{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T13:01:51Z","timestamp":1791378111976,"version":"4.3.2"},"reference-count":28,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,12,5]]},"abstract":"\n OBJECTIVE<\/jats:title>\n The incidence of nonsyndromic multisuture craniosynostosis is rare, accounting for < 5% of cases. Concurrent isolated bilateral lambdoid and sagittal synostosis (BLSS), colloquially known as Mercedes-Benz pattern synostosis, constitutes < 1% of all craniosynostosis cases. Patients with BLSS benefit from surgical correction in infancy to correct the characteristic frontal bossing, a high forehead with significant downward sloping toward the occiput, a prominent occiput with a notable point, and occipital concavity that starts immediately below that region. However, due to its rarity, there is a paucity of literature describing the surgical management of BLSS. In this study, the authors evaluated a single institution\u2019s clinical experience treating this condition with early endoscopic strip craniectomy (ESC).<\/jats:p>\n <\/jats:sec>\n \n METHODS<\/jats:title>\n Medical records for patients with a diagnosis of concurrent sagittal and bilateral lambdoid synostosis who underwent ESC between 2006 and 2023 at a single institution were reviewed for demographic, operative, and follow-up data. Patients with additional fused sutures or other syndromic diagnoses were excluded as those cases constitute a distinct pathology from pure Mercedes-Benz synostosis. All patients with less than 1 year of follow-up were also excluded.<\/jats:p>\n <\/jats:sec>\n \n RESULTS<\/jats:title>\n Seven patients underwent early ESC as the primary treatment for Mercedes-Benz pattern synostosis. The mean age at surgery was 3.0 months (range 1.60\u20135.97 months). The mean operative time was 67 minutes, with a time under anesthesia of 155 minutes. There were no complications intra- or postoperatively. No patients required readmission within 30 days or a subsequent surgical procedure. The mean length of follow-up was 3.5 years.<\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS<\/jats:title>\n Early endoscopic surgery is a safe and effective treatment for infants with Mercedes-Benz synostosis. Based on clinical criteria and limited imaging in some cases, the children have done extremely well with no need for additional surgery, but additional long-term follow-up is in process.<\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/2025.8.peds25157","type":"journal-article","created":{"date-parts":[[2025,12,8]],"date-time":"2025-12-08T17:42:50Z","timestamp":1765215770000},"page":"147-151","source":"Crossref","is-referenced-by-count":3,"title":["Surgical management of Mercedes-Benz pattern synostosis with early endoscopic strip craniectomy"],"prefix":"10.3171","volume":"37","author":[{"given":"Emma","family":"Hartman","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Boston Children\u2019s Hospital, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Proctor","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Boston Children\u2019s Hospital, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"1","key":"b1","series-title":"J Neurosurg Pediatr","first-page":"21","article-title":"Evolution in the frequency of nonsyndromic craniosynostosis","volume":"4","author":"Rocco FD","year":"2009","unstructured":"Rocco FD, Arnaud E, Renier D. Evolution in the frequency of nonsyndromic craniosynostosis. J Neurosurg Pediatr. 2009;4(1):21\u201325."},{"issue":"2","key":"b2","series-title":"J Neurosurg","first-page":"177","article-title":"Classification of previously unclassified cases of craniosynostosis","volume":"86","author":"Chumas PD","year":"1997","unstructured":"Chumas PD, Cinalli G, Arnaud E, Marchac D, Renier D. Classification of previously unclassified cases of craniosynostosis. J Neurosurg. 1997;86(2):177\u2013181."},{"issue":"1","key":"b3","series-title":"Plast Reconstr Surg","first-page":"299","article-title":"Mercedes Benz pattern craniosynostosis","volume":"125","author":"Rhodes JL","year":"2010","unstructured":"Rhodes JL, Kolar JC, Fearon JA. Mercedes Benz pattern craniosynostosis. Plast Reconstr Surg. 2010;125(1):299\u2013304."