{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T15:39:47Z","timestamp":1792597187539,"version":"4.5.0"},"reference-count":28,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,10,10]]},"abstract":"\n OBJECTIVE<\/jats:title>\n The treatment of sagittal craniosynostosis typically involves endoscopic suturectomy (ES) to allow skull expansion, followed by postoperative helmet orthosis, resulting in an improvement in cranial deformity as assessed using the cephalic index (CI). The impact of variations in surgical technique on long-term CI outcomes is not well understood, and there is controversy regarding whether adding barrel stave osteotomy (BSO) to standard ES leads to greater improvement in the CI postoperatively. This combined approach is thought to improve cranial shape and overall clinical outcomes but may increase operative burden. The aim of this study was to investigate the impact of BSO during ES on operative outcomes and postoperative cranial deformity in patients who underwent surgical correction of sagittal craniosynostosis.<\/jats:p>\n <\/jats:sec>\n \n METHODS<\/jats:title>\n The authors conducted a retrospective chart review of children who had been treated with ES for sagittal craniosynostosis between 2010 and 2021 at British Columbia Children's Hospital. Demographics, operative outcomes, and postoperative longitudinal CI measurements were collected and compared between patients who had undergone ES with BSO (ES+BSO) and those who had undergone ES alone. Operative outcomes related to anesthesia and surgical time, blood loss, and hospital length of stay were analyzed, as were changes in the CI at various follow-up times. A mixed-effects model was used to compare longitudinal CI measurements between treatment groups, controlling for patient age, preoperative CI, and duration of helmet therapy.<\/jats:p>\n <\/jats:sec>\n \n RESULTS<\/jats:title>\n Eighty-five patients were included in the analysis, 67 treated with ES+BSO and 18 treated with ES. Operative outcomes, including length of hospital stay, operative time, time under anesthesia, blood loss, and need for transfusion did not differ significantly between treatment groups (p > 0.05). The mean follow-up for the last CI measurements was 56.0 months. While preoperative CI was similar for the two groups (mean 67.4 for ES+BSO vs 66.8 for ES, p = 0.61), CI was significantly higher in the ES+BSO group immediately postoperatively (p = 0.004) and at the 6-month (p = 0.01), 2-year (p = 0.02), and final (p = 0.002) follow-ups. A mixed-effects model revealed that the addition of BSO led to significantly greater CI measurements independent of age, preoperative CI, and helmeting duration (estimated effect size 2.21, p = 0.001).<\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS<\/jats:title>\n In this series, the addition of BSO to ES significantly improved immediate and long-term cranial deformity in patients with sagittal craniosynostosis, without increasing the operative burden.<\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/2025.6.peds2523","type":"journal-article","created":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T02:07:04Z","timestamp":1760148424000},"page":"683-688","source":"Crossref","is-referenced-by-count":2,"title":["Impact of barrel stave osteotomy on cephalometric measurements in patients who have undergone endoscopic repair of sagittal craniosynostosis"],"prefix":"10.3171","volume":"36","author":[{"given":"Benjamin A.","family":"Brakel","sequence":"first","affiliation":[{"name":"Faculty of Medicine, University of British Columbia, Vancouver, British Columbia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mandeep S.","family":"Tamber","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of British Columbia, Vancouver, British Columbia;"},{"name":"Division of Neurosurgery, Department of Surgery, BC Children\u2019s Hospital and University of British Columbia, Vancouver, British Columbia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annika","family":"Weir","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Department of Surgery, BC Children\u2019s Hospital and University of British Columbia, Vancouver, British Columbia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isabella","family":"Watson","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Department of Surgery, BC Children\u2019s Hospital and University of British Columbia, Vancouver, British Columbia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A. Hana","family":"Miller","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Department of Surgery, BC Children\u2019s Hospital and University of British Columbia, Vancouver, British Columbia;"},{"name":"McGill