Surgical Management of Sagittal Synostosis: A Comparative Analysis of Strip Craniectomy and Calvarial Vault Remodeling

Maugans, Todd A.; McComb, Gordon; Levy, Michael L.

doi:10.1159/000121241

Cited by 84Craniofacial Disorders and TreatmentsPectus Deformity Diagnosis and TreatmentReconstructive Facial Surgery Techniques

Surgical Management of Sagittal Synostosis: A Comparative Analysis of Strip Craniectomy and Calvarial Vault Remodeling

Maugans, Todd A., McComb, Gordon, Levy, Michael L.·2008·Pediatric Neurosurgery

DOI 10.1159/000121241

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Abstract

Although surgical treatment of sagittal synostosis has become normative, the procedure of choice is still debated. This retrospective analysis, during a 10-year period (1986-1995) at Children’s Hospital Los Angeles, compares the more conservative strip craniectomy (SC) procedure with a more extensive occipital reduction-biparietal widening calvarial vault remodeling (CVR) technique for the management of sagittal synostosis. SC was performed in 72 patients (61%) and CVR in 46 (39%). Patients undergoing CVR were older (mean 5.3 vs. 3.0 months, p< 0.01), the procedure time longer (mean 126 min vs. 72 min, p < 0.01), intraoperative blood loss greater (mean 243 vs. 54 cm3, p < 0.01), and the frequency of intraoperative blood transfusion increased (100 vs. 38%, p < 0.01; mean volume 357 vs. 51 cm3, p < 0.01) compared to patients undergoing SC. No significant intraoperative complications occurred in either group. The total time of hospitalization was similar (mean 4.4 vs. 3.8 days, p = 0.02). No neurological, hematological, or transfusion-related complications or deaths were encountered in either group. Cosmetic outcomes were significantly better in the CVR group with 79% rated as excellent compared to 41% in the SC group (p < 0.01). Fifty-nine percent of the SC patients manifested bony defects at last follow-up visit. Two SC patients required reopera-tion for poor cosmetic outcomes; CVR was successfully employed in both cases. These findings demonstrate that CVR is superior to SC in providing immediate and lasting correction of calvarial deformities secondary to sagittal synostosis. The optimal age at time of surgery is <6 months; however, CVR can be utilized throughout infancy, while SC becomes progressively less effective after 6 months of age. No significant complications were observed in either group, despite the increased operative manipulation and greater incidence of blood transfusion in the CVR patients.

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Maugans et al. found that the effectiveness of SC procedures decreases with increasing age, in contrast to CVR.
“The results showed that the effectiveness of SC procedures decreases with increasing age, in contrast to the CVR method [43].”
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 [43]
Maugans et al. found bone defects in 59% of SC patients at final examination.
“In contrast to the CVR method, bone defects were found in 59% of the SC patients at the final examination”
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 [43]
Maugans et al. made it clear that despite increased blood loss, CVR allows immediate and long-term correction, especially in older patients with more pronounced findings.
“In the 1990s, the comparison of SC with CVR by Maugans et al. made it clear that, despite the more extensive procedure with significantly increased blood loss in contrast to SC, immediate and long-term correction is possible, especially in older patients with more pronounced findings [43].”
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 [43]

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Authors: Maugans, T. A., McComb, G., & Levy, M. L.
Affiliations: Dartmouth–Hitchcock Medical Center (US)
University of Southern California (US)
ORCID: Levy, Michael L.
Venue: Pediatric Neurosurgery
Publisher: S. Karger AG
Published: 2008-03-07
Volume: 27
Issue: 3
Pages: 137-148
ISSN: 1016-2291 (ISSN-L)
1423-0305
DOI: 10.1159/000121241
OpenAlex: W2117750181
Cited by: 84
References: 0
Citations by year: 2026: 2 · 2025: 2 · 2024: 4 · 2023: 3 · 2022: 1 · 2021: 2 · 2020: 3 · 2019: 4 · 2018: 5 · 2017: 2 · 2016: 3 · 2015: 5 · 2014: 3 · 2013: 2 · 2012: 4
FWCI: 2.85
Type: journal article
Language: en
Open access: closed
Licence: karger.com/pages/terms-and-conditions (vor)
karger.com/pages/terms-and-conditions (tdm)
Locations: Pediatric Neurosurgery (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: sagittal synostosis, strip craniectomy, surgical outcomes, cosmetic outcome, intraoperative blood transfusion, age at surgery, bony defects, reoperation
MeSH terms: Craniotomy, Diseases in Twins, Female, Humans, Infant, Infant, Newborn, Male, Postoperative Complications, Retrospective Studies, Skull, Synostosis

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Surgical Management of Sagittal Synostosis: A Comparative Analysis of Strip Craniectomy and Calvarial Vault Remodeling

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