Sagittal synostosis - surgical outcomes and long-term follow up

Abstract: The overall aim of this thesis was to evaluate and compare surgical outcomes in patients with sagittal synostosis operated with the most commonly used surgical methods in Sweden: craniotomy combined with springs, pi-plasty, or H-craniectomy. Paper I is a systematic review that identified the evidence showing that spring-assisted surgery is as efficient as more extensive cranioplasties to be of very low quality, thereby emphasizing the need for more rigorous studies. The aims of the other papers were to determine intracranial volume (ICV) in a large cohort of children with sagittal synostosis and compare ICV and cephalic index (CI) between sagittal synostosis patients operated with either craniotomy combined with springs, pi-plasty, or H-craniectomy. Additionally, they compared the effect using two versus three springs on the ICV and CI. Paper II indicated that ICV is normal in infants with sagittal synostosis, Paper III determined that craniotomy combined with springs represents an equally effective surgical method to modified pi-plasty in terms of improving ICV and CI, and Paper V showed that craniotomy combined with springs is a better surgical method than H-craniectomy for correcting CI. Moreover, Paper V showed that craniotomy combined with springs resulted in a lower risk of comorbidities, such as blood loss and need for blood transfusion. Furthermore, Paper IV showed that three springs were more effective at improving CI than two springs, even in the long-term.