Minimally Invasive Strip Craniectomy-Extended: A Technical Modification for Treatment of Sagittal Craniosynostosis

Treatment of sagittal craniosynostosis is achieved with a combination of surgery with or without helmet therapy, and a variety of surgical techniques have been described. Our institution utilizes early surgical correction, when possible, with a modified technique, the minimally invasive strip craniectomy-extended (MIS-E) followed by strict post-operative orthotic treatment to achieve maximum correction.

The modified approach emphasizes creation of enlarged anterior and posterior fontanelles to correct bossing, and a goal of 5 cm wide strip craniectomy with 2 cm wide at the base wedge ostectomies aiming toward the squamosal suture. Patients are then prescribed a cranial orthosis to be worn 23 h per day for 12 months to achieve and maintain a normocephalic shape with a goal of a Cephalic Index of 0.8. Retrospective analysis was performed on 18 non-syndromic sagittal craniosynostosis patients treated from 2021 to 2025, assessing surgical metrics and morphologic outcomes using the cephalic index.

The mean cephalic index increased from 0.726 to 0.807 by 3 months, 0.815 at 6 months, and 0.820 at 12 months (N = 17). 13/18 patients (72%) received a transfusion during their hospital stay. Average width of strip craniectomy was 5 cm.

MIS-E appears to be an effective procedure to rapidly correct sagittal craniosynostosis. At our institution, improved standardization of intraoperative transfusion protocols is needed to better determine the need for transfusions in patients treated with this technique. Assessment of sustained correction following helmet therapy is needed to further assess its long-term efficacy.