Developments in diagnostic and surgical techniques in children with sagittal suture craniosynostosis: a systematic review spanning the last 30 years

Probably not a substantial claim: may not pass S3 (load-bearing).

Cinca et al. (2022) proposed that mechanical factors such as crowding or abnormal positioning of twins may be a significant factor in the development of sagittal suture craniosynostosis alongside genetic causes.

“The authors propose that mechanical factors, such as crowding or abnormal positioning of the twins, may be a significant factor in the development of SSC, alongside genetic causes [38].”

• cites [38] Cinca KP, de Planque CA, Peters NCJ, Versnel SL, Mathijssen IMJ. Prenatal ultrasound parameters of twins with sagittal suture craniosynostosis question mechanical constraint as the leading cause. J Craniofac Surg. 2022;33(8):2350–3. sourceDisputed

  The Discussion concludes that scaphocephaly in twins is likely due to the same disturbed suture-development processes seen in singletons, “and not to mechanical constraint.” Although the Abstract notes that constraint had previously been suggested as a possible cause, the authors' findings argue against it rather than propose it as a significant factor alongside genetic causes. (LLM, conf=0.91)

  Checked by a reasoning model — may be wrong.

  Experimental — accuracy not yet measured

May combine two claims.

Endoscopic surgery demonstrates a significantly lower mortality rate compared to open techniques, attributed to its minimally invasive nature and reduced surgical trauma.

“Endoscopic surgery demonstrates a significantly lower mortality rate compared to open techniques, attributed to its minimally invasive nature and reduced surgical trauma.”

• cites [12] Han RH, Nguyen DC, Bruck BS, Skolnick GB, Yarbrough CK, Naidoo SD, et al. Characterization of complications associated with open and endoscopic craniosynostosis surgery at a single institution. J Neurosurg Pediatr. 2016;17(3):361–70. sourceDisputed

  The Abstract Results report no mortality in either the endoscopic or open group, so this study does not show a significantly lower mortality rate with endoscopic surgery. The Conclusions report lower blood loss and shorter procedures with endoscopic surgery, but do not attribute a mortality difference to reduced surgical trauma. (LLM, conf=0.90)

  Checked by a reasoning model — may be wrong.

  Experimental — accuracy not yet measured
• cites [13] Goyal A, Lu VM, Yolcu YU, Elminawy M, Daniels DJ. Endoscopic versus open approach in craniosynostosis repair: a systematic review and meta-analysis of perioperative outcomes. Childs Nerv Syst. 2018;34(9):1627–37. sourceNot checked — no full text of the source
• cites [14] Spazzapan P, Velnar T. Isolated sagittal craniosynostosis: a comprehensive review. Diagnostics. 2024. https://doi.org/10.3390/diagnostics14040435. sourcePartly supported

  Section 8 (Surgical Techniques; page unavailable) describes endoscopic surgery as less invasive than open procedures, with fewer incisions and less blood loss. It does not report a significantly lower mortality rate or establish that reduced surgical trauma causes a mortality difference. (LLM, conf=0.87)

  Experimental — accuracy not yet measured
• cites [15] Jimenez DF, Barone CM, McGee ME, Cartwright CC, Baker CL. Endoscopy-assisted wide-vertex craniectomy, barrel stave osteotomies, and postoperative helmet molding therapy in the management of sagittal suture craniosynostosis. J Neurosurg. 2004;100(5 Suppl Pediatrics):407–17. sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

Cinca et al. proposed that mechanical constraints in twin pregnancies may contribute to sagittal suture fusion.

“More recently Cinca et al. proposed that mechanical constraints in twin pregnancies may contribute to sagittal suture fusion, highlighting the multifactorial nature of this condition [38].”

• cites [38] Cinca KP, de Planque CA, Peters NCJ, Versnel SL, Mathijssen IMJ. Prenatal ultrasound parameters of twins with sagittal suture craniosynostosis question mechanical constraint as the leading cause. J Craniofac Surg. 2022;33(8):2350–3. sourceDisputed

  The Abstract describes mechanical constraint as an existing suggestion that Cinca et al. set out to test, not a proposal they make. Its conclusion says scaphocephaly in twins is likely due to disturbed suture-development processes, not mechanical constraint; the Discussion likewise calls reduced womb space an improbable influence at the apparent onset of synostosis. Page numbers are unavailable in our copy. (LLM, conf=0.88)

  Checked by a reasoning model — may be wrong.

  Experimental — accuracy not yet measured

Probably not a substantial claim: may not pass S3 (load-bearing).

The review was performed according to the PRISMA Guidelines for Systematic Reviews and Meta-Analyses.

“This review was performed according to the PRISMA Guidelines for Systematic Reviews and Meta-Analyses [25].”

• cites [25] Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. bmj. 2021;372:n71 sourceSupported

May combine two claims.

Cornelissen et al. (2018) found that foetuses with scaphocephaly had a significantly lower cephalic index at 20 weeks (0.76 vs. 0.79; p = 0.000), but CI alone was not reliable for screening.

“Findings showed that foetuses with scaphocephaly had a significantly lower CI (0.76 vs. 0.79; p = 0.000), but CI alone was not reliable for screening at 20 weeks.”

• cites [36] Cornelissen MJ, Apon I, van der Meulen J, Groenenberg IAL, Kraan-van der Est MN, Mathijssen IMJ, et al. Prenatal ultrasound parameters in single-suture craniosynostosis. J Matern Fetal Neonatal Med. 2018;31(15):2050–7. sourceSupported

May combine two claims.

Open surgery provides immediate correction but is more invasive, with higher risks of complications such as significant blood loss and scarring.

“Open surgery provides immediate correction but is more invasive, with higher risks of complications like significant blood loss and scarring [9–11].”

• cites [9] Jimenez DF, Barone CM. Endoscopic craniectomy for early surgical correction of sagittal craniosynostosis. J Neurosurg. 1998;88(1):77–81. sourceNot checked — no full text of the source
• cites [10] Dalle Ore CL, Dilip M, Brandel MG, McIntyre JK, Hoshide R, Calayag M, et al. Endoscopic surgery for nonsyndromic craniosynostosis: a 16-year single-center experience. J Neurosurg Pediatr. 2018;22(4):335–43. sourcePartly supported

  The Discussion describes endoscopic repair as minimally invasive and says it commonly requires postoperative cranial molding, supporting a contrast with open surgery. But the paper does not establish that open surgery provides immediate correction or has higher rates of significant blood loss or scarring; its reported bleeding events occurred during endoscopic procedures. Page numbers were not available in our copy. (LLM, conf=0.78)

  Experimental — accuracy not yet measured
• cites [11] Isaac KV, Meara JG, Proctor MR. Analysis of clinical outcomes for treatment of sagittal craniosynostosis: a comparison of endoscopic suturectomy and cranial vault remodeling. J Neurosurg Pediatr. 2018;22(5):467–74. sourcePartly supported

  The Operative Technique section (page not supplied) describes cranial vault remodeling as correcting the deformity during surgery, without postoperative helmeting. Perioperative Data (page not supplied) reports significantly greater blood loss with remodeling than with endoscopic suturectomy. The paper does not establish a higher risk of scarring, so that part of the claim is unsupported. (LLM, conf=0.86)

  Experimental — accuracy not yet measured

May combine two claims.

Diagnosis of craniosynostosis is typically based on clinical examination focused on skull shape, with additional methods such as head circumference, cranial ultrasound, and 3D stereophotography, and CT or MRI reserved for complex cases.

“The diagnosis of craniosynostosis is typically based on a clinical examination focused on skull shape. Additional methods, such as head circumference measurement, cranial ultrasound (CUS), and 3D stereophotography, may be used, with computed tomography (CT) or magnet resonance imaging (MRI) reserved for complex cases [2, 7, 8].”

• cites [2] Schmidt L, Fassl V, Erhardt L, Winter J, Lollert A, Heider J, et al. Moderne Behandlung von Kraniosynostosen. Monatsschrift Kinderheilkunde. 2023:1-9 sourcePartly supported

  In “Als erster” (page unavailable), the paper says the working diagnosis usually follows clinical assessment of skull shape; it also describes 3D stereophotography and cranial ultrasound, with CT or MRI used for complex or syndromal cases. It does not identify head-circumference measurement as an additional diagnostic method. “Nachbehandlung und Outcome” discusses head-circumference percentiles as a postoperative outcome measure instead. (LLM, conf=0.87)

  Experimental — accuracy not yet measured
• cites [7] Fearon JA, Ditthakasem K, Herbert M, Kolar J. An appraisal of the cephalic index in sagittal craniosynostosis, and the unseen third dimension. Plast Reconstr Surg. 2017;140(1):138–45. sourceNot checked — no full text of the source
• cites [8] de Jong G, Bijlsma E, Meulstee J, Wennen M, van Lindert E, Maal T, et al. Combining deep learning with 3D stereophotogrammetry for craniosynostosis diagnosis. Sci Rep. 2020;10(1):15346. sourcePartly supported

  The Introduction (page unavailable) says experts can diagnose craniosynostosis by examining head shape, and the Discussion (page unavailable) identifies ultrasound, MRI, and 3D stereophotogrammetry as diagnostic options. The copy does not substantiate head-circumference measurement or reserving CT and MRI for complex cases. Instead, the Introduction calls CT the primary imaging technique, and Methods says CT confirmation was part of the study center’s standard treatment protocol. (LLM, conf=0.88)

  Experimental — accuracy not yet measured

May combine two claims.

Endoscopic surgery offers reduced blood loss, shorter operation times, and minimal scarring but often requires postoperative helmet therapy.

“The endoscopic method offers benefits like reduced blood loss, shorter operation times, and minimal scarring but often requires postoperative helmet therapy.”

