Morphometric Outcomes of Late Presentation Nonsyndromic Sagittal Synostosis following Open Cranial Vault Reconstruction.

Background: Sagittal craniosynostosis (SS) occasionally presents in a delayed manner. This study aims to quantify the change in cranial morphometrics for patients with late presentation SS (defined as cranial vault expansion after 1 y of age) at presentation, immediately postoperatively, and at 2-year follow-up. Methods: A retrospective chart review was performed of patients with a diagnosis of SS who underwent open cranial vault reconstruction at older than 1 year of age. Computed tomography scans were matched with controls. Vector analysis was performed to model the effect of open cranial vault reconstruction. Subgroup analyses were performed to determine if specific approach, or age at time of surgery resulted in an improved postoperative outcome. Results: Thirty-two patients met inclusion criteria. Craniomorphometric analysis demonstrated significant improvement in head shape which was maintained at 2 years postoperatively compared to preoperative scans. Vector analysis demonstrated an improvement in frontal morphology that is sustained at 2 years postoperatively with no significant difference relative to controls when examined from multiple vectors. Subgroup analyses demonstrated that specific surgical approach did affect the 2-year postoperative head shape, whereas older age at time of surgery (≥18 mo) did not consistently diminish the postoperative outcome. Conclusions: Open cranial vault reconstruction performed for late presentation SS is associated with improvement in head shape at 2 years postoperatively.