Treatment of sagittal synostosis: Subtotal cranial vault remodelling with right-angled Z-osteotomies

SummaryIntroductionsSagittal synostosis is the most common type of non-syndromic craniosynostosis with fusion of the sagittal suture. Various techniques have been introduced for the treatment of this irregular calvarial deformity. However, since these methods were not suitable for patients who were aged over 1 year when they were diagnosed with sagittal synostosis, a new approach should be undertaken.Patients and methodsBetween 2001 and 2005, five patients who were diagnosed with sagittal synostosis, after the age of 1 year, were treated with subtotal cranial vault remodelling. The procedure consisted of right-angled Z-osteotomies in the frontal and parieto-occipital bones, a shortening of the sagittal strut, and barrel-stave osteotomies in the temporal bone. They were undertaken to expand bitemporal diameter and to shorten anteroposterior diameter.ResultsCranial index increased from 68.2 to 77.8 immediately after surgery and to 78.4 post-surgery 36 months. Cranial morphologies were satisfactory during follow-up. The main advantage of the procedure is the easy control of fixation angle according to the surgeon's preference. There were no major complications including infections or relapses.ConclusionsThe treatment goal of sagittal synostosis is to eliminate factors that may impede brain development by assuring an adequate cranial cavity and to maintain an aesthetically acceptable cranial morphology. We obtained functionally and aesthetically favourable results by right-angled Z-osteotomies. Further, our one-staged procedure is safe, especially in patients over the age of 1 year.