The Effect of Barrel-Stave Osteotomy Length in Sagittal Strip Craniectomy

ObjectiveIn 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.DesignA retrospective review of operative records and pre-operative and one-year post-operative three-dimensional images.SettingTertiary care pediatric institution.PatientsForty-five patients with sagittal craniosynostosisInterventionsSagittal strip craniectomy and either long, medium, or short barrel-stave osteotomy lengths followed by helmet therapyMain Outcome MeasuresOperative and three-dimensional craniometric outcomes.ResultsOperative time, estimated blood loss, and hospital length of stay were significantly decreased in the short group (<i>P</i> = .003; 0.002; 0.027). The cranial index was normalized in all groups, but the long group was significantly lower (<i>P</i> = .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 (<i>P</i> = .031; .035). The short group had significantly greater occipital bulleting than the medium group (<i>P</i> = .001). The long group had significantly greater narrowing than the short group (<i>P</i> = .036).ConclusionsStrip 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.