A comparison of subgaleal versus subperiosteal dissection in open cranial vault expansion for sagittal craniosynostosis.

ABSTRACT Objective The aim of this study is to evaluate surgical outcomes for patients with sagittal craniosynostosis undergoing open cranial vault remodeling with a modified pi procedure comparing subgaleal versus subperiosteal dissection. Methods A retrospective chart review was performed for children between the ages of 3 and 7 months with sagittal craniosynostosis undergoing open cranial vault expansion at Seattle Children’s Hospital. Patient demographics, operative variables, and post-operative outcomes including the surface area of bony cranial defects at 2-year follow up were evaluated. Results Over a 3-year period, 35 patients between the ages of 3-7 months underwent surgical correction of sagittal craniosynostosis using our institutional adaptation of the modified pi technique. Twenty-five patients underwent exposure via a sub-galeal (SG) approach, 10 patients had a sub-pericranial (SP) exposure. Compared to the SP group, the SG group had significant lower estimated blood loss and a shorter operating time (p > 0.48). At two-years post-operatively, there were no significant differences in the size of the largest cranial defects (SG: 1.1 + 0.1 cm2 versus 3.7 + 0.1 cm2, p = 0.40); no patients required a secondary cranioplasty. Conclusions Open posterior and middle cranial vault expansion is a safe and efficient method of open cranial vault expansion in sagittal craniosynostosis regardless of the plane of dissection. Elevation of the scalp flaps in the subgaleal plane is a minor technical modification that can reduce blood loss and operative times.