• cites [9] Jimenez DF, Barone CM. Endoscopic craniectomy for early surgical correction of sagittal craniosynostosis. J Neurosurg. 1998;88(1):77–81. sourceNot checked — no full text of the source
• cites [10] Dalle Ore CL, Dilip M, Brandel MG, McIntyre JK, Hoshide R, Calayag M, et al. Endoscopic surgery for nonsyndromic craniosynostosis: a 16-year single-center experience. J Neurosurg Pediatr. 2018;22(4):335–43. sourcePartly supported

  The Perioperative Data report a median surgical duration of 55.5 minutes and estimated blood loss of 25 ml, while the Discussion describes avoiding prolonged operative times. The introductory passage contrasts shorter endoscopic incisions with open approaches, and Operative and Postoperative Management confirms postoperative cranial orthotics. The paper does not directly establish less blood loss or shorter operations than open surgery, or measure scarring. (LLM, conf=0.84)

  Experimental — accuracy not yet measured
• cites [11] Isaac KV, Meara JG, Proctor MR. Analysis of clinical outcomes for treatment of sagittal craniosynostosis: a comparison of endoscopic suturectomy and cranial vault remodeling. J Neurosurg Pediatr. 2018;22(5):467–74. sourcePartly supported

  The Perioperative Data section reports significantly lower blood loss and operative time for endoscopic suturectomy than for cranial vault remodeling. The Operative Technique section describes two 2-cm incisions and postoperative helmeting, but the paper does not establish that scarring is minimal. Page numbers are not available in our copy. (LLM, conf=0.88)

  Experimental — accuracy not yet measured

Probably not a substantial claim: may not pass S3 (load-bearing).

These syndromes are increasingly caused by autosomal-dominant mutations in genes that influence cartilage and bone growth, such as fibroblast growth factor genes 1-3 and the TWIST1 gene.

“These syndromes are increasingly caused by autosomal-dominantly caused mutations in genes that influence cartilage and bone growth, such as mutations in the fibroblast growth factor gene 1–3 on chromosomes 4, 8, 10 and the TWIST 1 gene on chromosome 7 [4, 16, 18].”

• cites [4] Speer P, Gahr M. Pädiatrie. Berlin: Springer; 2013. sourceNot checked — no full text of the source
• cites [16] Lentze M, Schulte FJ, Schaub J, Spranger J, Hrsg. Pädiatrie. Grundlagen und Praxis. Berlin: Springer; 2003. sourceNot checked — no full text of the source
• cites [18] Di Rocco F, Rossi M, Verlut I, Szathmari A, Beuriat PA, Chatron N, et al. Clinical interest of molecular study in cases of isolated midline craniosynostosis. Eur J Hum Genet. 2023;31(6):621–8. sourcePartly supported

  The FGFR2 pathway section discusses FGFR2 variants previously described in syndromic craniosynostosis, and the Discussion associates heterozygous TWIST1 variants with Saethre–Chotzen syndrome. The paper does not substantiate an increasing frequency of autosomal-dominant causes or the full FGFR1–3 gene list; its own FGFR2 and TWIST1 findings concern isolated craniosynostosis and include variants classified as having uncertain significance. (LLM, conf=0.84)

  Experimental — accuracy not yet measured

May combine two claims.

Wilkie et al. (2010) found that 21% of non-syndromic craniosynostosis patients had a genetic cause, mainly single-gene mutations (86%) and fewer chromosomal abnormalities (14%), with FGFR3 P250R being the most common.

“Results showed that 21% of all non-syndromic had a genetic cause, mainly single-gene mutations (86%) and fewer chromosomal abnormalities (14%) with the FGFR3 P250R mutation being the most common.”

• cites [30] Wilkie AO, Byren JC, Hurst JA, Jayamohan J, Johnson D, Knight SJ, et al. Prevalence and complications of single-gene and chromosomal disorders in craniosynostosis. Pediatrics. 2010;126(2):e391-400. sourcePartly supported

  The Results report that 21% of all children with craniosynostosis had a proven genetic cause; the 86% single-gene and 14% chromosomal breakdown also describes genetic cases overall. For cases initially classified as non-syndromic, the Results instead report single-gene mutations in 11/204 (5.4%), with FGFR3 P250R the most common individual mutation. The claim incorrectly applies the overall percentages to non-syndromic patients. (LLM, conf=0.94)

  Experimental — accuracy not yet measured

Probably not a substantial claim: may not pass S3 (load-bearing).

Schmidt et al. (2023) recommended determining cephalic index as particularly appropriate for scaphocephaly and for follow-up assessment after surgery.

“Another recommended method of assessment would be to determine the CI. This parameter is particularly appropriate for the presence of scaphocephaly and for follow-up assessment, even after surgery [2].”

• cites [2] Schmidt L, Fassl V, Erhardt L, Winter J, Lollert A, Heider J, et al. Moderne Behandlung von Kraniosynostosen. Monatsschrift Kinderheilkunde. 2023:1-9 sourceSupported

May combine two claims.

Schmidt et al. (2023) reported that sonography shows an echo-poor gap in intact sutures and a missing gap in ossified sutures, with sensitivity almost 100% and specificity 86-98% compared to CT.

“In the article published in 2023, Schmidt et al. explained that in sonography an echo-poor gap between the adjoining cranial bones can be recognised in an intact suture, which corresponds to the fibrous unclosed suture; in an ossified cranial suture, however, a corresponding gap is missing [2].”

• Also stated in: § Diagnosis technology · plain

  “The sensitivity of this method is reported to be almost 100%, the specificity is 86–98% compared to the CT collective [2].”

• cites [2] Schmidt L, Fassl V, Erhardt L, Winter J, Lollert A, Heider J, et al. Moderne Behandlung von Kraniosynostosen. Monatsschrift Kinderheilkunde. 2023:1-9 sourceSupported

May combine two claims.

De Jong et al. (2020) found that 3D stereophotogrammetry combined with a deep learning algorithm classified 195/196 cases (99.5%) exactly, with sensitivity 100% and specificity 96% for scaphocephaly.

“The accuracy of this method is clearly demonstrated by the exact classification of 195/196 cases (99.5%), with a sensitivity of 100% and a specificity of 96% for scaphocephaly [8].”

• cites [8] de Jong G, Bijlsma E, Meulstee J, Wennen M, van Lindert E, Maal T, et al. Combining deep learning with 3D stereophotogrammetry for craniosynostosis diagnosis. Sci Rep. 2020;10(1):15346. sourcePartly supported

  The Results > Deep learning network passage reports that 195 of 196 subjects (99.5%) were correctly classified. It reports 100% sensitivity and specificity for scaphocephaly, not 96% specificity; the approximately 96% figure is the sensitivity for anterior plagiocephaly. (LLM, conf=0.94)

  Experimental — accuracy not yet measured

May combine two claims.

Wilkie et al. found that sagittal craniosynostosis showed minimal genetic links, suggesting non-genetic factors play a greater role.

“In contrast, sagittal craniosynostosis showed minimal genetic links, with only a small percentage linked to single-gene mutations and even fewer chromosomal abnormalities.”

• Also stated in: § Diagnosis technology · hedged

  “This suggests non-genetic factors play a greater role in sagittal craniosynostosis, though further research is needed.”

• cites [30] Wilkie AO, Byren JC, Hurst JA, Jayamohan J, Johnson D, Knight SJ, et al. Prevalence and complications of single-gene and chromosomal disorders in craniosynostosis. Pediatrics. 2010;126(2):e391-400. sourcePartly supported

  The Results (page unavailable) report negative molecular tests in all 27 tested children with non-syndromic sagittal synostosis, and no clinically significant chromosome abnormalities among tested non-syndromic children, including 14 with sagittal synostosis. These findings support a low yield for the genetic changes examined, but do not establish that sagittal craniosynostosis generally has minimal genetic links or that non-genetic factors play a greater role. The Results also report chromosome abnormalities involving midline sutures, so the finding needs its non-syndromic qualifier. (LLM, conf=0.82)

  Experimental — accuracy not yet measured

May combine two claims.

Lang et al. (2021) found that the likelihood of ICU admission, length of stay, and overall hospitalisation duration was greater in the spring-assisted surgery group.

“However, the likelihood of being admitted to the intensive care unit, as well as the length of stay and the overall hospitalisation duration, was greater in the spring-assisted surgery group, potentially due to the hospital's protocol [61].”

• cites [61] Lang SS, Meier PM, Paden WZ, Storm PB, Heuer GG, Bartlett SP, et al. Spring-mediated cranioplasty versus endoscopic strip craniectomy for sagittal craniosynostosis. J Neurosurg Pediatr. 2021;28(4):416–24. sourceSupported

Probably not a substantial claim: may not pass S3 (load-bearing).

Van Veelen et al. (2015) concluded that adding a widening bridge in late complete remodeling (older than 9 months) significantly and long-lastingly improves CI.

“Van Veelen et al. concluded that the addition of a widening bridge in the context of late complete remodeling (older than 9 months) significantly and long-lastingly improves CI [60].”

• cites [60] van Veelen ML, Mihajlović D, Dammers R, Lingsma H, van Adrichem LN, Mathijssen IM. Frontobiparietal remodeling with or without a widening bridge for sagittal synostosis: comparison of 2 cohorts for aesthetic and functional outcome. J Neurosurg Pediatr. 2015;16(1):86–93. sourceSupported

May combine two claims.

Van Veelen et al. (2015) found that head circumference decreased in both groups, with preoperative head circumference having the decisive influence, not the surgical technique.

“During the follow-up the head circumference decreased in both groups, whereby the preoperative head circumference had the decisive influence, but not the chosen surgical technique.”

