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.

1.
Lee
SS
,
Duncan
CC
,
Knoll
BI
,
Persing
JA
.
Intracranial compartment volume changes in sagittal craniosynostosis patients: influence of comprehensive cranioplasty
.
Plast Reconstr Surg
.
2010 Jul
;
126
(
1
):
187
96
. .
2.
Kabbani
H
,
Raghuveer
TS
.
Craniosynostosis
.
Am Fam Physician
.
2004 Jun 15
;
69
(
12
):
2863
70
.
3.
Garza
RM
,
Khosla
RK
.
Nonsyndromic craniosynostosis
.
Semin Plast Surg
.
2012 Feb
;
26
:
53
63
. .
4.
Renier
D
,
Sainte-Rose
C
,
Marchac
D
,
Hirsch
JF
.
Intracranial pressure in craniostenosis
.
J Neurosurg
.
1982
;
57
(
3
):
370
7
. .
5.
Thompson
DN
,
Harkness
W
,
Jones
B
,
Gonsalez
S
,
Andar
U
,
Hayward
R
.
Subdural intracranial pressure monitoring in craniosynostosis: its role in surgical management
.
Childs Nerv Syst
.
1995
;
11
(
5
):
269
75
. .
6.
Shipster
C
,
Hearst
D
,
Somerville
A
,
Stackhouse
J
,
Hayward
R
,
Wade
A
.
Speech, language, and cognitive development in children with isolated sagittal synostosis
.
Dev Med Child Neurol
.
2003 Jan
;
45
(
1
):
34
43
. .
7.
Speltz
ML
,
Kapp-Simon
KA
,
Cunningham
M
,
Marsh
J
,
Dawson
G
.
Single-suture craniosynostosis: a review of neurobehavioral research and theory
.
J Pediatr Psychol
.
2004 Dec
;
29
(
8
):
651
68
. .
8.
Venes
JL
,
Sayers
MP
.
Sagittal synostectomy. Technical note
.
J Neurosurg
.
1976 Mar
;
44
(
3
):
390
2
. .
9.
Guimarães-Ferreira
J
,
Gewalli
F
,
David
L
,
Darvann
TA
,
Hermann
NV
,
Kreiborg
S
,
Sagittal synostosis: II. Cranial morphology and growth after modified pi-plasty
.
Scand J Plast Reconstr Surg Hand Surg
.
2006
;
40
(
4
):
200
9
.
10.
Jane
JA
,
Edgerton
MT
,
Futrell
JW
,
Park
TS
.
Immediate correction of sagittal synostosis, 1978
.
J Neurosurg
.
2007 Nov
;
107
(
5 Suppl
):
427
32
. .
11.
Epstein
N
,
Epstein
F
,
Newman
G
.
Total vertex craniectomy for the treatment of scaphocephaly
.
Childs Brain
.
1982 Sep–Oct
;
9
(
5
):
309
16
. .
12.
Persing
JA
,
Jane
JA
,
Edgerton
MT
.
Surgical treatment of craniosynostosis
. In:
Persing
JA
,
Edgerton
MT
,
Jane
JA
, editors.
Scientific foundations and surgical treatments of craniosynostosis
.
Baltimore, MD
:
Williams & Wilkins
;
1989
. p.
124
7
.
13.
Boop
FA
,
Shewmake
K
,
Chadduck
WM
.
Synostectomy versus complex cranioplasty for the treatment of sagittal synostosis
.
Childs Nerv Syst
.
1996 Jul
;
12
(
7
):
371
5
. .
14.
Abbott
AH
,
Netherway
DJ
,
Niemann
DB
,
Clark
B
,
Yamamoto
M
,
Cole
J
,
CT-determined intracranial volume for a normal population
.
J Craniofac Surg
.
2000 May
;
11
(
3
):
211
23
.
15.
Tovetjärn
RC
,
Maltese
G
,
Wikberg
E
,
Bernhardt
P
,
Kölby
L
,
Tarnow
PE
.
Intracranial volume in 15 children with bilateral coronal craniosynostosis
.
Plast Reconstr Surg Glob Open
.
2014 Dec 5
;
2
(
11
):
e243
. .
16.
Helfer
TM
,
Peixoto
AB
,
Tonni
G
,
Araujo Júnior
E
.
Craniosynostosis: prenatal diagnosis by 2D/3D ultrasound, magnetic resonance imaging and computed tomography
.
Med Ultrason
.
2016 Sep
;
18
(
3
):
378
85
. .
17.
Lichtenberg
R
.
