{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T22:45:16Z","timestamp":1788993916353,"version":"build-2803163510"},"reference-count":38,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,11,1]]},"abstract":"\nOBJECTIVE<\/jats:title>\nSurgical treatment of sagittal craniosynostosis is challenging in older patients. This study aimed to assess the effect of increasing age on open surgical technique selection and patient outcomes using the multi-institutional Synostosis Research Group (SynRG) collaboration.<\/jats:p>\n<\/jats:sec>\n\nMETHODS<\/jats:title>\nSurgeons in SynRG were surveyed for key influences on their preferred open calvarial vault remodeling techniques at various patient ages: < 6, 6\u201312, and > 12 months. The SynRG database was then queried for open repairs of nonsyndromic sagittal craniosynostosis performed for patients older than 12 months of age. Perioperative measures, complications, and preoperative and postoperative cephalic indices were reviewed.<\/jats:p>\n<\/jats:sec>\n\nRESULTS<\/jats:title>\nAll surgeons preferred to treat patients at an earlier age, and most (89%) believed that less-optimal outcomes were achieved at ages older than 12 months. The modified pi procedure was the dominant technique in those younger than 12 months, while more involved open surgical techniques were performed for older patients, with a wide variety of open calvarial vault remodeling techniques used. Forty-four patients met inclusion criteria, with a mean (\u00b1 SD) age at surgery of 29 \u00b1 16 months. Eleven patients underwent parietal reshaping, 10 parietal-occipital switch, 9 clamshell craniotomy, 7 geometric parietal expansion, 6 modified pi procedure, and 1 parietal distraction. There were no readmissions, complications, or mortality within 30 days postoperatively. Patients\u2019 cephalic indices improved a mean of 6.4% \u00b1 4.0%, with a mean postoperative cephalic index of 74.2% \u00b1 4.9%. Differences in postoperative cephalic index (p < 0.04) and hospital length of stay (p = 0.01) were significant between technique cohorts. Post hoc Tukey-Kramer analysis identified the parietal reshaping technique as being significantly associated with a reduced hospital length of stay.<\/jats:p>\n<\/jats:sec>\n\nCONCLUSIONS<\/jats:title>\nPatient age is an important driver in technique selection, with surgeons selecting a more involved calvarial vault remodeling technique in older children. A variety of surgical techniques were analyzed, with the parietal reshaping technique being significantly associated with reduced length of stay; however, multiple perioperative factors may be contributory and require further analysis. When performed at high-volume centers by experienced pediatric neurosurgeons and craniofacial surgeons, open calvarial vault techniques can be a safe method for treating sagittal craniosynostosis in older children.<\/jats:p>\n<\/jats:sec>","DOI":"10.3171\/2022.7.peds22139","type":"journal-article","created":{"date-parts":[[2022,8,27]],"date-time":"2022-08-27T03:16:56Z","timestamp":1661570216000},"page":"490-498","source":"Crossref","is-referenced-by-count":13,"title":["A multi-institutional survey on calvarial vault remodeling techniques for sagittal synostosis and outcomes analysis for patients treated at 12 months and older"],"prefix":"10.3171","volume":"30","author":[{"given":"David","family":"Chi","sequence":"first","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ella","family":"Gibson","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah N.","family":"Chiang","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Koeun","family":"Lee","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sybill D.","family":"Naidoo","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amy","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Seattle Children\u2019s Hospital, University of Washington, Seattle, Washington;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Craig","family":"Birgfeld","sequence":"additional","affiliation":[{"name":"Division of Plastic Surgery, Seattle Children\u2019s Hospital, University of Washington, Seattle, Washington;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ian F.","family":"Pollack","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jesse","family":"Goldstein","sequence":"additional","affiliation":[{"name":"Plastic Surgery, UPMC Children\u2019s Hospital of Pittsburgh, University of Pittsburgh, Pennsylvania;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Golinko","sequence":"additional","affiliation":[{"name":"Departments of Plastic Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher M.","family":"Bonfield","sequence":"additional","affiliation":[{"name":"Neurological Surgery, Vanderbilt University, Nashville, Tennessee;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Faizi A.","family":"Siddiqi","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, University of Utah, Salt Lake City, Utah;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John R. 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