Impact of barrel stave osteotomy on cephalometric measurements in patients who have undergone endoscopic repair of sagittal craniosynostosis.

OBJECTIVE

The treatment of sagittal craniosynostosis typically involves endoscopic suturectomy (ES) to allow skull expansion, followed by postoperative helmet orthosis, resulting in an improvement in cranial deformity as assessed using the cephalic index (CI). The impact of variations in surgical technique on long-term CI outcomes is not well understood, and there is controversy regarding whether adding barrel stave osteotomy (BSO) to standard ES leads to greater improvement in the CI postoperatively. This combined approach is thought to improve cranial shape and overall clinical outcomes but may increase operative burden. The aim of this study was to investigate the impact of BSO during ES on operative outcomes and postoperative cranial deformity in patients who underwent surgical correction of sagittal craniosynostosis.

METHODS

The authors conducted a retrospective chart review of children who had been treated with ES for sagittal craniosynostosis between 2010 and 2021 at British Columbia Children's Hospital. Demographics, operative outcomes, and postoperative longitudinal CI measurements were collected and compared between patients who had undergone ES with BSO (ES+BSO) and those who had undergone ES alone. Operative outcomes related to anesthesia and surgical time, blood loss, and hospital length of stay were analyzed, as were changes in the CI at various follow-up times. A mixed-effects model was used to compare longitudinal CI measurements between treatment groups, controlling for patient age, preoperative CI, and duration of helmet therapy.

RESULTS

Eighty-five patients were included in the analysis, 67 treated with ES+BSO and 18 treated with ES. Operative outcomes, including length of hospital stay, operative time, time under anesthesia, blood loss, and need for transfusion did not differ significantly between treatment groups (p > 0.05). The mean follow-up for the last CI measurements was 56.0 months. While preoperative CI was similar for the two groups (mean 67.4 for ES+BSO vs 66.8 for ES, p = 0.61), CI was significantly higher in the ES+BSO group immediately postoperatively (p = 0.004) and at the 6-month (p = 0.01), 2-year (p = 0.02), and final (p = 0.002) follow-ups. A mixed-effects model revealed that the addition of BSO led to significantly greater CI measurements independent of age, preoperative CI, and helmeting duration (estimated effect size 2.21, p = 0.001).

CONCLUSIONS

In this series, the addition of BSO to ES significantly improved immediate and long-term cranial deformity in patients with sagittal craniosynostosis, without increasing the operative burden.