University, Montreal, Quebec; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick J.","family":"McDonald","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Department of Surgery, BC Children\u2019s Hospital and University of British Columbia, Vancouver, British Columbia;"},{"name":"Section of Neurosurgery, Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ash","family":"Singhal","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of British Columbia, Vancouver, British Columbia;"},{"name":"Division of Neurosurgery, Department of Surgery, BC Children\u2019s Hospital and University of British Columbia, Vancouver, British Columbia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Faizal A.","family":"Haji","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of British Columbia, Vancouver, British Columbia;"},{"name":"Division of Neurosurgery, Department of Surgery, BC Children\u2019s Hospital and University of British Columbia, Vancouver, British Columbia;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"1","key":"b1","series-title":"J Neurosurg","first-page":"77","article-title":"Endoscopic craniectomy for early surgical correction of sagittal craniosynostosis","volume":"88","author":"Jimenez DF","year":"1998","unstructured":"Jimenez DF, Barone CM. Endoscopic craniectomy for early surgical correction of sagittal craniosynostosis. J Neurosurg. 1998;88(1):77\u201381."},{"issue":"9","key":"b2","series-title":"Childs Nerv Syst","first-page":"1333","article-title":"Endoscopic technique for sagittal synostosis","volume":"28","author":"Jimenez DF","year":"2012","unstructured":"Jimenez DF, Barone CM. Endoscopic technique for sagittal synostosis. Childs Nerv Syst. 2012;28(9):1333\u20131339."},{"issue":"2","key":"b3","series-title":"Plast Surg (Oakv)","first-page":"283","article-title":"Head shape after sagittal craniosynostosis surgery: open versus endoscopic strip craniectomy","volume":"33","author":"Crofts H","year":"2025","unstructured":"Crofts H, Mankowski P, Tamber M, Courtemanche DJ. Head shape after sagittal craniosynostosis surgery: open versus endoscopic strip craniectomy. Plast Surg (Oakv). 2025;33(2):283\u2013288."},{"issue":"4","key":"b4","series-title":"Neurosurg Focus","first-page":"E7","article-title":"Improved cephalic index following early cranial vault remodeling in patients with isolated nonsyndromic sagittal synostosis","volume":"50","author":"Frostell A","year":"2021","unstructured":"Frostell A, Haghighi M, Bartek J, Improved cephalic index following early cranial vault remodeling in patients with isolated nonsyndromic sagittal synostosis. Neurosurg Focus. 2021;50(4):E7."},{"issue":"6","key":"b5","series-title":"J Neurosurg Pediatr","first-page":"674","article-title":"Endoscope-assisted management of sagittal synostosis: wide vertex suturectomy and barrel stave osteotomies versus narrow vertex suturectomy","volume":"25","author":"Dlouhy BJ","year":"2016","unstructured":"Dlouhy BJ, Nguyen DC, Patel KB, Endoscope-assisted management of sagittal synostosis: wide vertex suturectomy and barrel stave osteotomies versus narrow vertex suturectomy. J Neurosurg Pediatr. 2016;25(6):674\u2013678."},{"issue":"1","key":"b6","series-title":"J Neurosurg Pediatr","first-page":"86","article-title":"Less is more: does the addition of barrel staves improve results in endoscopic strip craniectomy for sagittal craniosynostosis?","volume":"20","author":"Wood BC","year":"2017","unstructured":"Wood BC, Ahn ES, Wang JY, Less is more: does the addition of barrel staves improve results in endoscopic strip craniectomy for sagittal craniosynostosis?. J Neurosurg Pediatr. 2017;20(1):86\u201390."},{"issue":"Suppl 1","key":"b7","series-title":"J Pediatr Neurosci","first-page":"S44","article-title":"Endoscopy in craniosynostosis surgery: evolution and current trends","volume":"17","author":"Marupudi NI","year":"2022","unstructured":"Marupudi NI, Reisen B, Rozzelle A, Sood S. Endoscopy in craniosynostosis surgery: evolution and current trends. J Pediatr Neurosci. 2022;17(Suppl 1):S44-S53."},{"issue":"5","key":"b8","series-title":"Crouzon\u2019s and Apert\u2019s diseases. Plast Reconstr Surg","first-page":"419","article-title":"The definitive plastic surgical treatment of the severe facial deformities of craniofacial dysostosis","volume":"48","author":"Tessier P","year":"1971","unstructured":"Tessier P. The definitive plastic surgical treatment of the severe facial deformities of craniofacial dysostosis. Crouzon\u2019s and Apert\u2019s diseases. Plast Reconstr Surg. 1971;48(5):419\u2013442."