Surgical Management of Nonsyndromic Scaphocephaly: A Review and a Standardized Cranial Vault Remodeling Technique

Premature sagittal suture fusion causes scaphocephaly, the most prevalent type of nonsyndromic craniosynostosis. There is no consensus on the optimal surgical approach, despite several corrective techniques having been described. The results of a standardized open cranial vault remodeling (CVR) technique with simplified osteotomy planning, intended to address the phenotypic characteristics of sagittal synostosis, are presented in this study.

Between 2013 and 2023, 22 consecutive patients with moderate-to-severe scaphocephaly who had total CVR using a reproducible technique were retrospectively reviewed. The cephalic index (CI), complications, operative parameters, and patient demographics were reviewed. The method includes occipital reshaping to restore cranial contour, posterior repositioning of a broad sagittal strip, and biparietal widening through outward fractures and triangular osteotomies.

A total of 59% of patients were male, and the mean age at surgery was 8.8 months (range: 4-13 mo). A total of 91% of patients needed a transfusion (mean volume: 418 mL), and the average operating time was 312.8 minutes. Postoperatively, all patients were managed in the intensive care unit for a mean duration of 66 hours (range: 48-93 h). No significant complications were noted. Two instances of minor wound separation were treated conservatively. There was no evidence of wire extrusion, hemorrhage, or bone graft loss. All patients showed subjective improvement in cranial morphology, supported by a significant improvement in the mean preoperative CI of 62 at follow-up (mean: 35 mo; range: 7-77 mo).

The proposed CVR method is safe and demonstrates improvement at long-term follow-up. It accomplishes posterior height correction and long-lasting biparietal widening without causing issues with the hardware. This method provides a dependable option for sagittal synostosis correction within the surgical spectrum.