},{"issue":"5","key":"b4","series-title":"J Craniofac Surg","first-page":"417","article-title":"Bilambdoid and posterior sagittal synostosis: the Mercedes Benz syndrome","volume":"9","author":"Moore MH","year":"1998","unstructured":"Moore MH, Abbott AH, Netherway DJ, Menard R, Hanieh A. Bilambdoid and posterior sagittal synostosis: the Mercedes Benz syndrome. J Craniofac Surg. 1998;9(5):417\u2013422."},{"issue":"5","key":"b5","series-title":"Am J Med Genet A","first-page":"1024","article-title":"Bilateral lambdoid and sagittal synostosis (BLSS): a unique craniosynostosis syndrome or predictable craniofacial phenotype?","volume":"149A","author":"Hing AV","year":"2009","unstructured":"Hing AV, Click ES, Holder U, Bilateral lambdoid and sagittal synostosis (BLSS): a unique craniosynostosis syndrome or predictable craniofacial phenotype?. Am J Med Genet A. 2009;149A(5):1024\u20131032."},{"issue":"2","key":"b6","series-title":"Anesth Analg","first-page":"407","article-title":"Endoscopic strip craniectomy in early infancy: the initial five years of anesthesia experience","volume":"112","author":"Meier PM","year":"2011","unstructured":"Meier PM, Goobie SM, DiNardo JA, Proctor MR, Zurakowski D, Soriano SG. Endoscopic strip craniectomy in early infancy: the initial five years of anesthesia experience. Anesth Analg. 2011;112(2):407\u2013414."},{"issue":"11","key":"b7","series-title":"Childs Nerv Syst","first-page":"2117","article-title":"Bilateral lambdoid and posterior sagittal craniosynostosis\u2013management, evolution, and outcome","volume":"29","author":"Pillai S","year":"2013","unstructured":"Pillai S, Cochrane D, Singhal A, Steinbok P. Bilateral lambdoid and posterior sagittal craniosynostosis\u2013management, evolution, and outcome. Childs Nerv Syst. 2013;29(11):2117\u20132121."},{"key":"b8","series-title":"Surg Neurol Int","first-page":"206","article-title":"Bilambdoid and sagittal synostosis: report of 39 cases","volume":"9","author":"Chivoret N","year":"2018","unstructured":"Chivoret N, Arnaud E, Giraudat K, Bilambdoid and sagittal synostosis: report of 39 cases. Surg Neurol Int. 2018;9:206."},{"key":"b9","series-title":"World Neurosurg","first-page":"77","article-title":"Pure bilateral lambdoid and posterior sagittal synostosis (Mercedes-Benz Syndrome): case report and literature review","volume":"128","author":"Balestrino A","year":"2019","unstructured":"Balestrino A, Secci F, Piatelli G, Pure bilateral lambdoid and posterior sagittal synostosis (Mercedes-Benz Syndrome): case report and literature review. World Neurosurg. 2019;128:77\u201382."},{"issue":"4","key":"b10","series-title":"Am J Med Genet A","first-page":"615","article-title":"ERF-related craniosynostosis: the phenotypic and developmental profile of a new craniosynostosis syndrome","volume":"179","author":"Glass GE","year":"2019","unstructured":"Glass GE, O\u2019Hara J, Canham N, ERF-related craniosynostosis: the phenotypic and developmental profile of a new craniosynostosis syndrome. Am J Med Genet A. 2019;179(4):615\u2013627."},{"issue":"3","key":"b11","series-title":"Neurol India","first-page":"592","article-title":"Bilateral lambdoid and sagittal craniosynostosis with hydrocephalus: ETV, bifrontal craniotomy, anterior cranial vault remodeling, and posterior cranial vault expansion","volume":"69","author":"Konar S","year":"2021","unstructured":"Konar S, Shukla D. Bilateral lambdoid and sagittal craniosynostosis with hydrocephalus: ETV, bifrontal craniotomy, anterior cranial vault remodeling, and posterior cranial vault expansion. Neurol India. 2021;69(3):592\u2013594."},{"issue":"6","key":"b12","series-title":"J Craniofac Surg","first-page":"2059","article-title":"Posterior cranial vault distraction osteogenesis utilizing a posterior-superior distraction vector in the treatment of Mercedes Benz pattern craniosynostosis","volume":"32","author":"Marji FP","year":"2021","unstructured":"Marji FP, Block LM, Anstadt EE, Posterior cranial vault distraction osteogenesis utilizing a posterior-superior distraction vector in the treatment of Mercedes Benz pattern craniosynostosis. J Craniofac Surg. 2021;32(6):2059\u20132063."