{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:02:51Z","timestamp":1787025771627,"version":"build-2736575974"},"reference-count":19,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,8,1]]},"abstract":"\n OBJECTIVE<\/jats:title>\n As many as 5% of normocephalic children may have a prematurely fused sagittal suture, yet the clinical significance and best course of management of this finding remain unclear. Providers in the Synostosis Research Group were surveyed to create a multicenter consensus on an optimal treatment and monitoring algorithm for this condition.<\/jats:p>\n <\/jats:sec>\n \n METHODS<\/jats:title>\n A four-round modified Delphi method was utilized. The first two rounds consisted of anonymous surveys distributed to 10 neurosurgeons and 9 plastic surgeons with expertise in craniosynostosis across 9 institutions, and presented 3 patients (aged 3 years, 2 years, and 2 months) with incidentally discovered fused sagittal sutures, normal cephalic indices, and no parietal dysmorphology. Surgeons were queried about their preferred term for this entity and how best to manage these patients. Results were synthesized to create a treatment algorithm. The third and fourth feedback rounds consisted of open discussion of the algorithm until no further concerns arose.<\/jats:p>\n <\/jats:sec>\n \n RESULTS<\/jats:title>\n Most surgeons preferred the term \"premature fusion of the sagittal suture\" (93%). At the conclusion of the final round, all surgeons agreed to not operate on the 3- and 2-year-old patients unless symptoms of intracranial hypertension or papilledema were present. In contrast, 50% preferred to operate on the 2-month-old. However, all agreed to utilize shared decision-making, taking into account any concerns about future head shape and neurodevelopment. Panelists agreed that patients over 18 months of age without signs or symptoms suggesting elevated intracranial pressure (ICP) should not undergo surgical treatment.<\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS<\/jats:title>\n Through the Delphi method, a consensus regarding management of premature fusion of the sagittal suture was obtained from a panel of North American craniofacial surgeons. Without signs or symptoms of ICP elevation, surgery is not recommended in patients over 18 months of age. However, for children younger than 18 months, surgery should be discussed with caregivers using a shared decision-making process.<\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/2024.2.peds23521","type":"journal-article","created":{"date-parts":[[2024,5,10]],"date-time":"2024-05-10T23:29:46Z","timestamp":1715383786000},"page":"182-189","source":"Crossref","is-referenced-by-count":2,"title":["What to do with an incidental finding of a fused sagittal suture: a modified Delphi study"],"prefix":"10.3171","volume":"34","author":[{"given":"Sarah N.","family":"Chiang","sequence":"first","affiliation":[{"name":"Department of Surgery, Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, St. Louis, Missouri;"},{"name":"Department of Surgery, Division of Plastic and Reconstructive Surgery, University of California, Los Angeles, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jocelyn","family":"Reckford","sequence":"additional","affiliation":[{"name":"Department of Surgery, Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, St. Louis, Missouri;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Allyson L.","family":"Alexander","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Colorado Anschutz School of Medicine, Aurora, Colorado;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Craig B.","family":"Birgfeld","sequence":"additional","affiliation":[{"name":"Department of Surgery, Division of Plastic Surgery, University of Washington School of Medicine, Seattle, Washington;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher M.","family":"Bonfield","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel E.","family":"Couture","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa R.","family":"David","sequence":"additional","affiliation":[{"name":"Plastic and Reconstructive Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brooke","family":"French","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Colorado Anschutz School of Medicine, Aurora, Colorado;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barbu","family":"Gociman","sequence":"additional","affiliation":[{"name":"Department of Surgery, Division of Plastic Surgery, University of Utah School of Medicine, Salt Lake City, Utah;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jesse A.","family":"Goldstein","sequence":"additional","affiliation":[{"name":"Departments of Plastic Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael S.","family":"Golinko","sequence":"additional","affiliation":[{"name":"Plastic Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John R. W.","family":"Kestle","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Utah School of Medicine, Salt Lake City, Utah;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amy","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Washington School of Medicine, Seattle, Washington;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suresh N.","family":"Magge","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Michigan