• cites [60] van Veelen ML, Mihajlović D, Dammers R, Lingsma H, van Adrichem LN, Mathijssen IM. Frontobiparietal remodeling with or without a widening bridge for sagittal synostosis: comparison of 2 cohorts for aesthetic and functional outcome. J Neurosurg Pediatr. 2015;16(1):86–93. sourceSupported

May combine two claims.

The incidence of single suture synostosis increased noticeably and constantly in recent years, with a dynamic change in the frequency of subtypes.

“The incidence of single suture synostosis increased noticeable constant in recent years. Moreover, there is a dynamic change in the frequency of the different subtypes of this clinical picture at the same time [21–24].”

• cites [21] Morriss-Kay GM, Wilkie AO. Growth of the normal skull vault and its alteration in craniosynostosis: insights from human genetics and experimental studies. J Anat. 2005;207(5):637–53. sourceCould not verify

  The epidemiology section (page not provided) gives the prevalence of different craniosynostosis subtypes, but no comparison across years. Searches for increasing incidence and changing subtype frequencies found no passage addressing either claimed trend. (LLM, conf=0.74)

  Experimental — accuracy not yet measured
• cites [22] Di Rocco F, Arnaud E, Renier D. Evolution in the frequency of nonsyndromic craniosynostosis. J Neurosurg Pediatr. 2009;4(1):21–5. sourceNot checked — no full text of the source
• cites [23] Kweldam CF, van der Vlugt JJ, van der Meulen JJ. The incidence of craniosynostosis in the Netherlands, 1997–2007. J Plast Reconstr Aesthet Surg. 2011;64(5):583–8. sourceNot checked — no full text of the source
• cites [24] Cornelissen M, Ottelander B, Rizopoulos D, van der Hulst R, Mink van der Molen A, van der Horst C, et al. Increase of prevalence of craniosynostosis. J Craniomaxillofac Surg. 2016;44(9):1273–9. sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

Image quality can be compromised by artefacts, such as hair when protective caps are not used.

“Image quality can also be compromised by artefacts, for example caused by hair when protective caps are not used [70].”

• cites [70] Kurniawan M, Tio PAE, Abdel Alim T, Roshchupkin G, Dirven CMF, Pleumeekers MM, et al. 3D analysis of the cranial and facial shape in craniosynostosis patients: a systematic review. J Craniofac Surg. 2024;35(3):813–21. sourceSupported

Probably not a substantial claim: may not pass S3 (load-bearing).

The effective use of these technologies requires specialized expertise for accurate interpretation.

“The effective use of these technologies still requires specialized expertise for accurate interpretation and further appropriate treatment recommendations based on the latest research findings [2, 6].”

• cites [2] Schmidt L, Fassl V, Erhardt L, Winter J, Lollert A, Heider J, et al. Moderne Behandlung von Kraniosynostosen. Monatsschrift Kinderheilkunde. 2023:1-9 sourceSupported
• cites [6] Mathijssen IMJ. Updated guideline on treatment and management of craniosynostosis. J Craniofac Surg. 2021;32(1):371–450. sourceSupported

May combine two claims.

Unlike coronal synostosis, which has stronger genetic associations, sagittal cases likely involve environmental factors.

“Unlike coronal synostosis, which has stronger genetic associations, sagittal cases likely involve environmental factors.”

• cites [30] Wilkie AO, Byren JC, Hurst JA, Jayamohan J, Johnson D, Knight SJ, et al. Prevalence and complications of single-gene and chromosomal disorders in craniosynostosis. Pediatrics. 2010;126(2):e391-400. sourcePartly supported

  The Results (Indications for Cytogenetic and Molecular Genetic Testing; page unavailable) report a substantially higher single-gene mutation yield in non-syndromic coronal than sagittal synostosis. The paper also describes mechanical contributions to craniosynostosis generally, but does not specifically attribute sagittal cases to environmental factors. (LLM, conf=0.87)

  Experimental — accuracy not yet measured

May combine two claims.

Practical limitations include cost of equipment and need for patient compliance during image acquisition.

“This is accompanied by several practical limitations in clinical, like the considerable cost of equipment and the need for patient compliance during image acquisition- particularly challenging in very young children who may be unable to remain still [70].”

• cites [70] Kurniawan M, Tio PAE, Abdel Alim T, Roshchupkin G, Dirven CMF, Pleumeekers MM, et al. 3D analysis of the cranial and facial shape in craniosynostosis patients: a systematic review. J Craniofac Surg. 2024;35(3):813–21. sourcePartly supported

  The Discussion’s “Type 3D Imaging Modalities” section says patients must hold still for several seconds during scanning and that portable scanners cost less than static devices. The Recommendations and Conclusion section adds that young children may struggle to remain seated. The paper does not establish that equipment costs are considerable; it gives only a relative cost comparison. Page numbers were not available in our copy. (LLM, conf=0.85)

  Experimental — accuracy not yet measured

May combine two claims.

Ultrasound is non-invasive and widely available, but CI alone is unreliable, and the feasibility of advanced imaging in routine screening requires further study.

“While ultrasound is non-invasive and widely available, CI alone is unreliable, and the feasibility of advanced imaging in routine screening requires further study [36, 38].”

• cites [36] Cornelissen MJ, Apon I, van der Meulen J, Groenenberg IAL, Kraan-van der Est MN, Mathijssen IMJ, et al. Prenatal ultrasound parameters in single-suture craniosynostosis. J Matern Fetal Neonatal Med. 2018;31(15):2050–7. sourcePartly supported

  The Discussion (page unavailable) says CI at 20 weeks is too limited to use alone and that 3D imaging of cranial sutures is not currently feasible for routine screening because it is time-consuming and requires substantial expertise. The paper reports widespread use of standard ultrasound in the Netherlands, but does not address its non-invasive nature or say that further study is needed to determine the feasibility of routine 3D imaging. (LLM, conf=0.83)

  Experimental — accuracy not yet measured
• cites [38] Cinca KP, de Planque CA, Peters NCJ, Versnel SL, Mathijssen IMJ. Prenatal ultrasound parameters of twins with sagittal suture craniosynostosis question mechanical constraint as the leading cause. J Craniofac Surg. 2022;33(8):2350–3. sourcePartly supported

  The Analysis section (page unavailable) says pregnancy ultrasound measurements are used in daily practice, and the Discussion notes that measurements are user-dependent. The paper does not establish that CI alone is unreliable or discuss the feasibility of advanced imaging in routine screening; it also does not address ultrasound's non-invasiveness. (LLM, conf=0.76)

  Experimental — accuracy not yet measured

May combine two claims.

Clinical evaluation alone can accurately identify craniosynostosis, eliminating the need for imaging and reducing associated risks.

“Both Agrawal et al. and Schmidt et al. highlighted that clinical evaluation alone can accurately identify the condition, eliminating the need for imaging and reducing associated risks.”

• cites [2] Schmidt L, Fassl V, Erhardt L, Winter J, Lollert A, Heider J, et al. Moderne Behandlung von Kraniosynostosen. Monatsschrift Kinderheilkunde. 2023:1-9 sourcePartly supported

  In “Als erster” (page not provided), the paper says clinical examination usually yields a working diagnosis from the characteristic skull shape. It does not say clinical evaluation eliminates imaging: the authors use suture ultrasound for final confirmation and reserve CT or MRI mainly for complex cases. They note that avoiding CT where possible reduces radiation exposure. (LLM, conf=0.90)

  Experimental — accuracy not yet measured
• cites [27] Agrawal D, Steinbok P, Cochrane DD. Diagnosis of isolated sagittal synostosis: are radiographic studies necessary? Childs Nerv Syst. 2006;22(4):375–8. sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Cornelissen et al. and other authors highlighted the potential of prenatal ultrasound, with BPD deviations suggesting improved accuracy using 3D imaging.

“Cornelissen et al. and other authors highlighted the potential of prenatal ultrasound, with BPD deviations suggesting improved accuracy using 3D imaging.”

• cites [36] Cornelissen MJ, Apon I, van der Meulen J, Groenenberg IAL, Kraan-van der Est MN, Mathijssen IMJ, et al. Prenatal ultrasound parameters in single-suture craniosynostosis. J Matern Fetal Neonatal Med. 2018;31(15):2050–7. sourcePartly supported

  The Abstract and Discussion say that a deflection in the BPD curve should prompt 3D imaging of the cranial sutures, supporting the proposed use of prenatal ultrasound. The paper does not establish that 3D imaging improves diagnostic accuracy; the Discussion also says routine 3D screening is not currently feasible. (LLM, conf=0.84)

  Experimental — accuracy not yet measured
• cites [38] Cinca KP, de Planque CA, Peters NCJ, Versnel SL, Mathijssen IMJ. Prenatal ultrasound parameters of twins with sagittal suture craniosynostosis question mechanical constraint as the leading cause. J Craniofac Surg. 2022;33(8):2350–3. sourcePartly supported

  The Biometrics results (page unavailable) report that affected twins had slower BPD growth and a smaller BPD later in pregnancy, supporting the point that prenatal ultrasound can reveal deviations. The paper does not report that 3D imaging improves accuracy, and it is not a study by Cornelissen et al. (LLM, conf=0.87)

  Experimental — accuracy not yet measured

May combine two claims.

Sonography up to 13 months of age can distinguish an open from a closed suture with a reported sensitivity of 100% and specificity of 86-98%, without anaesthesia.

“sonography up to 13 months of age can distinguish an open from a closed suture with a reported sensitivity of 100% and specificity of 86–98% [2, 32], without any necessary anaesthesia.”