},{"issue":"6","key":"b13","series-title":"J Craniofac Surg","first-page":"2134","article-title":"Clinical features of bilambdoid and sagittal synostosis (BLSS): a retrospective multicenter study in Japan","volume":"32","author":"Tamada I","year":"2021","unstructured":"Tamada I, Hikosaka M, Sakamoto Y, Clinical features of bilambdoid and sagittal synostosis (BLSS): a retrospective multicenter study in Japan. J Craniofac Surg. 2021;32(6):2134\u20132138."},{"issue":"3","key":"b14","series-title":"Prosthet Orthot Int","first-page":"235","article-title":"Cranial remolding orthosis for postoperative management of bilateral lambdoid and sagittal synostosis: a case report","volume":"45","author":"Taheri Z","year":"2021","unstructured":"Taheri Z, Babaee T, Hajiaghaei B, Mohammadi HR. Cranial remolding orthosis for postoperative management of bilateral lambdoid and sagittal synostosis: a case report. Prosthet Orthot Int. 2021;45(3):235\u2013239."},{"issue":"1","key":"b1","series-title":"J Neurosurg Pediatr","first-page":"21","article-title":"Evolution in the frequency of nonsyndromic craniosynostosis","volume":"4","author":"Rocco FD","year":"2009","unstructured":"Rocco FD, Arnaud E, Renier D. Evolution in the frequency of nonsyndromic craniosynostosis. J Neurosurg Pediatr. 2009;4(1):21\u201325."},{"issue":"2","key":"b2","series-title":"J Neurosurg","first-page":"177","article-title":"Classification of previously unclassified cases of craniosynostosis","volume":"86","author":"Chumas PD","year":"1997","unstructured":"Chumas PD, Cinalli G, Arnaud E, Marchac D, Renier D. Classification of previously unclassified cases of craniosynostosis. J Neurosurg. 1997;86(2):177\u2013181."},{"issue":"1","key":"b3","series-title":"Plast Reconstr Surg","first-page":"299","article-title":"Mercedes Benz pattern craniosynostosis","volume":"125","author":"Rhodes JL","year":"2010","unstructured":"Rhodes JL, Kolar JC, Fearon JA. Mercedes Benz pattern craniosynostosis. Plast Reconstr Surg. 2010;125(1):299\u2013304."},{"issue":"5","key":"b4","series-title":"J Craniofac Surg","first-page":"417","article-title":"Bilambdoid and posterior sagittal synostosis: the Mercedes Benz syndrome","volume":"9","author":"Moore MH","year":"1998","unstructured":"Moore MH, Abbott AH, Netherway DJ, Menard R, Hanieh A. Bilambdoid and posterior sagittal synostosis: the Mercedes Benz syndrome. J Craniofac Surg. 1998;9(5):417\u2013422."},{"issue":"5","key":"b5","series-title":"Am J Med Genet A","first-page":"1024","article-title":"Bilateral lambdoid and sagittal synostosis (BLSS): a unique craniosynostosis syndrome or predictable craniofacial phenotype?","volume":"149A","author":"Hing AV","year":"2009","unstructured":"Hing AV, Click ES, Holder U, Bilateral lambdoid and sagittal synostosis (BLSS): a unique craniosynostosis syndrome or predictable craniofacial phenotype?. Am J Med Genet A. 2009;149A(5):1024\u20131032."},{"issue":"2","key":"b6","series-title":"Anesth Analg","first-page":"407","article-title":"Endoscopic strip craniectomy in early infancy: the initial five years of anesthesia experience","volume":"112","author":"Meier PM","year":"2011","unstructured":"Meier PM, Goobie SM, DiNardo JA, Proctor MR, Zurakowski D, Soriano SG. Endoscopic strip craniectomy in early infancy: the initial five years of anesthesia experience. Anesth Analg. 2011;112(2):407\u2013414."},{"issue":"11","key":"b7","series-title":"Childs Nerv Syst","first-page":"2117","article-title":"Bilateral lambdoid and posterior sagittal craniosynostosis\u2013management, evolution, and outcome","volume":"29","author":"Pillai S","year":"2013","unstructured":"Pillai S, Cochrane D, Singhal A, Steinbok P. Bilateral lambdoid and posterior sagittal craniosynostosis\u2013management, evolution, and outcome. Childs Nerv Syst. 2013;29(11):2117\u20132121."