Medical School, Ann Arbor, Michigan;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ian F.","family":"Pollack","sequence":"additional","affiliation":[{"name":"Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S. Alex","family":"Rottgers","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher M.","family":"Runyan","sequence":"additional","affiliation":[{"name":"Plastic and Reconstructive Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew D.","family":"Smyth","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Johns Hopkins All Children\u2019s Hospital, St. Petersburg, Florida; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C. Corbett","family":"Wilkinson","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Colorado Anschutz School of Medicine, Aurora, Colorado;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gary B.","family":"Skolnick","sequence":"additional","affiliation":[{"name":"Department of Surgery, Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, St. Louis, Missouri;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer M.","family":"Strahle","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kamlesh B.","family":"Patel","sequence":"additional","affiliation":[{"name":"Department of Surgery, Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, St. Louis, Missouri;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"1","key":"b1","series-title":"Ann Plast Surg","first-page":"103","article-title":"Surgical correction of nonsyndromic sagittal craniosynostosis: concepts and controversies","volume":"78","author":"Simpson A","year":"2017","unstructured":"Simpson A, Wong AL, Bezuhly M. Surgical correction of nonsyndromic sagittal craniosynostosis: concepts and controversies. Ann Plast Surg. 2017;78(1):103\u2013110."},{"issue":"4","key":"b2","series-title":"J Neurosurg Pediatr","first-page":"352","article-title":"A systematic review and meta-analysis of endoscopic versus open treatment of craniosynostosis. Part 1: the sagittal suture","volume":"22","author":"Yan H","year":"2018","unstructured":"Yan H, Abel TJ, Alotaibi NM, A systematic review and meta-analysis of endoscopic versus open treatment of craniosynostosis. Part 1: the sagittal suture. J Neurosurg Pediatr. 2018;22(4):352\u2013360."},{"issue":"6","key":"b3","series-title":"J Neurosurg Pediatr","first-page":"622","article-title":"A review of the management of single-suture craniosynostosis, past, present, and future","volume":"24","author":"Proctor MR","year":"2019","unstructured":"Proctor MR, Meara JG. A review of the management of single-suture craniosynostosis, past, present, and future. J Neurosurg Pediatr. 2019;24(6):622\u2013631."},{"issue":"4","key":"b4","series-title":"J Neurosurg Pediatr","first-page":"455","article-title":"School-age anthropometric and patient-reported outcomes after open or endoscopic repair of sagittal craniosynostosis","volume":"32","author":"Fotouhi AR","year":"2023","unstructured":"Fotouhi AR, Patel KB, Skolnick GB, School-age anthropometric and patient-reported outcomes after open or endoscopic repair of sagittal craniosynostosis. J Neurosurg Pediatr. 2023;32(4):455\u2013463."},{"issue":"4","key":"b5","series-title":"Plast Reconstr Surg","first-page":"829","article-title":"Premature fusion of the sagittal suture as an incidental radiographic finding in young children","volume":"148","author":"Manrique M","year":"2021","unstructured":"Manrique M, Mantilla-Rivas E, Porras Perez AR, Premature fusion of the sagittal suture as an incidental radiographic finding in young children. Plast Reconstr Surg. 2021;148(4):829\u2013837."},{"issue":"5","key":"b6","series-title":"J Neurosurg Pediatr","first-page":"519","article-title":"Fusion patterns of major calvarial sutures on volume-rendered CT reconstructions","volume":"25","author":"Wilkinson CC","year":"2020","unstructured":"Wilkinson CC, Stence NV, Serrano CA, Fusion patterns of major calvarial sutures on volume-rendered CT reconstructions. J Neurosurg Pediatr. 2020;25(5):519\u2013528."},{"issue":"2","key":"b7","series-title":"Plast Reconstr Surg","first-page":"572","article-title":"Management of isolated sagittal synostosis in the absence of scaphocephaly: a series of eight cases","volume":"126","author":"Morritt DG","year":"2010","unstructured":"Morritt DG, Yeh FJ, Wall SA, Richards PG, Jayamohan J, Johnson D. Management of isolated sagittal synostosis in the absence of scaphocephaly: a series of eight cases. Plast Reconstr Surg. 2010;126(2):572\u2013580."},{"issue":"3","key":"b8","series-title":"Plast Reconstr Surg","first-page":"582","article-title":"A treatment algorithm for patients presenting with sagittal craniosynostosis after the age of 1 year","volume":"140","author":"Ruane EJ","year":"2017","unstructured":"Ruane EJ, Garland CB, Camison L, A treatment algorithm for patients presenting with sagittal craniosynostosis after the age of 1 year. Plast Reconstr Surg. 2017;140(3):582\u2013590."},{"issue":"5","key":"b9","series-title":"J Neurosurg","first-page":"1217","article-title":"Delphi studies in neurosurgery","volume":"136","author":"Amin-Hanjani S","year":"2021","unstructured":"Amin-Hanjani S, Riina HA, Barker FG. Editorial. Delphi studies in neurosurgery. J Neurosurg. 2021;136(5):1217\u20131218."