• cites [2] Schmidt L, Fassl V, Erhardt L, Winter J, Lollert A, Heider J, et al. Moderne Behandlung von Kraniosynostosen. Monatsschrift Kinderheilkunde. 2023:1-9 sourcePartly supported

  In “Redaktion > Als erster” (page unavailable), the paper describes sonography distinguishing open from ossified sutures, reports sensitivity of approximately 100% and specificity of 86–98%, and says it can be performed without sedation. It does not give a 13-month age limit, and its sensitivity figure is approximate rather than exactly 100%. (LLM, conf=0.88)

  Experimental — accuracy not yet measured
• cites [32] Eley KA, Watt-Smith SR, Sheerin F, Golding SJ. “Black Bone” MRI: a potential alternative to CT with three-dimensional reconstruction of the craniofacial skeleton in the diagnosis of craniosynostosis. Eur Radiol. 2014;24(10):2417–26. sourceNot checked — no full text of the source

May combine two claims.

Use of springs to treat prematurely fused sagittal suture is a successful addition and minimally invasive alternative, especially when families refuse helmet therapy or the child is too old for it.

“The use of springs to treat prematurely fused sagittal suture, especially in cases where families refuse helmet therapy or the child is too old for it, allows two-dimensional expansion of the skull and has been shown to be a successful addition and minimally invasive alternative [51, 64].”

• cites [51] Valetopoulou A, Constantinides M, Eccles S, Ong J, Hayward R, Dunaway D, et al. Endoscopic strip craniectomy with molding helmet therapy versus spring-assisted cranioplasty for nonsyndromic single-suture sagittal craniosynostosis: a systematic review. J Neurosurg Pediatr. 2022;30(4):455–62. sourcePartly supported

  The Abstract identifies spring-assisted cranioplasty as a minimally invasive treatment for sagittal craniosynostosis, and the Cephalic Index section reports postoperative improvement. The Discussion notes that helmet therapy depends on compliance, but does not establish spring treatment specifically for families who refuse helmets or children too old for them. Our copy also does not describe two-dimensional expansion; the review cautions that its comparative findings are hypothesis-generating. (LLM, conf=0.86)

  Experimental — accuracy not yet measured
• cites [64] Pyle J, Glazier S, Couture D, Sanger C, Gordon S, David L. Spring-assisted surgery-a surgeon’s manual for the manufacture and utilization of springs in craniofacial surgery. J Craniofac Surg. 2009;20(6):1962–8. sourceNot checked — no full text of the source

May combine two claims.

Early diagnosis through detailed physical examination enables timely surgical intervention and helps minimise healthcare costs.

“Early diagnosis through a detailed physical examination not only enables timely surgical intervention but also helps minimise healthcare costs, underscoring the value of clinical expertise in managing this condition [2, 27].”

• cites [2] Schmidt L, Fassl V, Erhardt L, Winter J, Lollert A, Heider J, et al. Moderne Behandlung von Kraniosynostosen. Monatsschrift Kinderheilkunde. 2023:1-9 sourcePartly supported

  The paper’s “Als erster” section describes clinical examination by an experienced examiner as the first diagnostic step. Its “Indikation” and “Nachbehandlung und Outcome” sections recommend early assessment and, in most cases where surgery is chosen, early correction. Our copy does not say that early diagnosis minimises healthcare costs (searched for Kosten and related terms). Page numbers were not available in the indexed passages. (LLM, conf=0.87)

  Experimental — accuracy not yet measured
• cites [27] Agrawal D, Steinbok P, Cochrane DD. Diagnosis of isolated sagittal synostosis: are radiographic studies necessary? Childs Nerv Syst. 2006;22(4):375–8. sourceNot checked — no full text of the source

May combine two claims.

Initially, SC focused on releasing the fused sagittal suture but did little to correct skull shape abnormalities.

“Initially, SC focused on releasing the fused sagittal suture but did little to correct skull shape abnormalities, such as frontal bossing or occipital elongation [14].”

• cites [14] Spazzapan P, Velnar T. Isolated sagittal craniosynostosis: a comprehensive review. Diagnostics. 2024. https://doi.org/10.3390/diagnostics14040435. sourceSupported

Probably not a substantial claim: may not pass S3 (load-bearing).

Birgfeld et al. and Seruya et al. emphasized that multidisciplinary surgical planning is crucial for ensuring both safety and effectiveness of CVR.

“In a more recent comparative study, Birgfeld et al. and Seruya et al. emphasised that multidisciplinary surgical planning is crucial in ensuring both the safety and effectiveness of CVR, underscoring the importance of postoperative monitoring to optimise long-term outcomes [44, 45].”

• cites [44] Seruya M, Tan SY, Wray AC, Penington AJ, Greensmith AL, Holmes AD, et al. Total cranial vault remodeling for isolated sagittal synostosis: part I. Postoperative cranial suture patency. Plast Reconstr Surg. 2013;132(4):602e–10e. sourceNot checked — no full text of the source
• cites [45] Birgfeld CB, Dufton L, Naumann H, Hopper RA, Gruss JS, Haberkern CM, et al. Safety of open cranial vault surgery for single-suture craniosynostosis: a case for the multidisciplinary team. J Craniofac Surg. 2015;26(7):2052–8. sourcePartly supported

  The Discussion (page unavailable) emphasizes multidisciplinary protocols and says the authors believe the team approach contributed to safety, but explicitly says the study cannot establish that team care is safer than care outside a team. The Introduction describes improved outcomes, and the postoperative-care section describes ICU monitoring; neither establishes that multidisciplinary planning ensures effectiveness or that monitoring optimizes long-term outcomes. (LLM, conf=0.88)

  Experimental — accuracy not yet measured

May combine two claims.

Wilkie et al. showed that sagittal craniosynostosis has minimal genetic links, reducing recurrence risk but complicating early diagnosis.

“Wilkie et al. showed that sagittal craniosynostosis has minimal genetic links, reducing recurrence risk but complicating early diagnosis.”

• cites [30] Wilkie AO, Byren JC, Hurst JA, Jayamohan J, Johnson D, Knight SJ, et al. Prevalence and complications of single-gene and chromosomal disorders in craniosynostosis. Pediatrics. 2010;126(2):e391-400. sourcePartly supported

  In Results (page unavailable), all 27 tested children with non-syndromic sagittal synostosis had negative molecular genetic tests; the Discussion says routine testing is not supported for that group. The paper does not show that this finding reduces recurrence risk or complicates early diagnosis. Its Conclusions instead say genetic assessment helps estimate recurrence risks generally. (LLM, conf=0.86)

  Experimental — accuracy not yet measured

May combine two claims.

Diagnostic confirmation typically involves measurement of head circumference, ultrasonography and, if required and technically possible, three-dimensional stereophotography.

“Diagnostic confirmation typically involves the use of methods such as measurement of the head circumference, ultrasonography and if required and technically possible three-dimensional stereophotography.”

• cites [2] Schmidt L, Fassl V, Erhardt L, Winter J, Lollert A, Heider J, et al. Moderne Behandlung von Kraniosynostosen. Monatsschrift Kinderheilkunde. 2023:1-9 sourcePartly supported

  The diagnostic section (‘Als erster’; page unavailable) describes 3D stereophotography as established imaging and says the centre uses cranial-suture ultrasonography for final diagnostic confirmation. It describes measuring the cephalic index, not head circumference, during initial assessment; ‘Nachbehandlung und Outcome’ mentions head-circumference percentiles only as a postoperative outcome measure. The source also describes 3D scans at initial visits rather than limiting them to cases where they are required and technically possible. (LLM, conf=0.87)

  Experimental — accuracy not yet measured
• cites [7] Fearon JA, Ditthakasem K, Herbert M, Kolar J. An appraisal of the cephalic index in sagittal craniosynostosis, and the unseen third dimension. Plast Reconstr Surg. 2017;140(1):138–45. sourceNot checked — no full text of the source
• cites [8] de Jong G, Bijlsma E, Meulstee J, Wennen M, van Lindert E, Maal T, et al. Combining deep learning with 3D stereophotogrammetry for craniosynostosis diagnosis. Sci Rep. 2020;10(1):15346. sourcePartly supported

  The Discussion (page not supplied) identifies ultrasound and 3D stereophotogrammetry as methods that can be used in craniosynostosis diagnosis. It does not mention head-circumference measurement or describe the claimed typical sequence of diagnostic confirmation. The Introduction and Methods > Data acquisition instead identify CT as the primary imaging technique and the method used to confirm cases in this study. (LLM, conf=0.86)

  Experimental — accuracy not yet measured
• cites [37] Ravindra VM, Awad AW, Baker CM, Lee A, Anderson RCE, Gociman B, et al. Preoperative imaging patterns and intracranial findings in single-suture craniosynostosis: a study from the synostosis research group. J Neurosurg Pediatr. 2021;28(3):344–50. sourceNot checked — no full text of the source

May combine two claims.

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].”

• cites [54] Lobb DC, Patel SK, Pan BS, Skoch J. Partial suturectomy for phenotypical craniosynostosis caused by incomplete fusion of cranial sutures: a novel surgical solution. Neurosurg Focus. 2021;50(4): E6. sourceNot checked — no full text of the source
• cites [81] Arenas-Ruiz JA, Martínez-Maldonado H, Hernández-Segura NE, Villarreal-Silva EE, González-Carranza V, Torres-García S, et al. Single sagittal craniosynostosis surgical treatment with the “Peau d́ours” technique. Single-center experience in Mexico. J Clin Neurosci. 2022;99:73–7. sourceNot checked — no full text of the source
• cites [82] Lehner M, Ferrari-von Klot F, Zundel S, Wendling-Keim D. Osteoclastic craniectomy for scaphocephaly in infants results in physiological head shapes. J Craniomaxillofac Surg. 2019;47(12):1891–7. sourceNot checked — no full text of the source
• cites [83] Micovic M, Zivkovic B, Bascarevic V, Mijalčić R, Rasulic L. Triple square extended osteotomies for treatment of scaphocephaly (Renier’s “H” technique modification). Neurosurg Rev. 2016;39(1):115–22 (discussion 22). sourceNot checked — no full text of the source
• cites [84] Park DH, Yoon SH. Transsutural distraction osteogenesis for 285 children with craniosynostosis: a single-institution experience. J Neurosurg Pediatr. 2016;17(2):230–9. sourcePartly supported

  Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

  Experimental — accuracy not yet measured

May combine two claims.

