Long-term outcome after sagittal synostosis operations.

We evaluated 27 children who had been operated on 5-10 years previously for sagittal synostosis. The mean age at operation was 0.55 years. Twenty-two children were treated by the senior author's technique, 4 by the Pi craniectomy technique and 1 by parasagittal sagittal strip craniectomies. The mean age at follow-up was 9.6 years. The cosmetic appearance of the head was graded independently by 3 examiners. Skull radiographs were graded by 2 examiners according to the appearance and presence of beaten copper markings. The cephalic index was measured. Frequent headaches were reported in 7 of 27 children and were migrainous in 3 of the 7. No child had papilledema. The children's appearance was considered to be normal or mildly abnormally by the parents in every case and by the medical observers in 25 of 27 (93%). The only 2 children with an unacceptable appearance were either operated late (3.3 years) or had a craniofacial syndrome. Skull radiographs revealed a normal or mildly abnormal appearance in 18-19 children, depending on the observer. Beaten copper markings were observed to some extent in 14 of 27 cases and did not correlate with the presence of headaches. The cranial index ranged from 62 to 78 with a mean of 70 (normal 81). Sagittal reconstructions resulted in an acceptable appearance 5-10 years postoperatively in all cases operated on at less than 1 year of age who had no syndrome. The need for long-term follow-up of children after sagittal synostosis operations cannot be determined from this sample size.