Evaluating Surgical Decision-making in Nonsyndromic Sagittal Craniosynostosis Using a Digital 3D Model.

Sagittal craniosynostosis is the most common form of nonsyndromic craniosynostosis.1 In unaffected patients without craniosynostosis, the morphology of the cranium is related to the underlying functional effects of the brain and dura: bones grow and head shape forms in the presence of patent cranial sutures.2 With premature sutural fusion, cranial morphology takes on characteristic shapes corresponding to the particular fused suture(s). Children with sagittal craniosynostosis exhibit varying degrees of scaphocephaly, which may include frontal bossing, an anteriorly displaced vertex, narrowed bi-parietal distance, and a bullet-shaped occiput.3 The effect on head shape is more significant when fusion occurs early in development.2,4 The head circumference typically increases as a result of excessive anomalous anterior-posterior skull growth.5 In all cases of craniosynostosis, surgical treatment is indicated for elevated intracranial pressure (ICP) and/or substantial alterations in normal anatomy and appearance. The risk of elevated ICP in single suture, nonsyndromic sagittal synostosis is estimated to be 10%–20%,6 but reports are inconclusive and often contradictory. Data regarding the probability of neurodevelopmental delay associated with the condition are likewise inconsistent; some suggest up to a 5-fold increased risk for developmental delays and learning deficits in infancy..7–9 Although there are numerous approaches in treating isolated sagittal craniosynostosis, there is currently no consensus among craniofacial surgeons or pediatric neurosurgeons regarding the optimal approach.10,11 Furthermore, the decision whether to operate at all in nonsyndromic patients with sagittal synostosis relies largely on intuition and individual surgical judgment, without objective data to clarify clinical management. Others have investigated similar decision-making processes for other forms of craniosynostosis.12 The goal of this study was to identify factors that prompt in cases of sagittal synostosis surgical intervention. Using a custom-engineered 3D design framework, we developed a novel survey tool to assess practice patterns among pediatric neurosurgeons and pediatric craniofacial surgeons around the world.