Early diagnosis enables appropriate planning and intervention and supports normal growth of the skull and brain in the best possible way.

“Early diagnosis enables appropriate planning and intervention, also to support the normal growth of the skull and brain in the best possible way, but also as the condition can be treated minimally invasively in the first months of life with reduced mortality [15, 88].”

• cites [15] Jimenez DF, Barone CM, McGee ME, Cartwright CC, Baker CL. Endoscopy-assisted wide-vertex craniectomy, barrel stave osteotomies, and postoperative helmet molding therapy in the management of sagittal suture craniosynostosis. J Neurosurg. 2004;100(5 Suppl Pediatrics):407–17. sourceNot checked — no full text of the source
• cites [88] Mathijssen IM. Guideline for care of patients with the diagnoses of craniosynostosis: working group on craniosynostosis. J Craniofac Surg. 2015;26(6):1735–807. sourceSupported

May combine two claims.

The condition can be treated minimally invasively in the first months of life with reduced mortality.

“Early diagnosis enables appropriate planning and intervention, also to support the normal growth of the skull and brain in the best possible way, but also as the condition can be treated minimally invasively in the first months of life with reduced mortality [15, 88].”

• cites [15] Jimenez DF, Barone CM, McGee ME, Cartwright CC, Baker CL. Endoscopy-assisted wide-vertex craniectomy, barrel stave osteotomies, and postoperative helmet molding therapy in the management of sagittal suture craniosynostosis. J Neurosurg. 2004;100(5 Suppl Pediatrics):407–17. sourceNot checked — no full text of the source
• cites [88] Mathijssen IM. Guideline for care of patients with the diagnoses of craniosynostosis: working group on craniosynostosis. J Craniofac Surg. 2015;26(6):1735–807. sourcePartly supported

  In section 5, “Timing of Surgery,” the guideline says minimally invasive techniques must be performed at a young age, and its discussion of strip craniectomy describes intervention in the first two months of life. But section 5, “Evaluation of the Outcome of Surgery,” reports mortality of 0–1% across all procedures and says most series are too small for significant mortality data; it does not establish reduced mortality with early minimally invasive treatment. Page numbers were not available in our copy. (LLM, conf=0.89)

  Experimental — accuracy not yet measured

May combine two claims.

Today the most common approach for evaluating suspected craniosynostosis is a detailed clinical examination by skilled professionals, where characteristic skull morphology serves as the primary indicator for provisional diagnosis.

“Today the most common approach for evaluating suspected craniosynostosis is a detailed clinical examination by skilled professionals, where characteristic skull morphology serves as the primary indicator for provisional diagnosis.”

• cites [2] Schmidt L, Fassl V, Erhardt L, Winter J, Lollert A, Heider J, et al. Moderne Behandlung von Kraniosynostosen. Monatsschrift Kinderheilkunde. 2023:1-9 sourceSupported
• cites [7] Fearon JA, Ditthakasem K, Herbert M, Kolar J. An appraisal of the cephalic index in sagittal craniosynostosis, and the unseen third dimension. Plast Reconstr Surg. 2017;140(1):138–45. sourceNot checked — no full text of the source
• cites [8] de Jong G, Bijlsma E, Meulstee J, Wennen M, van Lindert E, Maal T, et al. Combining deep learning with 3D stereophotogrammetry for craniosynostosis diagnosis. Sci Rep. 2020;10(1):15346. sourcePartly supported

  The Introduction (page unavailable) says specialists at tertiary centers can diagnose craniosynostosis accurately by visually examining head shape, supporting the role of skilled examination and skull morphology. It does not establish that clinical examination is the most common approach or that morphology is the primary indicator for a provisional diagnosis; it identifies CT as the primary imaging technique. (LLM, conf=0.85)

  Experimental — accuracy not yet measured
• cites [37] Ravindra VM, Awad AW, Baker CM, Lee A, Anderson RCE, Gociman B, et al. Preoperative imaging patterns and intracranial findings in single-suture craniosynostosis: a study from the synostosis research group. J Neurosurg Pediatr. 2021;28(3):344–50. sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

Ultra-early synostectomy in combination with helmet therapy has benefits and potential to optimise cranial remodeling outcomes.

“Mohanty et al. further highlighted the benefits of ultra-early synostectomy in combination with helmet therapy, emphasising its potential to optimise cranial remodeling outcomes [76].”

• cites [76] Mohanty A, Frank TS, Mohamed S, Godwin K, Malkani GG. Ultra-early synostectomy and cranial remodeling orthoses in the management of craniosynostoses. Neurosurg Focus. 2021;50(4):E8. sourceSupported

May combine two claims.

The endoscopic-assisted method offers advantages such as reduced blood transfusion rates, shorter surgical times, less scarring, and shorter hospital stays.

“The endoscopic-assisted method offers advantages such as reduced blood transfusion rates, shorter surgical times, less scarring, and shorter hospital stays.”

• cites [9] Jimenez DF, Barone CM. Endoscopic craniectomy for early surgical correction of sagittal craniosynostosis. J Neurosurg. 1998;88(1):77–81. sourceNot checked — no full text of the source
• cites [10] Dalle Ore CL, Dilip M, Brandel MG, McIntyre JK, Hoshide R, Calayag M, et al. Endoscopic surgery for nonsyndromic craniosynostosis: a 16-year single-center experience. J Neurosurg Pediatr. 2018;22(4):335–43. sourcePartly supported

  The Discussion describes avoiding prolonged operative times and hospital stays as potential benefits of minimally invasive surgery; the Perioperative Data report a median operation of 55.5 minutes, and the Discussion reports a median overnight stay of one night. The introduction describes shorter incisions than open approaches, but does not measure scarring. Reduced transfusion rates are not established: 50.2% of this series received transfusions, and the paper provides no open-surgery comparison. Page numbers are unavailable in our copy. (LLM, conf=0.86)

  Experimental — accuracy not yet measured

May combine two claims.

Open surgery is associated with significant drawbacks, including greater invasiveness, increased blood loss (a common intra- and postoperative complication), larger bone defects, and more pronounced scarring.

“In contrast, open surgery provides immediate correction of skull shape but is associated with significant drawbacks, including greater invasiveness, increased blood loss (a common intra- and postoperative complication), larger bone defects, and more pronounced scarring [10, 11].”

• cites [10] Dalle Ore CL, Dilip M, Brandel MG, McIntyre JK, Hoshide R, Calayag M, et al. Endoscopic surgery for nonsyndromic craniosynostosis: a 16-year single-center experience. J Neurosurg Pediatr. 2018;22(4):335–43. sourcePartly supported

  The introductory passage (labeled Abstract in our copy; page unavailable) describes open approaches as using long, typically ear-to-ear incisions and more involved cranial-vault and skull-base techniques. That supports greater invasiveness and longer incisions, but the paper does not establish that open surgery causes more blood loss, larger bone defects, or more pronounced scarring. Its Discussion describes significant bleeding events in the endoscopic series rather than an open-versus-endoscopic blood-loss comparison. (LLM, conf=0.85)

  Experimental — accuracy not yet measured
• cites [11] Isaac KV, Meara JG, Proctor MR. Analysis of clinical outcomes for treatment of sagittal craniosynostosis: a comparison of endoscopic suturectomy and cranial vault remodeling. J Neurosurg Pediatr. 2018;22(5):467–74. sourcePartly supported

  The Operative Technique section describes more extensive bone remodeling for open cranial vault remodeling, and Perioperative Data report significantly greater estimated blood loss than with endoscopic suturectomy. The Aesthetics section says bony skull defects are uncommon with either procedure; it does not establish that open surgery causes larger defects. The paper also does not establish more pronounced scarring or characterize blood loss as a common intra- and postoperative complication. Page numbers were not supplied in our copy. (LLM, conf=0.88)

  Experimental — accuracy not yet measured

May combine two claims.

Two primary surgical approaches are utilized for treatment of craniosynostosis: the (flexible) endoscopic-assisted technique and the conventional open surgical approach, with the choice depending on individual surgical planning and case specifics.

“Two primary surgical approaches are utilized for the treatment of craniosynostosis: the (flexible) endoscopic-assisted technique and the conventional open surgical approach, with the choice depending on individual surgical planning and case specifics.”

• cites [2] Schmidt L, Fassl V, Erhardt L, Winter J, Lollert A, Heider J, et al. Moderne Behandlung von Kraniosynostosen. Monatsschrift Kinderheilkunde. 2023:1-9 sourceSupported
• cites [50] Jimenez DF, Barone CM. Endoscopic technique for sagittal synostosis. Childs Nerv Syst. 2012;28(9):1333–9. sourceNot checked — no full text of the source
• cites [85] Labuschagne J, Mutyaba D, Ouma J, Dewan MC. Flexible endoscope-assisted suture release and barrel stave osteotomy for the correction of sagittal synostosis. J Neurosurg Pediatr. 2023;31(1):71–7. sourceNot checked — no full text of the source

May combine two claims.

Endoscopic approaches are preferred in infants younger than 6 months, while open surgical techniques are typically used in older children.

“Endoscopic approaches are preferred in infants younger than 6 months, while open surgical techniques are typically used in older children [2, 50, 85].”

