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Retrospective Investigation of Cranial Volume and Cephalic Index in Patients with Nonsyndromic Sagittal Synostosis
Maximilian Goetzinger1, Michael Verius2, Robert Eder2
1University Clinic of Oral and Maxillofacial Surgery, Paracelsus Medical University, Salzburg, Austria.
Insights
Total calvarial reconstruction effectively increases intracranial volume (ICV) and improves skull proportions in patients with nonsyndromic sagittal synostosis. This surgical approach offers lasting benefits for skull development and intracranial pressure management.
Area of Science:
- Craniofacial Surgery
- Pediatric Neurosurgery
- Plastic Surgery
Background:
- Craniosynostosis, premature fusion of cranial sutures, causes head deformity and can lead to increased intracranial pressure and restricted brain growth.
- Nonsyndromic sagittal synostosis specifically affects the sagittal suture, impacting skull shape.
- Surgical intervention aims to correct skull deformities and normalize intracranial pressure.
Purpose of the Study:
- To evaluate the efficacy of total calvarial reconstruction in patients with nonsyndromic sagittal synostosis.
- To assess the impact of this surgical technique on intracranial volume (ICV) and skull proportions.
Main Methods:
- The study included 24 patients (19 male, 5 female) with isolated nonsyndromic sagittal synostosis.
- Preoperative and postoperative computed tomography scans were used to measure ICV and cephalic index (CI).
- Temporarily fixed prebent metal plates guided intraoperative cranial expansion.
Main Results:
- Total calvarial reconstruction significantly increased mean ICV in both male (243.5 cm³) and female (211.1 cm³) patients.
- Postoperative cephalic index improved significantly in both sexes, indicating better skull proportions.
- These improvements in ICV and skull shape were sustained postoperatively.
Conclusions:
- Total vault remodeling is a reliable method for increasing ICV and improving skull length and width proportions.
- The surgical technique provides lasting benefits for skull development in patients with nonsyndromic sagittal synostosis.
- This approach effectively addresses skull deformities and intracranial volume normalization.
Background:
Premature fusion of cranial sutures affects skull development and leads to head deformity. Intracranial pressure increase and brain growth restriction can occur in untreated craniosynostosis. Operative treatment aims to achieve an immediate and long-lasting correction of skull shape that is close to the average and to prevent or release possible increased intracranial pressure by increasing the intracranial volume (ICV) or normalizing the ICV if it is already below the standards. This study was designed to evaluate the effect of a total calvarial reconstruction on skull development in patients with nonsyndromic sagittal synostosis.
Material And Methods:
The study population included 19 male and 5 female patients with isolated nonsyndromic sagittal suture synostosis. During the operation, temporarily fixed prebent metal plates provided an intraoperative reference for the desired cranial expansion gain of height and shortening. Preoperative and postoperative ICVs and cephalic indices were measured on computed tomography datasets using the software program ImageJ and were compared with one another and with normative data.
Results:
The male population presented with a preoperative mean ICV of 863.3 cm³. A postoperative mean ICV increase of 243.5 cm³ (p < 0.001) and a further ICV enlargement (p < 0.001) was measured. The mean CI changed from 71.0% preoperatively to 75.4% postoperatively (p = 0.002) and decreased insignificantly in the follow-up (p = 0.546). The female population had a preoperative mean ICV of 804.9 cm³. Postoperatively, the mean ICV increased by 211.1 cm³ (p = 0.043) and also increased in the follow-up (p = 0.043). Their mean CI values increased from 66.5% preoperatively to 72.8% (p = 0.043) postoperatively and decreased insignificantly in the follow-up (p = 0.345).
Conclusion:
This method of total vault remodeling provides reliable ICV increase and improvement in length and width of skull proportions beyond the immediate postoperative period together with an ICV increase.
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