Evaluating Cephalic Index Changes in Sagittal Synostosis Surgery: A Retrospective Study of Subtotal Versus Total Vault Remodeling

Scaphocephaly is the most common form of craniosynostosis, characterized by premature closure of the sagittal suture. Surgical intervention is the standard treatment, aimed at correcting cranial shape and improving the cephalic index (CI), the key metric to quantify postsurgical outcomes. Controversies exist in the literature regarding the optimal timing of surgery and the choice of surgical technique. At our center, children aged 6 to 24 months presenting with sagittal synostosis and frontal bossing without significant occipital bullet undergo subtotal (anterior 2/3) vault remodeling, whereas those with both occipital bullet and frontal bossing are treated with total vault remodeling. This retrospective monocenter study tracks the progression of CI in pediatric patients undergoing these 2 techniques at 3 timepoints. From 2007 to 2015 the authors operated on 32 patients, excluding syndromic cases and reoperations. Twenty-three patients underwent subtotal and 9 total vault remodeling. The mean age at surgery was 12.66 months (range 6-24 months). The CI improved significantly in all patients after surgery. Overall, the CI increased from 66.67% preoperatively to 76.67% postoperatively and to 76.83% at 4 years. In the subtotal vault remodeling group, CI increased from 67.27% to 76.81% postoperatively, reaching 77.27% at 4 years. In the total vault remodeling group, CI rose from 65.11% to 76.29% postoperatively but decreased to 75.07% at 4 years. The authors' data show a sustained improvement in CI postoperatively, with a slight reduction in the total vault remodeling group at long-term follow-up.