• cites [2] Schmidt L, Fassl V, Erhardt L, Winter J, Lollert A, Heider J, et al. Moderne Behandlung von Kraniosynostosen. Monatsschrift Kinderheilkunde. 2023:1-9 sourcePartly supported

  The Indikation section recommends endoscopic surgery at about 3 months and says open surgery is particularly suitable for children first presenting at 6 months or older. But the Nachbehandlung und Outcome section says this centre also tends to choose open surgery when a child first presents after 4 months, so the paper does not support a general preference for endoscopy throughout the entire under-6-month group. Page numbers were not available in our copy. (LLM, conf=0.87)

  Experimental — accuracy not yet measured
• cites [50] Jimenez DF, Barone CM. Endoscopic technique for sagittal synostosis. Childs Nerv Syst. 2012;28(9):1333–9. sourceNot checked — no full text of the source
• cites [85] Labuschagne J, Mutyaba D, Ouma J, Dewan MC. Flexible endoscope-assisted suture release and barrel stave osteotomy for the correction of sagittal synostosis. J Neurosurg Pediatr. 2023;31(1):71–7. sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The reviewed publications predominantly originated from the USA, followed by the Netherlands and the United Kingdom.

“The majority of publications were from the USA, followed by the Netherlands and United Kingdom.”

• Also stated in: § Results · plain

  “The reviewed studies, predominantly originated from the USA and the Netherlands and provided data on diagnostic methods, surgical techniques, patient-specific characteristics, and outcomes for non-syndromic sagittal craniosynostosis.”

May combine two claims.

The systematic literature search identified 301 records, a hand search identified 12 articles, and 57 articles met the inclusion criteria after evaluation.

“A systematic literature search identified 301, and a hand search identified 12 articles, of which a total of 57 met the inclusion criteria after careful evaluation.”

• Also stated in: § Literature search and study selection · plain

  “An initial search using the search terms related to the operative technique yielded 160 records, the search related to the diagnostic tools yielded 141 records. In addition, 12 articles were found by further examining the reference lists of the originally identified publications.”

• Also stated in: § Literature search and study selection · plain

  “Of all 313 relevant publications, a total of 57 articles remained after the precise evaluation (Fig. 1).”

Classified as probably not a substantial claim.

The review searched Medline/PubMed and the medical libraries of Ruhr University Bochum and Witten Herdecke University from 1994 until 2024.

“We carried out systematic literature research through the electronic databases Medline/PubMed and the medical libraries Ruhr University Bochum and Witten Herdecke University from 1994 until 2024.”

Classified as probably not a substantial claim.

Inclusion criteria required clinical studies, case reports, systematic reviews, and meta-analyses published between 1993 and 2024 in English or German.

“Clinical studies, case reports, systematic reviews, and meta-analyses published between 1993 and 2024 in English or German.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Articles were initially selected based on title and abstract screening using predefined inclusion and exclusion criteria for both search strings.

“Articles were initially selected based on an initial screening of the titles and abstracts using predefined inclusion and exclusion criteria for both search strings.”

May combine two claims.

The reviewed surgical studies largely agree on the efficacy and limitations of various techniques, highlighting the importance of age, method, and postoperative care in achieving optimal outcomes.

“These studies largely agree on the efficacy and limitations of various techniques, highlighting the importance of age, method, and postoperative care in achieving optimal outcomes.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Ciurea et al. (2011) emphasized 3D CT as the preferred diagnostic method for scaphocephaly and did not recommend conservative X-ray due to radiation exposure.

“In 2011 Ciurea et al. described the current state of diagnostics and therapy and emphasized the 3D CT scan as the preferred diagnostic method for the detection of scaphocephaly.”

• cites [31] Ciurea AV, Toader C, Mihalache C. Actual concepts in scaphocephaly : (an experience of 98 cases). J Med Life. 2011;4(4):424–31.Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

May combine two claims.

Ravindra et al. (2021) found that preoperative CT imaging in clinically diagnosed single suture craniosynostosis corroborated the clinical diagnosis and rarely altered the surgical approach.

“Results demonstrated that in most of the cases, CT imaging corroborated the clinical diagnosis and rarely altered the surgical approach.”

• cites [37] Ravindra VM, Awad AW, Baker CM, Lee A, Anderson RCE, Gociman B, et al. Preoperative imaging patterns and intracranial findings in single-suture craniosynostosis: a study from the synostosis research group. J Neurosurg Pediatr. 2021;28(3):344–50. sourceNot checked — no full text of the source

Classified as probably not a substantial claim.

Articles not directly related to the specific diagnostic and surgical aspects of sagittal craniosynostosis were excluded.

“Studies that were not directly related to the specific diagnostic and surgical aspects of a sagittal craniosynostosis”

Classified as probably not a substantial claim. May combine two claims.

Fearon et al. (2017) noted that the cephalic index cannot capture certain postoperative changes or accurately reflect the complexity of skull deformities.

“In addition, they note that the CI method cannot capture certain postoperative changes, such as changes in occipital skull height after sagittal suture synostosis surgery, or accurately reflect the complexity of skull deformities [7].”

• cites [7] Fearon JA, Ditthakasem K, Herbert M, Kolar J. An appraisal of the cephalic index in sagittal craniosynostosis, and the unseen third dimension. Plast Reconstr Surg. 2017;140(1):138–45. sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

In 20-30% of cases, primary multisutural craniosynostosis is observed in the context of complex syndromic diseases, which usually follow an autosomal dominant transmission pattern.

“In 20–30% of cases, primary multisutural craniosynostosis is observed in the context of complex syndromic diseases, which usually follow an autosomal dominant transmission pattern [4, 17].”

• cites [4] Speer P, Gahr M. Pädiatrie. Berlin: Springer; 2013. sourceNot checked — no full text of the source
• cites [17] Bald M. Kurzlehrbuch Pädiatrie. Stuttgart: Georg Thieme Verlag KG; 2012. sourceNot checked — no full text of the source

May combine two claims.

Rozovsky et al. (2015) found complete concordance between cranial ultrasound and radiography in assessing sagittal sutures, with CUS sensitivity 100% and specificity 98%.

“Their study revealed complete concordance between CUS and radiography in assessing especially the sagittal sutures. Overall, the results demonstrated that CUS possesses high sensitivity (100%) and specificity (98%), reliably detecting suture abnormalities while eliminating the risks associated with ionising radiation.”

• cites [34] Rozovsky K, Udjus K, Wilson N, Barrowman NJ, Simanovsky N, Miller E. Cranial ultrasound as a first-line imaging examination for craniosynostosis. Pediatrics. 2016;137(2): e20152230. sourceNot checked — no full text of the source
• cites [35] Pogliani L, Zuccotti GV, Furlanetto M, Giudici V, Erbetta A, Chiapparini L, et al. Cranial ultrasound is a reliable first step imaging in children with suspected craniosynostosis. Childs Nerv Syst. 2017;33(9):1545–52. sourceNot checked — no full text of the source

Classified as probably not a substantial claim.

Inclusion criteria required studies to focus on the diagnosis and surgical techniques of non-syndromic sagittal craniosynostosis.

“Studies were required to focus on the diagnosis and surgical techniques of non-syndromic sagittal craniosynostosis.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The review used two search strings, one targeting therapeutic or surgical perspectives and one targeting diagnostic aspects or technological advances and their outcomes.

“The methodological approach involved the use of a total of two search strings, with the first search string targeting therapeutic or surgical perspectives and the second focusing on diagnostic aspects or technological advances and their outcomes.”

May combine two claims.

Marcus et al. (2006) introduced Mid-Sagittal Vector Analysis as a CT-based morphometric technique that quantified preoperative deformity and postoperative correction in sagittal craniosynostosis.

“Marcus et al. introduced Mid-Sagittal Vector Analysis (MSVA) as a CT-based morphometric technique to assess cranial morphology in sagittal craniosynostosis in 2006.”

• Also stated in: § Diagnosis technology · plain

  “MSVA effectively quantified preoperative deformity and postoperative correction.”

• cites [28] Marcus JR, Stokes TH, Mukundan S, Forrest CR. Quantitative and qualitative assessment of morphology in sagittal synostosis: mid-sagittal vector analysis. J Craniofac Surg. 2006;17(4):680–6. sourceNot checked — no full text of the source

Classified as probably not a substantial claim.

Ravindra et al. suggested that routine preoperative CT imaging may not be essential in cases with a clear clinical diagnosis.

“Consequently, the authors suggest that routine preoperative CT imaging may not be essential in cases with a clear clinical diagnosis, thereby potentially reducing radiation exposure in affected infants [37].”

• cites [37] Ravindra VM, Awad AW, Baker CM, Lee A, Anderson RCE, Gociman B, et al. Preoperative imaging patterns and intracranial findings in single-suture craniosynostosis: a study from the synostosis research group. J Neurosurg Pediatr. 2021;28(3):344–50. sourceNot checked — no full text of the source

May combine two claims. The quote only partly states this claim.

Agrawal et al. concluded that surgery could proceed based on clinical diagnosis when symptoms are typical, making radiological investigations often unnecessary.

“The study concluded that surgery could proceed based on clinical diagnosis when symptoms are typical [27].”

• cites [27] Agrawal D, Steinbok P, Cochrane DD. Diagnosis of isolated sagittal synostosis: are radiographic studies necessary? Childs Nerv Syst. 2006;22(4):375–8. sourceNot checked — no full text of the source

Classified as probably not a substantial claim. May combine two claims.

Fearon et al. (2007) concluded that CT imaging is unnecessary for isolated craniosynostosis due to clear clinical detectability and radiation risk, and should be reserved for cases not clearly diagnosed clinically.

“Fearon et al. in 2007 demonstrated that CT imaging is unnecessary due to the condition’s clear clinical detectability and the associated risk of radiation exposure.”

• Also stated in: § Diagnosis technology · plain

  “CT scans should be reserved for cases where craniosynostosis cannot be clearly diagnosed by clinical assessment [29].”

• cites [29] Fearon JA, Singh DJ, Beals SP, Yu JC. The diagnosis and treatment of single-sutural synostoses: are computed tomographic scans necessary? Plast Reconstr Surg. 2007;120(5):1327–31. sourceNot checked — no full text of the source

Classified as probably not a substantial claim.

