Outcome analysis of morcellation craniotomy with distraction osteogenesis for scaphocephaly

Background: Techniques for sagittal synostosis correction continue to evolve, thus resulting in improved outcomes and minimized morbidity. Spring-assisted cranioplasty and strip craniotomy with postoperative helmet usage are simple minimally invasive surgeries. However, these procedures are only useful in younger patients (generally up to 9 months of age); older children usually undergo total cranial remodeling, which is more stressful. We have developed a procedure combining morcellation craniotomy with distraction osteogenesis (MoD), which we have been performing since 2000. Here, we describe and evaluate this method of treatment. Methods: Seven patients who underwent MoD for isolated sagittal synostosis were followed for 10 years postoperatively. The control group consisted of 7 patients who had undergone total cranial remodeling in the period immediately preceding the MoD operations. Cephalography, clinical examinations, medical record data and medical photographs were used to evaluate and compare the 2 groups. Results: In comparison with total cranial remodeling, the MoD procedure resulted in a significantly shorter mean operation time and a significantly lower mean blood transfusion volume. The postoperative cephalic index was not significantly different between the MoD (75.8 ± 0.9) and the control groups (75.6 ± 1.4), and satisfactory cranial shape volumes were achieved without serious complications. Conclusion: The MoD procedure is a safe, effective and reliable technique for dynamic total skull remodeling with minimal morbidity. It can be used to improve upon previous surgical concepts for treating scaphocephaly, particularly in older patients.