{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T12:03:51Z","timestamp":1787313831402,"version":"build-2736575974"},"reference-count":29,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["PED"],"published-print":{"date-parts":[[2016,11]]},"abstract":"\n OBJECTIVE<\/jats:title>\n Due to the changing properties of the infant skull, there is still no clear consensus on the ideal time to surgically intervene in cases of nonsyndromic craniosynostosis (NSC). This study aims to shed light on how patient age at the time of surgery may affect surgical outcomes and the subsequent need for reoperation.<\/jats:p>\n <\/jats:sec>\n \n METHODS<\/jats:title>\n A retrospective cohort review was conducted for patients with NSC who underwent primary cranial vault remodeling between 1990 and 2013. Patients' demographic and clinical characteristics and surgical interventions were recorded. Postoperative outcomes were assessed by assigning each procedure to a Whitaker category. Multivariate logistic regression analysis was performed to determine the relationship between age at surgery and need for minor (Whitaker I or II) versus major (Whitaker III or IV) reoperation. Odds ratios (ORs) for Whitaker category by age at surgery were assigned.<\/jats:p>\n <\/jats:sec>\n \n RESULTS<\/jats:title>\n A total of 413 unique patients underwent cranial vault remodeling procedures for NSC during the study period. Multivariate logistic regression demonstrated increased odds of requiring major surgical revisions (Whitaker III or IV) in patients younger than 6 months of age (OR 2.49, 95% CI 1.05\u20135.93), and increased odds of requiring minimal surgical revisions (Whitaker I or II) in patients older than 6 months of age (OR 2.72, 95% CI 1.16\u20136.41).<\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS<\/jats:title>\n Timing, as a proxy for the changing properties of the infant skull, is an important factor to consider when planning vault reconstruction in NSC. The data presented in this study demonstrate that patients operated on before 6 months of age had increased odds of requiring major surgical revisions.<\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/2016.5.peds1663","type":"journal-article","created":{"date-parts":[[2016,8,9]],"date-time":"2016-08-09T08:21:41Z","timestamp":1470730901000},"page":"629-634","source":"Crossref","is-referenced-by-count":35,"title":["Timing of cranial vault remodeling in nonsyndromic craniosynostosis: a single-institution 30-year experience"],"prefix":"10.3171","volume":"18","author":[{"given":"Alan F.","family":"Utria","sequence":"first","affiliation":[{"name":"Departments of Plastic and Reconstructive Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph","family":"Lopez","sequence":"additional","affiliation":[{"name":"Departments of Plastic and Reconstructive Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Regina S.","family":"Cho","sequence":"additional","affiliation":[{"name":"Departments of Plastic and Reconstructive Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerhard S.","family":"Mundinger","sequence":"additional","affiliation":[{"name":"Departments of Plastic and Reconstructive Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George I.","family":"Jallo","sequence":"additional","affiliation":[{"name":"Neurosurgery, Johns Hopkins Hospital; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edward S.","family":"Ahn","sequence":"additional","affiliation":[{"name":"Neurosurgery, Johns Hopkins Hospital; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Craig Vander","family":"Kolk","sequence":"additional","affiliation":[{"name":"Departments of Plastic and Reconstructive Surgery and"},{"name":"Division of Plastic Surgery, Mercy Medical Center, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amir H.","family":"Dorafshar","sequence":"additional","affiliation":[{"name":"Departments of Plastic and Reconstructive Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-peds1663","series-title":"Plast Reconstr Surg","doi-asserted-by":"publisher","first-page":"6","DOI":"10.1097\/00006534-200207000-00002","article-title":"Postoperative mental and morphological outcome for nonsyndromic brachycephaly","volume":"110","author":"Arnaud","year":"2002"},{"key":"b2-peds1663","series-title":"Pediatrics","doi-asserted-by":"publisher","first-page":"e1","DOI":"10.1542\/peds.2014-3526","article-title":"Cognition and brain structure following early childhood surgery with anesthesia","volume":"136","author":"Backeljauw","year":"2015"},{"key":"b3-peds1663","series-title":"Plast Reconstr Surg","doi-asserted-by":"publisher","first-page":"502","DOI":"10.1097\/PRS.0000000000000468","article-title":"Discussion: the effects of whole-vault cranioplasty versus strip craniectomy on long-term neuropsychological outcomes in sagittal craniosynostosis","volume":"134","author":"Bradley","year":"2014"},{"key":"b4-peds1663","series-title":"Plast Surg Nurs","doi-asserted-by":"publisher","first-page":"79","DOI":"10.1097\/01.PSN.0000324781.80590.f1","article-title":"Nonsyndromic craniosynostosis: current treatment options","volume":"28","author":"Cohen","year":"2008"},{"key":"b5-peds1663","series-title":"Semin Plast Surg","doi-asserted-by":"publisher","first-page":"64","DOI":"10.1055\/s-0032-1320064","article-title":"Syndromic craniosynostosis","volume":"26","author":"Derderian","year":"2012"},{"key":"b6-peds1663","series-title":"Plast Reconstr Surg","doi-asserted-by":"publisher","first-page":"114e","DOI":"10.1097\/PRS.0000000000001344","article-title":"The effects of whole-vault cranioplasty versus strip craniectomy on long-term neuropsychological outcomes in sagittal craniosynostosis","volume":"136","author":"Derderian","year":"2015"},{"key":"b7-peds1663","series-title":"Plast Reconstr Surg","doi-asserted-by":"publisher","first-page":"70e","DOI":"10.1097\/01.prs.0000299393.36063.de","article-title":"Recurrence of synostosis following surgical repair of craniosynostosis","volume":"121","author":"Foster","year":"2008"},{"key":"b8-peds1663","series-title":"Semin Plast Surg","doi-asserted-by":"publisher","first-page":"53","DOI":"10.1055\/s-0032-1320063","article-title":"Nonsyndromic craniosynostosis","volume":"26","author":"Garza","year":"2012"},{"key":"b9-peds1663","series-title":"Plast Reconstr Surg","doi-asserted-by":"publisher","first-page":"491","DOI":"10.1097\/PRS.0000000000000420","article-title":"The effects of whole-vault cranioplasty versus strip craniectomy on long-term neuropsychological outcomes in sagittal craniosynostosis","volume":"134","author":"Hashim","year":"2014"},{"key":"b10-peds1663","series-title":"Childs Nerv Syst","doi-asserted-by":"publisher","first-page":"269","DOI":"10.1007\/s00381-006-0251-z","article-title":"Neurodevelopment of children with single suture craniosynostosis: a review.","volume":"23","author":"Kapp-Simon","year":"2007"},{"key":"b11-peds1663","series-title":"JAMA","first-page":"49","article-title":"Pioneer craniectomy for relief of mental imbecility due to premature sutural closure and microcephalus","volume":"18","author":"Lane","year":"1892"},{"key":"b12-peds1663","series-title":"J Craniofac Surg","doi-asserted-by":"publisher","first-page":"1256","DOI":"10.1097\/SCS.0b013e31824e26d6","article-title":"Analysis of morbidity and mortality in surgical management of craniosynostosis.","volume":"23","author":"Lee","year":"2012"},{"key":"b13-peds1663","series-title":"Plast Reconstr Surg","doi-asserted-by":"publisher","first-page":"272","DOI":"10.1097\/00006534-199508000-00004","article-title":"Twenty-year experience with early surgery for craniosynostosis: I. 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