Treatment for craniosynostosis involves two main approaches: endoscopic-assisted surgery and open surgery.

“Treatment involves two main approaches: endoscopic-assisted surgery and open surgery.”

May combine two claims. The quote only partly states this claim.

Eley et al. (2014) found that black bone MRI in 13 children with craniosynostosis showed physiological sutures contrasting from cranial bones with increased signal intensity while prematurely closed ones do not, indicating potential for radiation-free diagnosis.

“As a pioneering new alternative to conventional CT imaging, Eley et al. (2014) examined the so-called “black bone MRI” (in 2D and 3D).”

• Also stated in: § Diagnosis technology · plain

  “Within a “black bone image”, physiological sutures contrast from the cranial bones with increased signal intensity, prematurely closed ones do not, so the clinical potential for diagnosis without radiation became evident [32].”

• cites [32] Eley KA, Watt-Smith SR, Sheerin F, Golding SJ. “Black Bone” MRI: a potential alternative to CT with three-dimensional reconstruction of the craniofacial skeleton in the diagnosis of craniosynostosis. Eur Radiol. 2014;24(10):2417–26. sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

In 2003, Cedzich and Farmand recommended confirming suspected craniosynostosis with posterior-anterior and lateral skull X-ray and CT, with SPECT scintigraphy to assess suture occlusion and sonography only for follow-up.

“In 2003, Cedzich and Farmand published the status of the necessary diagnosis of craniosynostosis. Accordingly, an existing suspected diagnosis should be confirmed at that time by a posterior-anterior and a lateral conventional X-Ray of the skull and a more detailed image should also be obtained by computed tomography (CT).”

• cites [26] Cedzich C, Farmand M. Diagnosis and therapy of syndromic and non-syndromic craniosynostosis. HNO. 2003;51(3):198–208. sourceNot checked — no full text of the source

May combine two claims.

Marcus et al. analysed pre- and postoperative CT scans of 16 patients and identified three key affected regions: frontal, vertex, and occipital.

“Pre- and postoperative CT scans of 16 patients were analysed, identifying three key affected regions: frontal, vertex, and occipital.”

• cites [28] Marcus JR, Stokes TH, Mukundan S, Forrest CR. Quantitative and qualitative assessment of morphology in sagittal synostosis: mid-sagittal vector analysis. J Craniofac Surg. 2006;17(4):680–6. sourceNot checked — no full text of the source

May combine two claims.

Shah et al. found that endoscopic surgery had significantly lower mean blood loss (29 ml vs 218 ml) and lower transfusion rate compared to open surgery.

“The endoscopic method not only showed a significantly lower mean blood loss (29 ml compared to 218 ml in the open method) and a lower transfusion rate (all openly operated children received one, whereas only 3 endoscopically operated children received one)”

• cites [58] Shah MN, Kane AA, Petersen JD, Woo AS, Naidoo SD, Smyth MD. Endoscopically assisted versus open repair of sagittal craniosynostosis: the St. Louis Children’s Hospital experience. J Neurosurg Pediatr. 2011;8(2):165–70. sourceNot checked — no full text of the source

May combine two claims.

In the 16-year experience with 256 patients, blood loss was reduced to 27 ml and transfusion rate to 7%.

“Blood loss was reduced to an average of 27 ml and the transfusion rate to 7%.”

• cites [50] Jimenez DF, Barone CM. Endoscopic technique for sagittal synostosis. Childs Nerv Syst. 2012;28(9):1333–9. sourceNot checked — no full text of the source

May combine two claims.

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].”

• cites [43] Maugans TA, McComb JG, Levy ML. Surgical management of sagittal synostosis: a comparative analysis of strip craniectomy and calvarial vault remodeling. Pediatr Neurosurg. 1997;27(3):137–48. sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The majority of all craniosynostoses occur in isolation, irregularly, and with an ambiguous aetiology.

“However, the majority of all craniosynostoses occur in isolation, irregularly and with an ambiguous aetiology [3, 17].”

• cites [3] Gortner L, Meyer S, Sitzmann F-C. Pädiatrie. Stuttgart: Georg Thieme Verlag KG; 2012. sourceNot checked — no full text of the source
• cites [17] Bald M. Kurzlehrbuch Pädiatrie. Stuttgart: Georg Thieme Verlag KG; 2012. sourceNot checked — no full text of the source

May combine two claims.

Van Veelen et al. (2013) found that variant D showed the greatest initial improvement in CI, but after two years no significant difference was found between variants.

“Compared to the initial CI, variant D, in which the excised sagittal strip is fixed rotationally between the parietal lobes, showed the greatest initial improvement. After two years of follow-up, however, no significant difference was found between the variants.”

• cites [59] van Veelen ML, Eelkman Rooda OH, de Jong T, Dammers R, van Adrichem LN, Mathijssen IM. Results of early surgery for sagittal suture synostosis: long-term follow-up and the occurrence of raised intracranial pressure. Childs Nerv Syst. 2013;29(6):997–1005. sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

Panchal et al. concluded that extended SC does not lead to a normal skull width-to-length ratio, even if performed before 4 months of age.

“He concluded that, extended SC for sagittal craniosynostosis does not lead to a normal ratio between skull width and length, even if performed before 4 months of age.”

• cites [46] Panchal J, Marsh JL, Park TS, Kaufman B, Pilgram T, Huang SH. Sagittal craniosynostosis outcome assessment for two methods and timings of intervention. Plast Reconstr Surg. 1999;103(6):1574–84. sourceNot checked — no full text of the source

May combine two claims.

In the 2004 publication, 87% of patients had excellent outcomes with CI >75, 8.7% good (70-75), 4.3% poor (<70).

“The results showed that 87% of patients had excellent outcomes with a cephalic index of over 75, 8.7% had good outcomes between 70 and 75 and 4.3% had poor outcomes (< 70) had poor outcomes.”

• cites [15] Jimenez DF, Barone CM, McGee ME, Cartwright CC, Baker CL. Endoscopy-assisted wide-vertex craniectomy, barrel stave osteotomies, and postoperative helmet molding therapy in the management of sagittal suture craniosynostosis. J Neurosurg. 2004;100(5 Suppl Pediatrics):407–17. sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The Pi procedure preserves the sagittal suture and reshapes the skull with bone strip removal and compression, unlike total cranial vault remodeling.

“Unlike total cranial vault remodeling, the procedure preserves the sagittal suture and reshapes the skull with bone strip removal and compression [39, 40].”

• cites [39] Jane JA, Edgerton MT, Futrell JW, Park TS. Immediate correction of sagittal synostosis. J Neurosurg. 1978;49(5):705–10. sourceNot checked — no full text of the source
• cites [40] Guimarães-Ferreira J, Gewalli F, David L, Darvann TA, Hermann NV, Kreiborg S, et al. Sagittal synostosis: II. Cranial morphology and growth after the modified pi-plasty. Scand J Plast Reconstr Surg Hand Surg. 2006;40(4):200–9. sourceNot checked — no full text of the source

May combine two claims.

The mortality rate with the endoscopic technique was lower than with traditional reconstruction methods such as full CVR, and no serious complications occurred.

“The mortality rate was lower than with traditional reconstruction methods such as full CVR, and no serious complications occurred [15].”

• cites [15] Jimenez DF, Barone CM, McGee ME, Cartwright CC, Baker CL. Endoscopy-assisted wide-vertex craniectomy, barrel stave osteotomies, and postoperative helmet molding therapy in the management of sagittal suture craniosynostosis. J Neurosurg. 2004;100(5 Suppl Pediatrics):407–17. sourceNot checked — no full text of the source

May combine two claims.

In Jimenez & Barone's initial four patients, three did not require blood transfusion and were discharged after 24 h.

“Three out of four patients did not require a blood transfusion and could be discharged after just 24 h.”

• cites [9] Jimenez DF, Barone CM. Endoscopic craniectomy for early surgical correction of sagittal craniosynostosis. J Neurosurg. 1998;88(1):77–81. sourceNot checked — no full text of the source

May combine two claims.

Jimenez & Barone's endoscopic technique with Barrel-Staves osteotomies had an average operating time of 1.68 h and average blood loss of 54.2 ml.

“An average operating time of 1.68 h with an average blood loss of 54.2 ml was determined.”

• cites [9] Jimenez DF, Barone CM. Endoscopic craniectomy for early surgical correction of sagittal craniosynostosis. J Neurosurg. 1998;88(1):77–81. sourceNot checked — no full text of the source

May combine two claims.

In the 2004 publication, 9% of 139 patients required blood transfusions, mean blood loss was 29 ml.

“A total of 9% (two intraoperative, 12 postoperative) required blood transfusions, the mean blood loss was 29 ml.”

• cites [15] Jimenez DF, Barone CM, McGee ME, Cartwright CC, Baker CL. Endoscopy-assisted wide-vertex craniectomy, barrel stave osteotomies, and postoperative helmet molding therapy in the management of sagittal suture craniosynostosis. J Neurosurg. 2004;100(5 Suppl Pediatrics):407–17. sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

The Pi procedure involves dynamic cranioplasty using π-shaped osteotomies to enable controlled cranial expansion.

“The Pi procedure, introduced by Jane et al. in 1978 and named after the Greek letter π, involves dynamic cranioplasty using osteotomies shaped like the symbol π to enable controlled cranial expansion [39].”

• cites [39] Jane JA, Edgerton MT, Futrell JW, Park TS. Immediate correction of sagittal synostosis. J Neurosurg. 1978;49(5):705–10. sourceNot checked — no full text of the source

May combine two claims.

Eley et al. examined 'black bone MRI', which enables precise cranial suture assessment without radiation but necessitates anaesthesia in young children.