},{"issue":"4","key":"b9","series-title":"Can J Anaesth","first-page":"473","article-title":"Craniosynostosis: an assessment of blood loss and transfusion practices","volume":"36","author":"Kearney RA","year":"1989","unstructured":"Kearney RA, Rosales JK, Howes WJ. Craniosynostosis: an assessment of blood loss and transfusion practices. Can J Anaesth. 1989;36(4):473\u2013477."},{"issue":"3","key":"b10","series-title":"J Neurosurg Anesthesiol","first-page":"167","article-title":"Blood loss and transfusion practice in the perioperative management of craniosynostosis repair","volume":"11","author":"Faberowski LW","year":"1999","unstructured":"Faberowski LW, Black S, Mickle JP. Blood loss and transfusion practice in the perioperative management of craniosynostosis repair. J Neurosurg Anesthesiol. 1999;11(3):167\u2013172."},{"issue":"2","key":"b11","series-title":"Neurosurg Focus","first-page":"E5","article-title":"Endoscope-assisted strip craniectomy and postoperative helmet therapy for treatment of craniosynostosis","volume":"31","author":"Berry-Candelario J","year":"2011","unstructured":"Berry-Candelario J, Ridgway EB, Grondin RT, Rogers GF, Proctor MR. Endoscope-assisted strip craniectomy and postoperative helmet therapy for treatment of craniosynostosis. Neurosurg Focus. 2011;31(2):E5."},{"key":"b12","series-title":"Surg Neurol Int","first-page":"59","article-title":"Endoscopy-assisted craniosynostosis surgery followed by helmet therapy","volume":"9","author":"Delye HHK","year":"2018","unstructured":"Delye HHK, Borstlap WA, van Lindert EJ. Endoscopy-assisted craniosynostosis surgery followed by helmet therapy. Surg Neurol Int. 2018;9:59."},{"issue":"3","key":"b13","series-title":"J Neurosurg Pediatr","first-page":"291","article-title":"Long-term 3D CT follow-up after endoscopic sagittal craniosynostosis repair","volume":"25","author":"Persad A","year":"2020","unstructured":"Persad A, Aronyk K, Beaudoin W, Mehta V. Long-term 3D CT follow-up after endoscopic sagittal craniosynostosis repair. J Neurosurg Pediatr. 2020;25(3):291\u2013297."},{"issue":"3","key":"b14","series-title":"J Neurosurg Pediatr","first-page":"277","article-title":"Multicenter comparison of head shape outcomes for three minimally invasive strip craniectomy techniques for sagittal craniosynostosis","volume":"32","author":"Rizvi I","year":"2023","unstructured":"Rizvi I, Hallac RR, Geisler EL, Multicenter comparison of head shape outcomes for three minimally invasive strip craniectomy techniques for sagittal craniosynostosis. J Neurosurg Pediatr. 2023;32(3):277\u2013284."},{"issue":"1","key":"b1","series-title":"J Neurosurg","first-page":"77","article-title":"Endoscopic craniectomy for early surgical correction of sagittal craniosynostosis","volume":"88","author":"Jimenez DF","year":"1998","unstructured":"Jimenez DF, Barone CM. Endoscopic craniectomy for early surgical correction of sagittal craniosynostosis. J Neurosurg. 1998;88(1):77\u201381."},{"issue":"9","key":"b2","series-title":"Childs Nerv Syst","first-page":"1333","article-title":"Endoscopic technique for sagittal synostosis","volume":"28","author":"Jimenez DF","year":"2012","unstructured":"Jimenez DF, Barone CM. Endoscopic technique for sagittal synostosis. Childs Nerv Syst. 2012;28(9):1333\u20131339."},{"issue":"2","key":"b3","series-title":"Plast Surg (Oakv)","first-page":"283","article-title":"Head shape after sagittal craniosynostosis surgery: open versus endoscopic strip craniectomy","volume":"33","author":"Crofts H","year":"2025","unstructured":"Crofts H, Mankowski P, Tamber M, Courtemanche DJ. Head shape after sagittal craniosynostosis surgery: open versus endoscopic strip craniectomy. Plast Surg (Oakv). 2025;33(2):283\u2013288."},{"issue":"4","key":"b4","series-title":"Neurosurg Focus","first-page":"E7","article-title":"Improved cephalic index following early cranial vault remodeling in patients with isolated nonsyndromic sagittal synostosis","volume":"50","author":"Frostell A","year":"2021","unstructured":"Frostell A, Haghighi M, Bartek J, Improved cephalic index following early cranial vault remodeling in patients with isolated nonsyndromic sagittal synostosis. Neurosurg Focus. 2021;50(4):E7."},{"issue":"6","key":"b5","series-title":"J Neurosurg Pediatr","first-page":"674","article-title":"Endoscope-assisted management of sagittal synostosis: wide vertex suturectomy and barrel stave osteotomies versus narrow vertex suturectomy","volume":"25","author":"Dlouhy BJ","year":"2016","unstructured":"Dlouhy BJ, Nguyen DC, Patel KB, Endoscope-assisted management of sagittal synostosis: wide vertex suturectomy and barrel stave osteotomies versus narrow vertex suturectomy. J Neurosurg Pediatr. 2016;25(6):674\u2013678."