Less is more: does the addition of barrel staves improve results in endoscopic strip craniectomy for sagittal craniosynostosis?
Open accessAbstract
OBJECTIVE: Endoscopic strip craniectomy (ESC) with postoperative helmet orthosis is a well-established treatment option for sagittal craniosynostosis. There are many technical variations to the surgery ranging from simple strip craniectomy to methods that employ multiple cranial osteotomies. The purpose of this study was to determine whether the addition of lateral barrel-stave osteotomies during ESC improved morphological outcomes. METHODS: An IRB-approved retrospective review was conducted on a consecutive series of cases involving ESC for sagittal craniosynostosis at 2 different institutions from March 2008 to August 2014. The patients in Group A underwent ESC and those in Group B had ESC with lateral barrel-stave osteotomies. Demographic and perioperative data were recorded; postoperative morphological outcomes were analyzed using 3D laser scan data acquired from a single orthotic manufacturer who managed patients from both institutions. RESULTS: A total of 73 patients were included (34 in Group A and 39 in Group B). Compared with Group B patients, Group A patients had a shorter mean anesthetic time (161.7 vs 195 minutes; p < 0.01) and operative time (71.6 vs 111 minutes; p < 0.01). The mean hospital stay was similar for the 2 groups (1.2 days for Group A vs 1.4 days for Group B; p = 0.1). Adequate postoperative data on morphological outcomes were reported by the orthotic manufacturer for 65 patients (29 in Group A and 36 in Group B). The 2 groups had similar improvement in the cephalic index (CI): Group A, mean change 10.5% (mean preoperative CI 72.6, final 80.4) at a mean follow-up of 13.2 months; Group B, mean change 12.2% (mean preoperative CI 71.0, final 79.6) at a mean follow-up of 19.4 months. The difference was not statistically significant (p = 0.15). CONCLUSIONS: Both ESC alone and ESC with barrel staving produced excellent outcomes. However, the addition of barrel staves did not improve the results and, therefore, may not be warranted in the endoscopic treatment of sagittal craniosynostosis.
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Data collected with the 3D stereography method can be used for post-operative production of a personalised helmet orthosis.
“In addition to finding a diagnosis with the 3D stereography method described from de Jong et al. 2020, this method also enables an effective follow-up assessment, and the data collected can also be used for the post-operative production of a personalised helmet orthosis [77–79].”
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 [77]
The Helmet Therapy and Outcome Analysis section says patients received postoperative helmet therapy and that the orthotic manufacturer supplied laser scans used to assess outcomes. It does not say that 3D stereography data were used to produce personalised helmets. (LLM, conf=0.82)
Experimental — accuracy not yet measuredThe 3D stereography method described by de Jong et al. 2020 enables effective follow-up assessment.
“In addition to finding a diagnosis with the 3D stereography method described from de Jong et al. 2020, this method also enables an effective follow-up assessment, and the data collected can also be used for the post-operative production of a personalised helmet orthosis [77–79].”
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 [77]
The Helmet Therapy and Outcome Analysis section (page unavailable) says postoperative laser scans were used to assess outcomes and define follow-up duration. It does not describe de Jong et al.’s 2020 3D stereography method or establish that this specific method enables effective follow-up assessment. (LLM, conf=0.84)
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“Adjunctive barrel stave osteotomies have also been used to increase calvarial mobility and remodeling potential [11], although their added benefit remains debated and may not be uniform across patients [12].”
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- Authors
- Wood, B. C., Ahn, E. S., Wang, J. Y., Oh, A. K., Keating, R. F., Rogers, G. F., & Magge, S. N.
- Affiliations
- Divisions of Plastic Surgery and
- Johns Hopkins University (US)
- Children's National (US)
- Corresponding author
- Wood, Benjamin C.
- Venue
- Journal of Neurosurgery: Pediatrics
- Published
- 2017-07
- Volume
- 20
- Issue
- 1
- Pages
- 86-90
- ISSN
- 1933-0707 (ISSN-L)
- 1933-0715
- OpenAlex
- W2607341432
- Cited by
- 23
- References
- 37
- Citations by year
- 2026: 4 · 2025: 5 · 2024: 4 · 2023: 3 · 2022: 2 · 2020: 1 · 2019: 1 · 2018: 2 · 2017: 1
- FWCI
- 0.91
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of Neurosurgery Pediatrics (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Craniofacial Disorders and Treatments
- Health Sciences › Medicine › Surgery › Pectus Deformity Diagnosis and Treatment
- Health Sciences › Medicine › Surgery › Reconstructive Facial Surgery Techniques
- Keywords
- sagittal craniosynostosis, endoscopic strip craniectomy, cephalic index, skull morphology, operative time
- MeSH terms
- Child, Preschool, Craniosynostoses, Craniotomy, Follow-Up Studies, Humans, Length of Stay, Orthotic Devices, Osteotomy, Retrospective Studies, Treatment Outcome, Neuroendoscopy, Operative Time
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