Management of sagittal synostosis: a solution to equipoise

Area of Science:

• Craniofacial Surgery
• Pediatric Neurosurgery
• Plastic Surgery

Background:

• Nonsyndromic sagittal synostosis treatment lacks a defined standard of care.
• Significant disagreement exists in the craniofacial surgery literature regarding optimal management.
• Level 1 evidence is insufficient to guide treatment decisions.

Purpose of the Study:

• To survey current practices of craniofacial surgeons globally.
• To identify variations in the diagnosis and treatment of nonsyndromic sagittal synostosis.
• To explore the potential for establishing a standard of care.

Main Methods:

• An internet-based survey was distributed to 102 craniofacial surgeons across 14 countries.
• Data collected included surgical indications, timing, operative interventions, and perioperative protocols.
• A 58% response rate was achieved, providing insights into current surgical trends.

Main Results:

• Skull deformity was the primary indication for surgery in 63% of cases.
• Open surgical management was most common at 6 months (35%), with total cranial vault remodeling being the preferred procedure (37%).
• Endoscopic surgery was favored for infants under 4 months (35%), while spring-assisted surgery was rare (10%).

Conclusions:

• A significant disparity in opinions on diagnosing and treating nonsyndromic sagittal synostosis persists among surgeons.
• Current clinical practices show notable discrepancies when compared to existing literature.
• Further research is needed to establish evidence-based guidelines for standardized care.