“Eley et al. examined the “black bone MRI”, which enables precise cranial suture assessment without radiation but necessitates anaesthesia in young children [5, 32, 33]”

• cites [5] Bächli H, Lütschg J, Messing-Jünger M. Pädiatrische Neurochirurgie. Berlin: Springer; 2018. sourceNot checked — no full text of the source
• cites [32] Eley KA, Watt-Smith SR, Sheerin F, Golding SJ. “Black Bone” MRI: a potential alternative to CT with three-dimensional reconstruction of the craniofacial skeleton in the diagnosis of craniosynostosis. Eur Radiol. 2014;24(10):2417–26. sourceNot checked — no full text of the source
• cites [33] Engel M, Hoffmann J, Mühling J, Castrillón-Oberndorfer G, Seeberger R, Freudlsperger C. Magnetic resonance imaging in isolated sagittal synostosis. J Craniofac Surg. 2012;23(4):e366–9. sourceNot checked — no full text of the source

May combine two claims.

In the past three decades, diagnosis was mainly carried out using X-rays or CT scans, but this was problematic due to radiation exposure for the developing brain.

“In the past three decades, diagnosis was mainly carried out using X-rays or CT scans, but this was problematic due to the radiation exposure for the developing brain [65].”

• cites [65] Schweitzer T, Kunz F, Meyer-Marcotty P, Müller-Richter UD, Böhm H, Wirth C, et al. Diagnostic features of prematurely fused cranial sutures on plain skull X-rays. Childs Nerv Syst. 2015;31(11):2071–80. sourceNot checked — no full text of the source

May combine two claims.

Shah et al. found that pre- and postoperative CI after 13 months were comparable in endoscopically treated children (68% and 76%), while open procedures had comparable CI values after 25 months (68% and 77%).

“It is also noteworthy that the pre- and postoperative CI after 13 months were comparable in the endoscopically treated children (68% and 76%), while the open procedures had comparable CI values after 25 months (68% and 77%) [58].”

• cites [58] Shah MN, Kane AA, Petersen JD, Woo AS, Naidoo SD, Smyth MD. Endoscopically assisted versus open repair of sagittal craniosynostosis: the St. Louis Children’s Hospital experience. J Neurosurg Pediatr. 2011;8(2):165–70. sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

Brenner et al. concluded that paediatric CT scans significantly increase the lifetime risk of cancer mortality.

“Brenner et al. concluded already in 2001 that paediatric CT scans significantly increase the lifetime risk of cancer mortality due to the higher radiation sensitivity of children”

• cites [66] Brenner D, Elliston C, Hall E, Berdon W. Estimated risks of radiation-induced fatal cancer from pediatric CT. AJR Am J Roentgenol. 2001;176(2):289–96. sourceNot checked — no full text of the source

May combine two claims.

Fearon et al. found that post-surgical growth did not fully return to normal after CVR, with a tendency for the calvaria to revert towards the original deformity.

“The study found that while cranial indices normalised with low preoperative rates and minimal complications, post-surgical growth did not fully return to normal, with a tendency for the calvaria to revert towards the original deformity.”

• cites [57] Fearon JA, Ruotolo RA, Kolar JC. Single sutural craniosynostoses: surgical outcomes and long-term growth. Plast Reconstr Surg. 2009;123(2):635–42. sourceNot checked — no full text of the source

May combine two claims.

Ossification of the sagittal suture leads to a longitudinal skull known as scaphocephaly, with reduced bitemporal dimension and compensatory anterior-posterior lengthening.

“Ossification of the sagittal suture leads to a longitudinal skull, known as scaphocephaly [4, 16]. This shows a characteristic skull deformity, characterised by a reduced extension of the bitemporal dimension and a compensatory lengthening of the skull in the anterior–posterior direction.”

• cites [4] Speer P, Gahr M. Pädiatrie. Berlin: Springer; 2013. sourceNot checked — no full text of the source
• cites [16] Lentze M, Schulte FJ, Schaub J, Spranger J, Hrsg. Pädiatrie. Grundlagen und Praxis. Berlin: Springer; 2003. sourceNot checked — no full text of the source

May combine two claims.

Abnormal head shape, occlusion of sutures, and disproportion between brain growth and skull size can result in increased intracranial pressure and developmental disorders.

“In addition, the abnormal characteristic head shape, the occlusion of usually several sutures and consecutive disproportion between brain growth and skull size can result in organic complications, including increased intracranial pressure (ICP) and developmental disorders [3, 4].”

• cites [3] Gortner L, Meyer S, Sitzmann F-C. Pädiatrie. Stuttgart: Georg Thieme Verlag KG; 2012. sourceNot checked — no full text of the source
• cites [4] Speer P, Gahr M. Pädiatrie. Berlin: Springer; 2013. sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Marcus et al. emphasized that the CI is a relative measure that cannot differentiate between frontal and occipital bossing or quantify deformity severity.

“Marcus et al. have emphasised already in 2006 in their study that the CI is a relative measure that cannot differentiate between frontal and occipital bossing or quantify deformity severity.”

• cites [28] Marcus JR, Stokes TH, Mukundan S, Forrest CR. Quantitative and qualitative assessment of morphology in sagittal synostosis: mid-sagittal vector analysis. J Craniofac Surg. 2006;17(4):680–6. sourceNot checked — no full text of the source

May combine two claims.

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].”

• cites [43] Maugans TA, McComb JG, Levy ML. Surgical management of sagittal synostosis: a comparative analysis of strip craniectomy and calvarial vault remodeling. Pediatr Neurosurg. 1997;27(3):137–48. sourceNot checked — no full text of the source

May combine two claims.

ESC with barrel staves markedly decreased transfusion rates and mortality risk.

“In contrast, the introduction of ESC with barrel staves in the late 1990s by Jimenez and Barone, which was made possible by technological advances in image-guided surgery, instrumentation and neuroendoscopy, resulted in a reduction in blood loss to an average of 27 ml, markedly decreasing transfusion rates and mortality risk [9, 50].”

• cites [9] Jimenez DF, Barone CM. Endoscopic craniectomy for early surgical correction of sagittal craniosynostosis. J Neurosurg. 1998;88(1):77–81. sourceNot checked — no full text of the source
• cites [50] Jimenez DF, Barone CM. Endoscopic technique for sagittal synostosis. Childs Nerv Syst. 2012;28(9):1333–9. sourceNot checked — no full text of the source

May combine two claims.

The disadvantages of sonography are that findings are dependent on the diagnostic physician and difficult to interpret in older children.

“The disadvantages are that the findings are dependent on the diagnostic physician and are difficult to interpret in older children due to the fact that some of the sutures are already physiologically closed or the disease may be at an already advanced stage [34, 35].”

• cites [34] Rozovsky K, Udjus K, Wilson N, Barrowman NJ, Simanovsky N, Miller E. Cranial ultrasound as a first-line imaging examination for craniosynostosis. Pediatrics. 2016;137(2): e20152230. sourceNot checked — no full text of the source
• cites [35] Pogliani L, Zuccotti GV, Furlanetto M, Giudici V, Erbetta A, Chiapparini L, et al. Cranial ultrasound is a reliable first step imaging in children with suspected craniosynostosis. Childs Nerv Syst. 2017;33(9):1545–52. sourceNot checked — no full text of the source

May combine two claims.

Resorbable plating systems provide effective stabilisation with no loss in rigidity and improve surgical outcomes.

“These systems provide effective stabilisation with no loss in rigidity and improve surgical outcomes.”

• cites [80] Losken A, Williams JK, Burstein FD, Cohen SR, Hudgins R, Boydston W, et al. Outcome analysis for correction of single suture craniosynostosis using resorbable fixation. J Craniofac Surg. 2001;12(5):451–5. sourceNot checked — no full text of the source

May combine two claims.

Minimally invasive techniques such as ESC are efficacious, particularly in younger patients, and are viable alternatives in the surgical management of craniosynostosis.

“Additionally, Riordan et al. and Gociman et al. supported the efficacy of minimally invasive techniques such as ESC, particularly in younger patients, reinforcing their role as viable alternatives in the surgical management of craniosynostosis [55, 56].”

• cites [55] Riordan CP, Zurakowski D, Meier PM, Alexopoulos G, Meara JG, Proctor MR, et al. Minimally invasive endoscopic surgery for infantile craniosynostosis: a longitudinal cohort study. J Pediatr. 2020;216:142-9.e2. sourceNot checked — no full text of the source
• cites [56] Gociman B, Marengo J, Ying J, Kestle JR, Siddiqi F. Minimally invasive strip craniectomy for sagittal synostosis. J Craniofac Surg. 2012;23(3):825–8. sourceNot checked — no full text of the source

Classified as probably not a substantial claim. May combine two claims.

Although alternative surgical techniques have shown promise, their efficacy and safety require further validation through long-term studies before they can be recommended as standard treatments.

“Although these techniques have shown promise, their efficacy and safety require further validation through long-term studies before they can be recommended as standard treatments.”

May combine two claims.

Resorbable plates are a safer, effective alternative without the complications of permanent implants.

“Resorbable plates have become the preferred choice, offering a safer, effective alternative without the complications of permanent implants and are now the standard for infant cranial reconstruction [80].”

• cites [80] Losken A, Williams JK, Burstein FD, Cohen SR, Hudgins R, Boydston W, et al. Outcome analysis for correction of single suture craniosynostosis using resorbable fixation. J Craniofac Surg. 2001;12(5):451–5. sourceNot checked — no full text of the source

May combine two claims.

Over the last 30 years, there has been considerable development in the diagnosis, surgical techniques and treatment of craniosynostosis due to technological progress.

“Over the last 30 years, there has been considerable development in the diagnosis, surgical techniques and treatment of craniosynostosis due to technological progress.”