The Effect of Barrel-Stave Osteotomy Length in Sagittal Strip Craniectomy.
CLEFT PALATE CRANIOFACIAL JOURNAL（2024）
Dept Plast Surg
Abstract
Objective In managing sagittal craniosynostosis, strip craniectomy of the affected suture is commonly paired with barrel-stave osteotomies to allow for additional cranial remodeling. However, the effect of these osteotomies is not well-established. This study aimed to evaluate the effect of the length of barrel-stave osteotomies on outcomes in patients with sagittal craniosynostosis.Design A retrospective review of operative records and pre-operative and one-year post-operative three-dimensional images.Setting Tertiary care pediatric institution.Patients Forty-five patients with sagittal craniosynostosisInterventions Sagittal strip craniectomy and either long, medium, or short barrel-stave osteotomy lengths followed by helmet therapyMain Outcome Measures Operative and three-dimensional craniometric outcomes.Results Operative time, estimated blood loss, and hospital length of stay were significantly decreased in the short group (P = .003; 0.002; 0.027). The cranial index was normalized in all groups, but the long group was significantly lower (P = .007; 0.025). Head circumference was similar between groups. All indexes were within the normal percentiles in all groups. The medium group had a significantly decreased scaphocephalic index (P = .031; .035). The short group had significantly greater occipital bulleting than the medium group (P = .001). The long group had significantly greater narrowing than the short group (P = .036).Conclusions Strip craniectomy with the addition of long, medium, or short barrel staves all resulted in clinically successful outcomes. Our findings suggest that increased barrel-stave osteotomy length may not be necessary for a successful outcome while avoiding more extensive dissection, potential risk, increased operative time, and hospital length of stay.
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Key words
craniosynostosis,cephalometry,craniofacial morphology,craniofacial surgery,surgical technique,outcomes
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