The Efficacy of Postoperative Helmet Therapy After Open Cranial Vault Remodeling for Nonsyndromic Craniosynostosis

Postoperative helmet therapy (PHT) is commonly utilized after endoscopic craniosynostosis repair to guide cranial reshaping and symmetry. Our institution routinely offers PHT to patients undergoing open calvarial vault remodeling (CVR) with unicoronal and lambdoid craniosynostosis. This study aims to determine if PHT is effective in improving residual asymmetry after open CVR for patients with unicoronal or lambdoid synostosis. Patients with non-syndromic craniosynostosis who underwent open CVR+PHT between 2016 and 2023 were reviewed retrospectively. Suture types with <4 cases were excluded. Pre-helmet and post-helmet measurements were assessed. Outcomes of interest included cephalic index (CI) and cranial vault asymmetry index (CVAI). Paired t tests compared pre-helmet and post-helmet measurements for each suture type. One sample t tests compared post-helmet measurements to normocephalic CI and CVAI values. Multivariate linear regression assessed contributors toward improvement in CI and CVAI following PHT. Of 284 patients who underwent open CVR, 35 met the inclusion criteria (21 unicoronal and 14 lambdoid). The average follow-up time was 2.1±1.7 years. Comparing pre-helmet and post-helmet measurements in patients who underwent open CVR, PHT improved CI for patients with unicoronal ( P <0.001) and lambdoid synostosis ( P <0.001). PHT also significantly improved CVAI for patients with unicoronal ( P <0.001) and lambdoid synostosis ( P =0.004). For both unicoronal and lambdoid synostosis, the average CI and CVAI at PHT completion were equivalent to normocephalic CI and CVAI values ( P >0.05). PHT improved cranial shape and symmetry in patients who underwent open CVR with unicoronal or lambdoid synostosis. PHT should not be limited to treating patients who undergo endoscopic suturectomy.