Comparison of Cranial Vault Remodeling, Suturectomy, and Suturectomy with Springs for Lambdoid Craniosynostosis

BACKGROUND: Craniosynostosis of the lambdoid suture is a rare malformation, accounting for 1-5% of all non-syndromic craniosynostoses, and may present as unilateral, bilateral, or in complex forms.1 Insufficient surgical correction may render patients with permanent mental deficits from intracranial hypertension and psychological distress from cosmetic deformity. Surgical techniques to address craniosynostoses have evolved, with common options being cranial vault remodeling (CVR), suturectomy, and more recently, spring-assisted suturectomy.2 There is a paucity of literature surrounding comparison between different techniques for treatment of lambdoid craniosynostosis. We present outcomes of patients with lambdoid craniosynostosis who underwent surgical intervention at a level one pediatric institution. METHODS: A retrospective analysis of 26 patients who were surgically treated from January 2011 to February 2025 for lambdoid craniosynostosis was conducted. Patients with bilateral lambdoid craniosynostosis and those with three or more affected sutures were excluded from the study. RESULTS: Of the 26 patients, the average age at diagnosis by CT scan was 7.7 months (Range: 0.8-23.5 months). Sixty-five percent of the patients were male, and 77% of the patients were white. Isolated lambdoid craniosynostosis (77%) was the most common presentation, followed by lambdoid craniosynostosis with sagittal suture involvement (19%), and lambdoid craniosynostosis with metopic suture involvement (4%). The right lambdoid suture was involved in 54% of cases, and all patients were non-syndromic. Cranial vault remodeling (CVR) was completed in 65% of patients, suturectomy with molding helmet therapy (23%), and suturectomy with springs (12%). Of patients who underwent CVR, the median age at surgery was 10.7 months (Range: 7.2-26.7 months), median operative time was 340 minutes (Range: 240-528), 11.8% had additional suture involvement, 35% experienced postoperative complications, and no patients required additional surgery. Of patients who underwent suturectomy with molding helmet therapy, the median age at surgery was 3.7 months (Range: 2.2-4.6 months), median operative time was 259 minutes (Range: 210-407), 50% had additional suture involvement, 67% experienced postoperative complications, and 33% required secondary CVR due to refusion of sutures in one patient and residual head deformity in another. Of patients who underwent suturectomy with springs, the median age at surgery was 6.5 months (Range: 5-8.4), median operative time was 207 minutes (Range: 113-260), and no patients required additional surgery. CONCLUSION: Suturectomy and molding helmet therapy has limited utility to address lambdoid craniosynostosis with 33% of cases in our study requiring additional vault remodeling surgery. While CVR is the current standard of care for craniosynostosis, cosmetic results are modest at best. Suturectomy with spring assisted-cranioplasty demonstrates promising correction of the primary deformity with low morbidity and may become more commonplace for lambdoid craniosynostosis.