The "clamshell" craniotomy technique in treating sagittal craniosynostosis in older children

J Neurosurg. 2006 Oct;105(4 Suppl):245-51. doi: 10.3171/ped.2006.105.4.245.


Object: Although most patients with sagittal craniosynostosis are recognized and treated in infancy, some children are not referred to craniofacial centers until later in childhood. In this paper the authors describe a novel operative technique for calvarial reconstruction in older children with previously untreated sagittal craniosynostosis.

Methods: The authors report a clinical series of eight patients who were treated using novel single-stage calvarial reconstruction, and they assess the complications and outcomes. The patient is placed supine for the procedure, which consists of a coronal incision, bifrontal craniotomy without orbital osteotomy, and multiple interlocking midline parietooccipital osteotomies and recontouring. Fixation is achieved using a bioabsorbable plate system. Cranial indices were calculated from measurements obtained before and after the reconstructive procedures. Preoperative, intraoperative, and postoperative photographs and three-dimensional computed tomography scans are presented for review. Between November 2003 and April 2005, the authors treated seven boys (age range approximately 1-10 years, mean age 4.2 years) with uncorrected sagittal craniosynostosis and one with bicoronal and sagittal synostosis. The mean operating time was 5.13 hours (range 4.3-8 hours), with a mean blood loss of 425 ml (range 200-800 ml). As a percentage of the estimated circulating blood volume, the mean operative blood loss was 33.5% (range 17-57%). The mean hospital stay was 4.9 days. The cranial index significantly improved from a mean of 65.6 to 71.3% (p = 0.001). No acute or delayed complications have been noted. Follow-up examinations performed at an average of 12 months (range 1-17 months) have confirmed early patient and family satisfaction.

Conclusions: An approach of aggressive calvarial reconstruction with multiple interleaving osteotomies crossing the midline achieves improvements in biparietal narrowing. Combined with a bifrontal reconstruction, early outcomes are excellent, with an acceptable amount of intraoperative blood loss and no significant complications.

MeSH terms

  • Blood Loss, Surgical
  • Child
  • Child, Preschool
  • Craniosynostoses / diagnostic imaging
  • Craniosynostoses / surgery*
  • Craniotomy / methods*
  • Follow-Up Studies
  • Humans
  • Image Processing, Computer-Assisted
  • Imaging, Three-Dimensional
  • Infant
  • Length of Stay
  • Male
  • Patient Satisfaction
  • Postoperative Period
  • Time Factors
  • Tomography, X-Ray Computed