Watmore, Trey D.

Objective To compare perioperative outcomes, complications, imaging utilization, and device management following posterior vault distraction osteogenesis (PVDO) and spring-mediated cranioplasty (SMC) for multisutural craniosynostosis. Design Retrospective cohort study. Setting Single pediatric tertiary care center. Patients, Participants Twenty-three patients with multisutural craniosynostosis treated between 2017 and 2025 (PVDO, n = 18; SMC, n = 5). Interventions PVDO or SMC. Main Outcome Measure(s) Time to device removal, imaging utilization, reoperations, readmissions, device-related complications, revision surgeries, wound infections, and absolute intracranial volume change. Results PVDO was associated with earlier device removal than SMC (78.7 ± 22.1 vs. 133.0 ± 27.4 days; P = .0015) but greater postoperative imaging utilization during the first year (5.33 ± 1.28 vs. 2.80 ± 1.64 studies; P = .01). Rates of reoperation (22.2% vs. 0%), readmission (22.2% vs. 40.0%), device-related complications (11.1% vs. 0%), revision surgery (16.7% vs. 0%), and wound infection (22.2% vs. 20.0%) did not differ significantly (all P ≥ .50). Preoperative imaging utilization and postoperative intracranial volume gain were comparable between groups. Conclusions PVDO and SMC demonstrated similar safety profiles and intracranial volume expansion in patients with multisutural craniosynostosis. Compared with SMC, PVDO enabled earlier device removal but required increased postoperative imaging. These findings may inform operative planning, postoperative surveillance, and family counseling. Larger, multicenter studies with longer follow-up are needed to evaluate long-term outcomes.

Objective To evaluate the incidence and characteristics of secondary synostosis following spring-mediated cranioplasty (SMC) for nonsyndromic sagittal craniosynostosis. Design Retrospective cohort study. Setting Single tertiary pediatric hospital. Patients/Participants Ten patients with isolated sagittal craniosynostosis who underwent primary SMC between 2021 and 2023. Patients with syndromic diagnoses or prior cranial surgery were excluded. Interventions SMC was performed using 2 to 3 stainless-steel springs following sagittal strip craniectomy. Springs were typically removed 3 to 4 months postoperatively. Follow-up included review of clinical photographs, radiographs, and operative records. Main Outcome Measures Change in cephalic index (CI) from preoperative to postoperative assessment and occurrence of secondary suture fusion, particularly coronal synostosis. Results Mean age at surgery was 4 months (range, 3-6 months). Mean CI improved from 68.5 to 79 following expansion. Three patients (30%) developed left unicoronal synostosis (UCS) during the perioperative period prior to spring removal. One patient required secondary coronal suturectomy for significant frontal asymmetry, while 2 were observed without intervention. Conclusions Secondary synostosis, particularly UCS, may represent an underrecognized sequela of SMC. Altered biomechanical forces or asymmetric cranial remodeling during distraction may contribute to this finding. Larger, multicenter studies with longitudinal imaging are warranted to determine incidence, risk factors, and preventive strategies.

Objective: Our objective is to examine which sociodemographic factors may influence the time of presentation of patients with craniosynostosis, which can impact perioperative outcomes. Design: Retrospective cohort study. Setting: Tertiary pediatric hospital. Patients, Participants: All patients with nonsyndromic sagittal synostosis who underwent surgery at a tertiary pediatric hospital from January 1, 2007 to January 2, 2024 were eligible for inclusion. Interventions: Comparing demographic variables between those undergoing early and late craniosynostosis repair. Main Outcome Measure(s): Demographic variables, social vulnerability index (SVI) and area deprivation index (ADI), median household income, education rate, and employment rates. Results: 77.5% (n = 234) of patients underwent minimally invasive repair. 22.5% (n = 68) underwent open cranial vault remodeling. Age at consultation differed significantly between those undergoing early repair compared to late repair (0.18 years v. 1.01 years, P < .0001). Patients undergoing late repair were more likely to be Hispanic (42.6% v. 24.4%, P = .0378), on public insurance (66.2% v. 45.3%, P = .0079), have lower parental education rates (24.78% vs. 31.64%, P = .0019), and lower median household income ($65 657 vs. $75 281, P = .0226). Interestingly, ADI scores and SVI scores did not significantly differ between groups. Conclusions: Patients who presented later for treatment of nonsyndromic sagittal synostosis had lower median household income, were more likely to be Hispanic, had lower parental education rates, and were more likely to be on public insurance compared to those who received early treatment.