Photogrammetric evaluation of extended midline strip craniectomy with bilateral parietal osteotomies on frontal morphology in patients with isolated sagittal synostosis

OBJECTIVE Isolated craniosynostosis of the sagittal suture results in scaphocephaly characterized by a long, narrow skull. Surgical correction of this condition remains debated, particularly regarding the necessity of directly addressing frontal bossing. This study aimed to assess the effectiveness of extended strip craniectomy combined with bilateral barrel staving in improving cranial morphology without direct intervention on the forehead. METHODS This retrospective study included 81 patients diagnosed with isolated sagittal synostosis, treated surgically at an average age of 5.3 months. Three-dimensional photogrammetric scans were obtained 1 day before surgery and 14 days, 3 months, and 12 months postoperatively. The bossing angle, nasofrontal angle, cephalic index, and vertex ratio were analyzed. A control group of age-matched healthy children was used for comparison. RESULTS Significant reductions in the bossing angle were observed from preoperatively to 12 months postoperatively, indicating that the intervention contributed to a more normalized cranial shape. The cephalic index increased significantly postoperatively, although it remained lower than that of the control group. The nasofrontal angle remained stable across all time points, with minimal differences between the study and control groups. The vertex ratio decreased significantly over time, suggesting a balanced cranial shape. However, persistent differences between the study and control groups suggest that the intervention did not fully normalize cranial morphology in the short to midterm. CONCLUSIONS Extended strip craniectomy with bilateral barrel staving, while effective in improving certain aspects of cranial morphology, may not fully equalize cranial shape within the short to midterm. The use of 3D photogrammetry as a noninvasive method for assessing cranial changes is validated in this study and holds promise for broader applications in craniofacial surgery.