The Scarab Technique for Correction of Late-Presenting Sagittal Suture Craniosynostosis

Sagittal synostosis (SS) is the most prevalent form of craniosynostosis. It is the premature fusion of the sagittal suture, resulting in a "boat like" skull shape. Early surgical intervention is crucial to prevent complications, yet no standard procedure exists for patients over 12 months old. This study introduces the "Scarab technique", a novel surgical approach for late-presenting SS cases diagnosed after 1 year of age.

A single-center, board-approved retrospective review was conducted from May 2017 to June 2020. The Scarab technique was used exclusively for delayed SS diagnosed after 1 year old. A 4 cm craniectomy was outlined around the sagittal suture, and vascularized scarab bone flaps attached to the parietal bone vasculature were created. These extension flaps were then lifted for further biparietal and bitemporal expansion, followed by an occipital-type advancement and fixation with resorbable plates and screws.

A total of 7 patients with delayed sagittal synostosis diagnosis underwent scarab technique surgery. The majority were male (71%) and Caucasian (43%). Mean surgery age was 2.6 years (SD=1.3), with 3.43-hour average operation time (SD=0.86), 101.4 mL estimated blood loss (SD=54.5), 3.85 days in the PICU (SD=0.69), and only 1 patient with a resolved postoperative infection.

The Scarab technique is an effective alternative for treating delayed sagittal craniosynostosis, yielding statistically significant improvements in head shape and overall development post-surgery. Further long-term analysis and multicenter comparative studies with alternative techniques are warranted to fully assess its efficacy and outcomes.