Radiographie du crane de 226 enfants normaux de la naissance a 8 ans: Impressions digitiformes, capacite, angles et indices
. Doctoral En Médecine Thesis,
University of Paris
;
1960
.
18.
Dekaban
AS
.
Tables of cranial and orbital measurements, cranial volume, and derived indexes in males and females from 7 days to 20 years of age
.
Ann Neurol
.
1977 Dec
;
2
(
6
):
485
91
. .
19.
Cinalli
G
,
Sainte-Rose
C
,
Kollar
EM
,
Zerah
M
,
Brunelle
F
,
Chumas
P
,
Hydrocephalus and craniosynostosis
.
J Neurosurg
.
1998
;
88
(
2
):
209
14
.
20.
Posnick
JC
,
Armstrong
D
,
Bite
U
.
Metopic and sagittal synostosis: intracranial volume measurements prior to and after cranio-orbital reshaping in childhood
.
Plast Reconstr Surg
.
1995
;
96
:
299
5
. .
21.
Heller
JB
,
Heller
MM
,
Knoll
B
,
Gabbay
JS
,
Duncan
C
,
Persing
JA
.
Intracranial volume and cephalic index outcomes for total calvarial reconstruction among nonsyndromic sagittal synostosis patients
.
Plast Reconstr Surg
.
2008
;
121
(
1
):
187
95
. .
22.
Gault
DT
,
Renier
D
,
Marchac
D
,
Ackland
FM
,
Jones
BM
.
Intracranial volume in children with craniosynostosis
.
J Craniofac Surg
.
1990 Jan
;
1
(
1
):
1
3
. .
23.
Marsh
JL
.
Metopic and sagittal synostosis: intracranial volume measurement prior to and after cranio-orbital reshaping in childhood (Discussion)
.
Plast Reconstr Surg
.
1995
;
96
:
310
5
.
24.
Netherway
DJ
,
Abbott
AH
,
Anderson
PJ
,
David
DJ
.
Intracranial volume in patients with nonsyndromal craniosynostosis
.
J Neurosurg
.
2005 Aug
;
103
(
2 Suppl
):
137
41
. .
25.
Widmann
G
,
Schullian
P
,
Gassner
EM
,
Hoermann
R
,
Bale
R
,
Puelacher
W
.
Ultralow-dose CT of the craniofacial bone for navigated surgery using adaptive statistical iterative reconstruction and model-based iterative reconstruction: 2D and 3D image quality
.
AJR Am J Roentgenol
.
2015 Mar
;
204
(
3
):
563
9
. .
26.
Michikawa
T
,
Suzuki
H
,
Moriguchi
M
,
Ogihara
N
,
Kondo
O
,
Kobayashi
Y
.
Automatic extraction of endocranial surfaces from CT images of crania
.
PLoS One
.
2017
;
12
(
4
):
e0168516
. .
27.
Muenke
M
,
Kress
W
,
Collmann
H
,
Solomon
BD
, editors.
Craniosynostoses: molecular genetics, principles of diagnosis, and treatment
. 1 Auflage.
Basel
:
Karger
.
2011
.
28.
Schwarz
AM
.
Das Fernröntgen
. In:
Schwarz
AM
, editor.
Lehrbuch der Gebißregulierung, Band 1
.
Wien, Austria
:
Urban & Schwarzenberg
;
1951
. p.
277
98
.
29.
Likus
W
,
Bajor
G
,
Gruszczyńska
K
,
Baron
J
,
Markowski
J
,
Machnikowska-Sokołowska
M
,
Cephalic index in the first three years of life: study of children with normal brain development based on computed tomography
.
ScientificWorldJournal
.
2014 Feb 4
;
2014
:
502836
.
30.
Seruya
M
,
Tan
SY
,
Wray
AC
,
Penington
AJ
,
Greensmith
AL
,
Holmes
AD
,
Total cranial vault remodeling for isolated sagittal synostosis: part I. Postoperative cranial suture patency
.
Plast Reconstr Surg
.
2013 Oct
;
132
:
602e
10e
. .
31.
Fischer
S
,
Maltese
G
,
Tarnow
P
,
Wikberg
E
,
Bernhardt
P
,
Tovetjärn
R
,
Intracranial volume is normal in infants with sagittal synostosis
.
J Plast Surg Hand Surg
.
2015 Feb
;
49
(
1
):
62
4
.
32.
Cohen
MM
 Jr
,
MacLean
RE
, editors.
Craniosynostosis: diagnosis, evaluation and management
. 2nd ed.
New York
:
Oxford University Press
;
2000
.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.