},{"issue":"8","key":"b10","series-title":"Palliat Med","first-page":"684","article-title":"Guidance on Conducting and REporting DElphi Studies (CREDES) in palliative care: recommendations based on a methodological systematic review","volume":"31","author":"J\u00fcnger S","year":"2017","unstructured":"J\u00fcnger S, Payne SA, Brine J, Radbruch L, Brearley SG. Guidance on Conducting and REporting DElphi Studies (CREDES) in palliative care: recommendations based on a methodological systematic review. Palliat Med. 2017;31(8):684\u2013706."},{"issue":"2","key":"b11","series-title":"J Neurosurg Pediatr","first-page":"177","article-title":"Hydrocephalus surveillance following CSF diversion: a modified Delphi study","volume":"30","author":"Hersh DS","year":"2022","unstructured":"Hersh DS, Martin JE, Bristol RE, Hydrocephalus surveillance following CSF diversion: a modified Delphi study. J Neurosurg Pediatr. 2022;30(2):177\u2013187."},{"issue":"6","key":"b12","series-title":"J Neurosurg Pediatr","first-page":"701","article-title":"Development of best practices to minimize wound complications after complex tethered spinal cord surgery: a modified Delphi study","volume":"22","author":"Alexiades NG","year":"2018","unstructured":"Alexiades NG, Ahn ES, Blount JP, Development of best practices to minimize wound complications after complex tethered spinal cord surgery: a modified Delphi study. J Neurosurg Pediatr. 2018;22(6):701\u2013709."},{"issue":"4","key":"b13","series-title":"Neurosurg Focus","first-page":"E3","article-title":"Management of sagittal synostosis in the Synostosis Research Group: baseline data and early outcomes","volume":"50","author":"Baker CM","year":"2021","unstructured":"Baker CM, Ravindra VM, Gociman B, Management of sagittal synostosis in the Synostosis Research Group: baseline data and early outcomes. Neurosurg Focus. 2021;50(4):E3."},{"issue":"6","key":"b14","series-title":"J Neurosurg Pediatr","first-page":"674","article-title":"The preoperative incidence of raised intracranial pressure in nonsyndromic sagittal craniosynostosis is underestimated in the literature","volume":"14","author":"Wall SA","year":"2014","unstructured":"Wall SA, Thomas GP, Johnson D, The preoperative incidence of raised intracranial pressure in nonsyndromic sagittal craniosynostosis is underestimated in the literature. J Neurosurg Pediatr. 2014;14(6):674\u2013681."},{"issue":"5","key":"b15","series-title":"Plast Reconstr Surg","first-page":"1069","article-title":"Late-Presenting sagittal craniosynostosis: an update to a standardized treatment protocol","volume":"152","author":"Beiriger JW","year":"2023","unstructured":"Beiriger JW, Bruce MK, Mak A, Late-Presenting sagittal craniosynostosis: an update to a standardized treatment protocol. Plast Reconstr Surg. 2023;152(5):1069\u20131076."},{"issue":"9","key":"b16","series-title":"JAMA Netw Open","first-page":"e2121937","article-title":"Sagittal synostosis and its association with cognitive, behavioral, and psychological functioning: a meta-analysis","volume":"4","author":"Osborn AJ","year":"2021","unstructured":"Osborn AJ, Roberts RM, Dorstyn DS, Grave BG, David DJ. Sagittal synostosis and its association with cognitive, behavioral, and psychological functioning: a meta-analysis. JAMA Netw Open. 2021;4(9):e2121937."},{"key":"b17","series-title":"World Neurosurg","first-page":"x","article-title":"Paternalism versus shared decision making","volume":"174","author":"Benzel E","year":"2023","unstructured":"Benzel E. Paternalism versus shared decision making. World Neurosurg. 2023;174:x."},{"issue":"8","key":"b18","series-title":"Childs Nerv Syst","first-page":"1371","article-title":"Noninvasive methods of detecting increased intracranial pressure","volume":"32","author":"Xu W","year":"2016","unstructured":"Xu W, Gerety P, Aleman T, Swanson J, Taylor J. Noninvasive methods of detecting increased intracranial pressure. Childs Nerv Syst. 2016;32(8):1371\u20131386."},{"issue":"1","key":"b19","series-title":"J Neuroophthalmol","first-page":"77","article-title":"Optical coherence tomography neuro-toolbox for the diagnosis and management of papilledema, optic disc edema, and pseudopapilledema","volume":"41","author":"Sibony PA","year":"2021","unstructured":"Sibony PA, Kupersmith MJ, Kardon RH. Optical coherence tomography neuro-toolbox for the diagnosis and management of papilledema, optic disc edema, and pseudopapilledema. J Neuroophthalmol. 2021;41(1):77\u201392."}],"container-title":["Journal of Neurosurgery: Pediatrics"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-pediatr\/34\/2\/article-p182.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-pediatr\/34\/2\/article-p182.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-pediatr\/34\/2\/article-p182.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,12,6]],"date-time":"2024-12-06T08:07:48Z","timestamp":1733472468000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-pediatr\/34\/2\/article-p182.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,8,1]]},"references-count":19,"journal-issue":{"issue":"2"},"URL":"https:\/\/doi.org\/10.3171\/2024.2.peds23521","relation":{},"ISSN":["1933-0707","1933-0715"],"issn-type":[{"value":"1933-0707","type":"print"},{"value":"1933-0715","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,8,1]]}}}