},{"issue":"1","key":"b6","series-title":"J Neurosurg Pediatr","first-page":"86","article-title":"Less is more: does the addition of barrel staves improve results in endoscopic strip craniectomy for sagittal craniosynostosis?","volume":"20","author":"Wood BC","year":"2017","unstructured":"Wood BC, Ahn ES, Wang JY, Less is more: does the addition of barrel staves improve results in endoscopic strip craniectomy for sagittal craniosynostosis?. J Neurosurg Pediatr. 2017;20(1):86\u201390."},{"issue":"Suppl 1","key":"b7","series-title":"J Pediatr Neurosci","first-page":"S44","article-title":"Endoscopy in craniosynostosis surgery: evolution and current trends","volume":"17","author":"Marupudi NI","year":"2022","unstructured":"Marupudi NI, Reisen B, Rozzelle A, Sood S. Endoscopy in craniosynostosis surgery: evolution and current trends. J Pediatr Neurosci. 2022;17(Suppl 1):S44-S53."},{"issue":"5","key":"b8","series-title":"Crouzon\u2019s and Apert\u2019s diseases. Plast Reconstr Surg","first-page":"419","article-title":"The definitive plastic surgical treatment of the severe facial deformities of craniofacial dysostosis","volume":"48","author":"Tessier P","year":"1971","unstructured":"Tessier P. The definitive plastic surgical treatment of the severe facial deformities of craniofacial dysostosis. Crouzon\u2019s and Apert\u2019s diseases. Plast Reconstr Surg. 1971;48(5):419\u2013442."},{"issue":"4","key":"b9","series-title":"Can J Anaesth","first-page":"473","article-title":"Craniosynostosis: an assessment of blood loss and transfusion practices","volume":"36","author":"Kearney RA","year":"1989","unstructured":"Kearney RA, Rosales JK, Howes WJ. Craniosynostosis: an assessment of blood loss and transfusion practices. Can J Anaesth. 1989;36(4):473\u2013477."},{"issue":"3","key":"b10","series-title":"J Neurosurg Anesthesiol","first-page":"167","article-title":"Blood loss and transfusion practice in the perioperative management of craniosynostosis repair","volume":"11","author":"Faberowski LW","year":"1999","unstructured":"Faberowski LW, Black S, Mickle JP. Blood loss and transfusion practice in the perioperative management of craniosynostosis repair. J Neurosurg Anesthesiol. 1999;11(3):167\u2013172."},{"issue":"2","key":"b11","series-title":"Neurosurg Focus","first-page":"E5","article-title":"Endoscope-assisted strip craniectomy and postoperative helmet therapy for treatment of craniosynostosis","volume":"31","author":"Berry-Candelario J","year":"2011","unstructured":"Berry-Candelario J, Ridgway EB, Grondin RT, Rogers GF, Proctor MR. Endoscope-assisted strip craniectomy and postoperative helmet therapy for treatment of craniosynostosis. Neurosurg Focus. 2011;31(2):E5."},{"key":"b12","series-title":"Surg Neurol Int","first-page":"59","article-title":"Endoscopy-assisted craniosynostosis surgery followed by helmet therapy","volume":"9","author":"Delye HHK","year":"2018","unstructured":"Delye HHK, Borstlap WA, van Lindert EJ. Endoscopy-assisted craniosynostosis surgery followed by helmet therapy. Surg Neurol Int. 2018;9:59."},{"issue":"3","key":"b13","series-title":"J Neurosurg Pediatr","first-page":"291","article-title":"Long-term 3D CT follow-up after endoscopic sagittal craniosynostosis repair","volume":"25","author":"Persad A","year":"2020","unstructured":"Persad A, Aronyk K, Beaudoin W, Mehta V. Long-term 3D CT follow-up after endoscopic sagittal craniosynostosis repair. J Neurosurg Pediatr. 2020;25(3):291\u2013297."},{"issue":"3","key":"b14","series-title":"J Neurosurg Pediatr","first-page":"277","article-title":"Multicenter comparison of head shape outcomes for three minimally invasive strip craniectomy techniques for sagittal craniosynostosis","volume":"32","author":"Rizvi I","year":"2023","unstructured":"Rizvi I, Hallac RR, Geisler EL, Multicenter comparison of head shape outcomes for three minimally invasive strip craniectomy techniques for sagittal craniosynostosis. J Neurosurg Pediatr. 2023;32(3):277\u2013284."}],"container-title":["Journal of Neurosurgery: Pediatrics"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-pediatr\/36\/6\/article-p683.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-pediatr\/36\/6\/article-p683.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-pediatr\/36\/6\/article-p683.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,6]],"date-time":"2026-03-06T13:46:11Z","timestamp":1772804771000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-pediatr\/36\/6\/article-p683.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,10]]},"references-count":28,"journal-issue":{"issue":"6"},"URL":"https:\/\/doi.org\/10.3171\/2025.6.peds2523","relation":{},"ISSN":["1933-0707","1933-0715"],"issn-type":[{"value":"1933-0707","type":"print"},{"value":"1933-0715","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,10]]}}}