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Cited by 6Craniofacial Disorders and TreatmentsPectus Deformity Diagnosis and TreatmentReconstructive Facial Surgery Techniques

Osteoclastic craniectomy for scaphocephaly in infants results in physiological head shapes

Lehner, M., Ferrari-von Klot, F., Zundel, S., Wendling-Keim, D.·2019·Journal of Cranio-Maxillofacial Surgery
DOI 10.1016/j.jcms.2019.10.006
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Abstract

Introduction Sagittal synostosis leading to scaphocephaly is the most common type of craniostenosis being operated. Different treatment options are known, but the optimal treatment method is still controversial. Head growth indicated by measurements of the head´s circumference and cephalic index (CI) are valid surrogate parameters for normal head shapes in children. The aim of the study was to analyze if osteoclastic craniectomy (OC) in scaphocephaly children at four to ten months of age results in normal head shapes.Patients and methods Twenty-seven patients with scaphocephaly underwent OC between 2003 and 2011. The mean patient age at the time of surgery was 6.75 months. The body weight was between 6.1 and 9.3 kg, mean 8.0 kg. The average duration of surgery was 108 minutes. The mean blood loss during the procedure was 168 ml and the mean amount of erythrocyte transfusion was 152 ml. The mean time spent on the ICU was 1.48 days and the mean of total hospital stay was 5.81 days. The operative method is described. During the mean follow-up time of 6.3 years (min 3.8, max 10.4, median 7.1) focus was set on the patient´s head growth and cephalic index (CI) following OC. For statistical reason the follow up period was divided into three groups: follow up 2-4 years, 5-7 years and 8-10 years.Results For all cases the total head growth was 9.5cm (mean) during the follow up period of 6.3 years. Analyzing the mean head growth by bootstrapping analysis, the three observational groups showed a significant increase of the head circumference in all cases being analyzed: group 1 p=0.003, group 2 p=0.005 and group 3 p=0.028 Evaluation of the CI showed a statistically significant change from a pathologic value of 0.67 (mean) preoperatively to a normal value of 0.78 (mean) postoperatively during the follow up analyzing all patients. To precise these findings, the bootstrapping analysis showed in the first period an increase of the mean CI not reaching statistical significance (p=0.351). Analyzing the second and third period the CI significantly increased in both groups (p=0.016 and p=0.037). All patients showed a nearly complete re-ossification during the follow up period. No secondary operation was necessary in any patient of this cohort.Conclusion As shown in this single-center observational study, the surgical intervention significantly improved the cephalic index and resulted in a symmetric head shape with excellent aesthetic appearance. The results were not dependent on postoperative helmet therapy, and compliance of caregivers. Re-ossification reached 100% within the observation period. According to these data, we recommend osteoclastic craniectomy as the method of choice in infants six to twelve months of age.

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  • Alternative surgical techniques such as the Peau d'Ours technique, triple square extended osteotomies, and transsutural distraction osteogenesis remain limited to specialized centres and lack widespread clinical acceptance due to their complexity and the availability of more established techniques.

    “Despite ongoing advancements, several alternative surgical techniques remain limited to specialized centres. Approaches such as the Peau d'Ours technique, triple square extended osteotomies, and transsutural distraction osteogenesis have been explored but lack widespread clinical acceptance due to their complexity and the availability of more established techniques [54, 81–84].”

    From Developments in diagnostic and surgical techniques in children with sagittal suture craniosynostosis: a systematic review spanning the last 30 years (2025) · cites this paper as [82]

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Authors
Lehner, M., Ferrari-von Klot, F., Zundel, S., & Wendling-Keim, D.
Affiliations
Luzerner Kantonsspital (CH)
Corresponding author
Lehner, M.
ORCID
Venue
Journal of Cranio-Maxillofacial Surgery
Publisher
Elsevier BV
Published
2019-12
Volume
47
Issue
12
Pages
1891-1897
ISSN
1010-5182 (ISSN-L)
DOI
10.1016/j.jcms.2019.10.006
OpenAlex
W2991207814
Cited by
6
References
28
Citations by year
2026: 1 · 2025: 1 · 2024: 1 · 2023: 1 · 2021: 2
FWCI
0.30
Type
journal article
Language
en
Open access
closed
Licence
Locations
  • Journal of Cranio-Maxillofacial Surgery (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Craniofacial Disorders and Treatments
  • Health Sciences › Medicine › Surgery › Pectus Deformity Diagnosis and Treatment
  • Health Sciences › Medicine › Surgery › Reconstructive Facial Surgery Techniques
Keywords
scaphocephaly, sagittal synostosis, craniostenosis, infants, head growth, cephalic index, head shape, head circumference, surgical outcomes, long-term follow-up, operative blood loss, red blood cell transfusion, postoperative complications, pediatric neurosurgery
MeSH terms
Child, Child, Preschool, Cranial Sutures, Craniosynostoses, Craniotomy, Female, Head, Humans, Male, Retrospective Studies, Treatment Outcome

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