.
Main Methods:
- Retrospective review of cranial vault remodeling cases for scaphocephaly in patients >1 year old.
- Data collected from October 2000 to December 2010 at Children's Hospital of Pittsburgh.
- Analysis of surgical procedures, head shape improvement, ICH signs, and cranial defect development.
Main Results:
- Ten patients met inclusion criteria; various vault remodeling techniques were used.
- All patients showed improved head shape, with mean cephalic index increasing significantly (p=0.05).
- Six patients (60%) presented with signs of intracranial hypertension (ICH).
Conclusions:
- Surgical treatment of sagittal synostosis after 1 year of age is linked to increased ICH rates, necessitating vigilant monitoring.
- Clinically significant cranial defects are rare with appropriate bone grafting during surgery.
- Acceptable aesthetic and functional head shape improvements can be achieved in older patients.
Abstract:
OBJECT Sagittal craniosynostosis is the most common form of craniosynostosis and is commonly treated within the first year of life. Optimal treatment of patients older than 1 year of age is not well characterized. The authors reviewed cases of sagittal craniosynostosis involving patients who were treated surgically at their institution when they were older than 1 year in order to determine the rate of intracranial hypertension (ICH), potential to develop nonhealing cranial defects, and the need for various surgical procedures to treat the more mature phenotype. METHODS A retrospective chart review was conducted of all cases in the Children's Hospital of Pittsburgh Neurosurgery Database involving patients who underwent cranial vault remodeling for scaphocephaly after 1 year of age between October 2000 and December 2010. RESULTS Ten patients were identified who met the inclusion criteria. Five patients underwent anterior two-thirds cranial vault remodeling procedures, 3 patients underwent posterior vault remodeling, and 2 patients underwent 2-staged total vault remodeling. All patients had improved head shapes, and mean cephalic indices improved from 65.4 to 69.1 (p = 0.05). Six patients exhibited signs of ICH. No patients with more than 3 months of follow-up exhibited palpable calvarial defects. CONCLUSIONS Patients with sagittal synostosis treated after 1 year of age demonstrate increased rates of ICH, warranting diligent evaluations and surveillance to detect it; rarely develop clinically significant cranial defects if appropriate bone grafting is performed at the time of surgery; and achieve acceptable improvements in head shape.
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