Frontobiparietal remodeling with or without a widening bridge for sagittal synostosis: comparison of 2 cohorts for aesthetic and functional outcome
Open accessAbstract
OBJECT: Various techniques to correct sagittal synostosis have been described. The authors of this study assess the results of 2 techniques for late complete cranial remodeling and test the hypothesis that adding a widening bridge would improve outcome. METHODS: In this retrospective study, the authors evaluated patients with nonsyndromic sagittal synostosis—those who underwent frontobiparietal remodeling (FBR) and those who underwent modified FBR (MFBR) involving the introduction of a bony bridge to increase the width of the skull. Outcomes for both groups are described in terms of the aesthetic results assessed on photographs and any changes in the cranial index (CI) and head circumference over time, the presence of papilledema, and complaints of headache. The effect of the surgical technique on CI and head circumference over time was assessed using linear regression analysis, with adjustment for preoperative CI and head circumference. RESULTS: Sixty-nine patients with isolated sagittal synostosis were included in this study: 35 underwent MFBR and 34 underwent the original technique of FBR. The mean follow-up period was 7 years. In the 1st year after surgery, mean CI improved by 9% in the FBR group and by 12% in the MFBR group. One year after surgery, CI in the MFBR group was on average 4.7% higher than that in the FBR group (p < 0.001). During follow-up, CI decreased in both groups; however, at all time points CI was significantly higher in the MFBR group than in the FBR group. The impact of surgical technique on CI was less important than the impact of preoperative CI (R 2= 0.26 vs 0.54), and this applied at all time points during follow-up. Head circumference declined during follow-up in both groups. It was influenced by preoperative head circumference, but not by surgical technique. Aesthetic outcome, prevalence of headache (42%), and papilledema (7%) were comparable in both groups. CONCLUSIONS: Adding a widening bridge to late complete remodeling significantly improved CI and helped to prevent CI from decreasing in the long term. This addition did not affect the head circumference growth curve. Despite a mean head circumference remaining at +1 SD, patients continued to develop papilledema postoperatively (7%).
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In children with sagittal craniosynostosis, modified frontoparietal remodeling (mFBR) by rotating a bone segment to widen the skull significantly reduced blood loss compared with frontoparietal remodeling (FBR) (914 ml vs. 1174 ml).
“Van Veelen et al. demonstrated that modified frontoparietal remodeling (mFBR) by rotating a bone segment to widen the skull significantly reduced the blood loss (914 ml in the mFBR group vs. 1174 ml in the FBR group) while sustaining long-term CI improvements [60].”
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 [60]
Table 1 in the Results reports the cited mean blood-loss figures: 914 ml for MFBR and 1174 ml for FBR. But the Results attribute the difference to one FBR patient who lost 7000 ml after a sagittal sinus tear, and the Discussion says the techniques were comparable in blood loss. The paper supports the widening-bridge technique and sustained cranial-index improvement, not a significant reduction in blood loss. (LLM, conf=0.90)
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Experimental — accuracy not yet measuredVan 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.”
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 [60]
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].”
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 [60]
Modified frontoparietal remodeling (mFBR) sustains long-term cranial index (CI) improvements.
“Van Veelen et al. demonstrated that modified frontoparietal remodeling (mFBR) by rotating a bone segment to widen the skull significantly reduced the blood loss (914 ml in the mFBR group vs. 1174 ml in the FBR group) while sustaining long-term CI improvements [60].”
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 [60]
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“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].”
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- Authors
- van Veelen, M.-L. C., Mihajlović, D., Dammers, R., Lingsma, H., van Adrichem, L. N. A., & Mathijssen, I. M. J.
- Affiliations
- Departments of Neurosurgery,
- Public Health, and
- Plastic and Reconstructive Surgery and Hand Surgery, Erasmus University Medical Center Rotterdam, The Netherlands
- Erasmus MC (NL)
- ORCID
- Lingsma, Hester
- Venue
- Journal of Neurosurgery: Pediatrics
- Published
- 2015-07
- Volume
- 16
- Issue
- 1
- Pages
- 86-93
- ISSN
- 1933-0707 (ISSN-L)
- 1933-0715
- OpenAlex
- W2028753067
- Cited by
- 27
- References
- 53
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 5 · 2023: 2 · 2022: 2 · 2021: 2 · 2020: 2 · 2019: 5 · 2018: 3 · 2017: 2 · 2016: 2
- FWCI
- 1.60
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of Neurosurgery Pediatrics (publishedVersion)
- PubMed (publishedVersion)
- EUR Research Repository (Erasmus University Rotterdam) (publishedVersion)
- EUR Research Repository (Erasmus University Rotterdam) (submittedVersion)
- 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, cranial remodeling, cranial index, head circumference, papilledema, headache, cosmetic outcome, nonsyndromic craniosynostosis, pediatric neurosurgery
- MeSH terms
- Beauty, Cephalometry, Craniosynostoses, Craniotomy, Female, Follow-Up Studies, Frontal Bone, Humans, Male, Papilledema, Parietal Bone, Postoperative Period, Retrospective Studies, Skull, Linear Models, Treatment Outcome, Orthopedic Procedures, Plastic Surgery Procedures, Recovery of Function
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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