To Stave or Not to Stave: Outcomes of Barrel Stave Osteotomies in Strip Craniectomy for Sagittal Craniosynostosis.

BACKGROUND

Endoscopic strip craniectomy (ESC) with postoperative helmet molding is an accepted treatment for sagittal craniosynostosis. Barrel stave osteotomies (BSO) with immediate greenstick outfracture can be added to ESC for immediate cranial expansion. BSO is hypothesized to improve cranial remodeling, but its benefits and complications remain debated. This study compares operative and morphologic outcomes in patients with sagittal craniosynostosis treated with ESC with and without BSO.

METHODS

A retrospective review of patients with isolated sagittal craniosynostosis treated with endoscopic strip craniectomy from 2015 to 2024 was conducted. Patients were grouped by whether they received BSO. The primary outcomes were changes in cephalic index (CI), cranial vault asymmetry (CVA), and head circumference (FOC). Secondary outcomes were operative time, transfusion rates, complications, and helmeting duration.

RESULTS

Of 247 patients, 48 met the inclusion criteria. Thirty-three received BSO. CI improved significantly in both groups: from 63.9 to 73.9 in BSO patients and from 65.3 to 74.7 in non-BSO patients. CVA improved by 50% in the BSO group and 75% in the non-BSO group. FOC increased similarly in both groups. The duration of helmet therapy did not significantly differ between groups. Complication profiles were also similar between groups. There were 2 reoperations in the BSO group and 1 reoperation in the non-BSO group. Operating time, rates of transfusion, estimated blood loss, and self-resolving hematoma were similar.

CONCLUSION

The addition of BSO to ESC does not significantly affect operative time, complication rates, or craniometric outcomes. ESC in combination with postoperative helmeting may be sufficient for effective cranial remodeling in sagittal craniosynostosis.