{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T05:48:26Z","timestamp":1793166506513,"version":"4.5.0"},"reference-count":21,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2018,12]]},"abstract":"<jats:sec><jats:title>OBJECTIVE<\/jats:title><jats:p>Many infants with sagittal craniosynostosis undergo effective surgical correction with endoscopic strip craniectomy (ESC) and postoperative helmet therapy (PHT). While PHT is essential to achieving optimal cosmesis following ESC, there has been little comprehensive analysis of the ideal PHT duration needed to attain this goal.<\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS<\/jats:title><jats:p>The authors retrospectively reviewed the charts of infants undergoing ESC and PHT for sagittal synostosis at our institution between 2008 and 2015. Data collected included age at surgery, follow-up duration, and PHT duration. Cephalic index (CI) was evaluated preoperatively (CI<jats:sub>pre<\/jats:sub>), at its peak level (CI<jats:sub>max<\/jats:sub>), at termination of helmet therapy (CI<jats:sub>off<\/jats:sub>), and at last follow-up (CI<jats:sub>final<\/jats:sub>). A multivariate regression analysis was performed to determine factors influencing CI<jats:sub>final<\/jats:sub>.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p>Thirty-one patients (27 male, 4 female) were treated in the studied time period. The median age at surgery was 2.7 months (range 1.6 to 3.2) and the median duration of PHT was 10.4 months (range 8.4 to 14.4). The mean CI<jats:sub>max<\/jats:sub> was 0.83 (SD 0.01), which was attained an average of 8.4 months (SD 1.2) following PHT initiation. At last follow-up, there was an average retraction of CI<jats:sub>final<\/jats:sub> among all patients to 0.78 (SD 0.01). Longer helmet duration after achieving CI<jats:sub>max<\/jats:sub> did not correlate with higher CI<jats:sub>final<\/jats:sub> values. While CI<jats:sub>max<\/jats:sub> was a significant predictor of CI<jats:sub>final<\/jats:sub>, neither age at surgery nor CI<jats:sub>pre<\/jats:sub> were found to be predictive of final outcome.<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS<\/jats:title><jats:p>Patients undergoing ESC and PHT for sagittal synostosis reach a peak CI around 7 to 9 months after surgery. PHT beyond CI<jats:sub>max<\/jats:sub> does not improve final anthropometric outcomes. CI<jats:sub>final<\/jats:sub> is significantly dependent on CI<jats:sub>max<\/jats:sub>, but not on age, nor CI<jats:sub>pre<\/jats:sub>. These results imply that helmet removal at CI<jats:sub>max<\/jats:sub> may be appropriate for ESC patients, while helmeting beyond the peak does not change final outcome.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2018.5.peds184","type":"journal-article","created":{"date-parts":[[2018,8,31]],"date-time":"2018-08-31T13:55:31Z","timestamp":1535723731000},"page":"610-615","source":"Crossref","is-referenced-by-count":38,"title":["Optimal duration of postoperative helmet therapy following endoscopic strip craniectomy for sagittal craniosynostosis"],"prefix":"10.3171","volume":"22","author":[{"given":"Rajiv R.","family":"Iyer","sequence":"first","affiliation":[{"name":"Division of Pediatric Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaobu","family":"Ye","sequence":"additional","affiliation":[{"name":"Division of Pediatric Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qiuyu","family":"Jin","sequence":"additional","affiliation":[{"name":"Division of Pediatric Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yao","family":"Lu","sequence":"additional","affiliation":[{"name":"Division of Biostatistics and Epidemiology, Weill Cornell Medical College, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luckmini","family":"Liyanage","sequence":"additional","affiliation":[{"name":"Division of Pediatric Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edward S.","family":"Ahn","sequence":"additional","affiliation":[{"name":"Division of Pediatric Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1","series-title":"J Craniofac Surg","doi-asserted-by":"publisher","first-page":"88","DOI":"10.1097\/SCS.0b013e318240f965","article-title":"Cost of treating sagittal synostosis in the first year of life","volume":"23","author":"Abbott MM","year":"2012","unstructured":"Abbott MM, Rogers GF, Proctor MR, Busa K, Meara JG: Cost of treating sagittal synostosis in the first year of life. 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