Sagittal suture craniosynostosis is a congenital condition in which the normal separation between the parietal bones has closed too early (synostosis).  This separation is a suture line, and this suture line between the parietal bones is called the sagittal suture.  The premature closure of this suture line is called sagittal synostosis and gives the condition named "scaphocephaly."  There are other forms of craniosynostosis when other suture lines are involved.  Scaphocephaly is the most common form of synostosis and it occurs in approximately 1 in 1000 newborns.

What Caused This?

In most situations it is caused by a disproportion in the size of the pelvis of the mother and the size of the fetal head, which creates a limitation of the growth of the fetal head in one direction and brings the two parietal bones together too early, creating the synostosis in the pelvis before birth.  This is why it is most commonly seen with the first pregnancy.  The fetus is usually a male, as males have larger heads than females.  The association of these two elements is what favors the development of this condition.  There is nothing that can prevent this condition from happening.  Fortunately though, there is a treatment.

Treatment of Sagittal Suture Synostosis

Since there is no medical treatment for synostosis, it is treated with surgery.  The surgical treatment has evolved over the years, not only by an improvement and refining of pediatric neurosurgical techniques, but also by the development of pediatric anesthesia.  Many forms of surgical interventions have been, and are being employed for sagittal synostosis.

Pediatric neurosurgeons perform surgery in, on and around the brain of infants and children affected with many conditions.  Therefore, they know how delicate and important cranial surgery is, and this experience permits them to perform craniosynostosis surgery with efficiency and at the same time protecting the underlying brain from any potential damage.  After surgery, they monitor the infants until they are fully recovered, observing for potential complications.

Over the past 30 years, Hector E. James, M.D. has developed reconstructive surgery (craniectomy) for sagittal craniosynostosis that permits: (a) rapid intervention that (b) corrects the majority of the craniosynostosis at the time of surgery, (c) followed by a rapid recovery and limited hospital stay, (d) eliminates the need for cranial helmets and/or other operations, and (e) minimizes postoperative follow-up appointments and visits.

Other surgeons employ differing techniques for the correction of sagittal suture synostosis.  More recently the neuroendoscopic techniques have become more fashionable.  They are described as "less invasive" to the infant, but since they do not correct the deformity at the time of surgery, the child has to wear a medically designed expensive helmet for a few months to correct the skull shape.  This mandates visits to the orthotist to mold the helmet and fit it, and subsequent visits to adjust the helmet to allow for cranial growth.

The reconstructive craniectomy not only significantly corrects the deformity at the time of surgery, but also sets in motion the normal growth of the brain.  Together with the remodeling of the cranium that took place at the time of surgery, the brain growth permits for a continued displacement of the bones of the head in normal directions.  In this fashion, the head shape continues to change over the subsequent months to attain a normal configuration.

Comparison of Operative Interventions

James Reconstructive Craniectomy Neuroendoscopic Surgery
1.  Operative time usually less than one hour. 1.  Operative time usually more than one hour.
2.  Corrects 60% or more of the deformity by the end of the
      operation.  No helmet is needed.
2.  The shape of the head is the same as before the operation. An
      expensive helmet is needed for several months to shape the 
      head following surgery.
3.  The hospital stay is approximately three (3) days following
3.  The hospital stay is approximately 1-2 days following surgery.
4.  Follow-up physician visits at two weeks, three months, and
      one year.
4.  Follow-up physician visits at two weeks, three months, and
      one year.
5.  No allied health personnel visits after surgery.
5.  Multiple follow-up visits with orthotist for sizing, molding, fitting  
     and adjusting of the helmet.
6.  Health care costs: surgeon, anesthesia, hospital stay.
      NO postoperative office visit charges.
6.  Health care costs: surgical team, anesthesia, hospital stay,
      helmet maker, and orthotist.

To contact us for further information:

Lucy Gooding Pediatric Neurosurgery Center
836 Prudential Drive
Pavilion Building, Suite 1005
Jacksonville, FL  32207
Phone: (904) 633-0780 (Monday - Friday 9:00 a.m. - 4:30 p.m. EST)
Fax:  (904) 633-0781

Parents may wish to stay while in Jacksonville at one of the largest and most modern Ronald McDonald House, which is conveniently located close to Wolfson Children's Hospital.

This information was provided by:
The Foundation for Pediatric and Laser Neurosurgery, Inc.

A Non Profit Corporation

In collaboration with
The Lucy Gooding Pediatric Neurosurgery Center
at Wolfson Children's Hospital
and the University of Florida Health Science Center Jacksonville
and Baptist Health of Northeast Florida