Surgical treatment of sagittal craniosynostosis is challenging in older patients. This study aimed to assess the effect of increasing age on open surgical technique selection and patient outcomes using the multi-institutional Synostosis Research Group (SynRG) collaboration.

Surgeons in SynRG were surveyed for key influences on their preferred open calvarial vault remodeling techniques at various patient ages: < 6, 6–12, and > 12 months. The SynRG database was then queried for open repairs of nonsyndromic sagittal craniosynostosis performed for patients older than 12 months of age. Perioperative measures, complications, and preoperative and postoperative cephalic indices were reviewed.

All surgeons preferred to treat patients at an earlier age, and most (89%) believed that less-optimal outcomes were achieved at ages older than 12 months. The modified pi procedure was the dominant technique in those younger than 12 months, while more involved open surgical techniques were performed for older patients, with a wide variety of open calvarial vault remodeling techniques used. Forty-four patients met inclusion criteria, with a mean (± SD) age at surgery of 29 ± 16 months. Eleven patients underwent parietal reshaping, 10 parietal-occipital switch, 9 clamshell craniotomy, 7 geometric parietal expansion, 6 modified pi procedure, and 1 parietal distraction. There were no readmissions, complications, or mortality within 30 days postoperatively. Patients’ cephalic indices improved a mean of 6.4% ± 4.0%, with a mean postoperative cephalic index of 74.2% ± 4.9%. Differences in postoperative cephalic index (p < 0.04) and hospital length of stay (p = 0.01) were significant between technique cohorts. Post hoc Tukey-Kramer analysis identified the parietal reshaping technique as being significantly associated with a reduced hospital length of stay.

Patient age is an important driver in technique selection, with surgeons selecting a more involved calvarial vault remodeling technique in older children. A variety of surgical techniques were analyzed, with the parietal reshaping technique being significantly associated with reduced length of stay; however, multiple perioperative factors may be contributory and require further analysis. When performed at high-volume centers by experienced pediatric neurosurgeons and craniofacial surgeons, open calvarial vault techniques can be a safe method for treating sagittal craniosynostosis in older children.

对于老年患者，矢状面颅缝早闭的手术治疗具有挑战性。本研究旨在通过多机构骨融合研究小组 (SynRG) 合作评估年龄增长对开放手术技术选择和患者预后的影响。

SynRG 的外科医生接受了调查，以了解他们在不同患者年龄（< 6、6-12 和 > 12 个月）首选的开放式颅骨穹窿重塑技术的关键影响。然后在 SynRG 数据库中查询对大于 12 个月大的患者进行的非综合征矢状颅缝早闭的开放性修复。回顾了围手术期措施、并发症以及术前和术后头颅指数。

所有外科医生都喜欢在更早的年龄治疗患者，并且大多数 (89%) 认为在 12 个月以上的年龄获得不太理想的结果。改良的 pi 手术是 12 个月以下儿童的主要技术，而对年龄较大的患者进行了更多涉及的开放式手术技术，并使用了多种开放式颅骨穹窿重塑技术。44 名患者符合纳入标准，手术时平均 (± SD) 年龄为 29 ± 16 个月。11 例患者接受了顶叶重塑、10 例顶枕转换、9 例翻盖开颅术、7 例几何顶叶扩张、6 例改良 pi 手术和 1 例顶叶撑开术。术后 30 天内没有再入院、并发症或死亡。患者的头部指数平均改善了 6.4% ± 4.0%，术后平均头颅指数为 74.2% ± 4.9%。术后头颅指数 (p < 0.04) 和住院时间 (p = 0.01) 的差异在技术队列之间是显着的。事后 Tukey-Kramer 分析确定顶叶重塑技术与缩短住院时间显着相关。

患者年龄是技术选择的重要驱动因素，外科医生在年龄较大的儿童中选择了更复杂的颅骨穹窿重建技术。分析了多种手术技术，其中顶叶重塑技术与缩短住院时间显着相关；然而，多种围手术期因素可能是促成因素，需要进一步分析。当由经验丰富的儿科神经外科医生和颅面外科医生在高容量中心进行时，开放式颅骨穹窿技术可以成为治疗大龄儿童矢状面颅缝早闭的安全方法。