},{"key":"b8","series-title":"Surg Neurol Int","first-page":"206","article-title":"Bilambdoid and sagittal synostosis: report of 39 cases","volume":"9","author":"Chivoret N","year":"2018","unstructured":"Chivoret N, Arnaud E, Giraudat K, Bilambdoid and sagittal synostosis: report of 39 cases. Surg Neurol Int. 2018;9:206."},{"key":"b9","series-title":"World Neurosurg","first-page":"77","article-title":"Pure bilateral lambdoid and posterior sagittal synostosis (Mercedes-Benz Syndrome): case report and literature review","volume":"128","author":"Balestrino A","year":"2019","unstructured":"Balestrino A, Secci F, Piatelli G, Pure bilateral lambdoid and posterior sagittal synostosis (Mercedes-Benz Syndrome): case report and literature review. World Neurosurg. 2019;128:77\u201382."},{"issue":"4","key":"b10","series-title":"Am J Med Genet A","first-page":"615","article-title":"ERF-related craniosynostosis: the phenotypic and developmental profile of a new craniosynostosis syndrome","volume":"179","author":"Glass GE","year":"2019","unstructured":"Glass GE, O\u2019Hara J, Canham N, ERF-related craniosynostosis: the phenotypic and developmental profile of a new craniosynostosis syndrome. Am J Med Genet A. 2019;179(4):615\u2013627."},{"issue":"3","key":"b11","series-title":"Neurol India","first-page":"592","article-title":"Bilateral lambdoid and sagittal craniosynostosis with hydrocephalus: ETV, bifrontal craniotomy, anterior cranial vault remodeling, and posterior cranial vault expansion","volume":"69","author":"Konar S","year":"2021","unstructured":"Konar S, Shukla D. Bilateral lambdoid and sagittal craniosynostosis with hydrocephalus: ETV, bifrontal craniotomy, anterior cranial vault remodeling, and posterior cranial vault expansion. Neurol India. 2021;69(3):592\u2013594."},{"issue":"6","key":"b12","series-title":"J Craniofac Surg","first-page":"2059","article-title":"Posterior cranial vault distraction osteogenesis utilizing a posterior-superior distraction vector in the treatment of Mercedes Benz pattern craniosynostosis","volume":"32","author":"Marji FP","year":"2021","unstructured":"Marji FP, Block LM, Anstadt EE, Posterior cranial vault distraction osteogenesis utilizing a posterior-superior distraction vector in the treatment of Mercedes Benz pattern craniosynostosis. J Craniofac Surg. 2021;32(6):2059\u20132063."},{"issue":"6","key":"b13","series-title":"J Craniofac Surg","first-page":"2134","article-title":"Clinical features of bilambdoid and sagittal synostosis (BLSS): a retrospective multicenter study in Japan","volume":"32","author":"Tamada I","year":"2021","unstructured":"Tamada I, Hikosaka M, Sakamoto Y, Clinical features of bilambdoid and sagittal synostosis (BLSS): a retrospective multicenter study in Japan. J Craniofac Surg. 2021;32(6):2134\u20132138."},{"issue":"3","key":"b14","series-title":"Prosthet Orthot Int","first-page":"235","article-title":"Cranial remolding orthosis for postoperative management of bilateral lambdoid and sagittal synostosis: a case report","volume":"45","author":"Taheri Z","year":"2021","unstructured":"Taheri Z, Babaee T, Hajiaghaei B, Mohammadi HR. Cranial remolding orthosis for postoperative management of bilateral lambdoid and sagittal synostosis: a case report. Prosthet Orthot Int. 2021;45(3):235\u2013239."}],"container-title":["Journal of Neurosurgery: Pediatrics"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-pediatr\/37\/2\/article-p147.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-pediatr\/37\/2\/article-p147.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-pediatr\/37\/2\/article-p147.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,6]],"date-time":"2026-03-06T13:46:40Z","timestamp":1772804800000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-pediatr\/37\/2\/article-p147.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,5]]},"references-count":28,"journal-issue":{"issue":"2"},"URL":"https:\/\/doi.org\/10.3171\/2025.8.peds25157","relation":{},"ISSN":["1933-0707","1933-0715"],"issn-type":[{"value":"1933-0707","type":"print"},{"value":"1933-0715","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,5]]}}}