Short-term outcomes after suturectomy and cranial remodeling orthosis treatment for craniosynostosis in infants 5 months and older.

OBJECTIVE

Suturectomy followed by cranial remodeling orthosis (CRO) is traditionally performed in infants younger than 4 months. The authors aimed to evaluate the effectiveness of this technique in patients aged 5 months and older.

METHODS

A single-institution retrospective chart review of all patients undergoing nonendoscopic suturectomy for craniosynostosis between January 2018 and June 2023 was performed. Demographic and operative data and remodeling outcomes assessed by cranial measurements from head scans were analyzed. Patients were stratified into 2 groups based on age: age ≥ 5 months and ≤ 4 months at surgery. A literature review was performed to contextualize outcomes.

RESULTS

A total of 61 patients were included: 22 aged ≥ 5 months (mean 6.3, range 5-10 months) and 39 aged ≤ 4 months (mean 3.4, range 2-4.5 months). Overall, 50.8% had sagittal craniosynostosis. There were no intraoperative complications. Blood loss, transfusion needs, and postoperative hemoglobin levels were comparable. The mean hospital length of stay for older infants was 1.68 compared with 1.51 days for younger patients. Remodeling outcomes were assessed in 46 patients with pre- and post-treatment scans. In sagittal cases, the parietal mediolateral (ML) distance improved by 15.5 mm (15.7% improvement) in older infants and by 20.4 mm (15%) in younger infants (p = 0.150). Anteroposterior growth was 8.4 and 13.8 mm, respectively (p = 0.017). Cephalic index (CI) improvements were similar (6.1% in older vs 7.1% in younger infants). In metopic cases, the frontal ML distance improved by 9.4 mm (10.3% improvement) in older patients and 12.3 mm (14.5%) in younger patients (p = 0.563), with CI improvements of 2.8% and 7.6%, respectively (p = 0.347), and respective interfrontal angle improvements of 5.2° (4%) and 8.7° (6.5%) (p = 0.21). Coronal cases demonstrated marked ML and cranial vault asymmetry index improvements in both groups. By 15 months after surgery, full reossification of the suturectomy site was observed in 81.2% of older versus 57.1% of younger infants (p = 0.14, OR 3.25). A literature review revealed limited detailed published data (72 infants ≥ 5 months of age with specified age and compared outcomes); authors described less favorable results in older patients.

CONCLUSIONS

Suturectomy with CRO in infants aged 5-10 months achieves favorable and satisfactory cranial remodeling outcomes, nearly comparable to those of younger patients. These findings support extending the age eligibility for suturectomy to include infants up to around 10 months old.