• Daniel Y Cho, Craig B Birgfeld, Amy Lee, Richard G Ellenbogen, and Srinivas M Susarla.
• Division of Plastic Surgery, Department of Surgery, University of Washington School of Medicine, Seattle, Washington, USA.
• World Neurosurg. 2020 Nov 1; 143: 108-113.

BackgroundThe aim of this study was to evaluate surgical outcomes for patients with sagittal craniosynostosis undergoing open cranial vault remodeling with a modified pi procedure comparing subgaleal versus subperiosteal dissection.MethodsA 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 postoperative outcomes including the surface area of bony cranial defects at 2-year follow-up were evaluated.ResultsOver a 3-year period, 35 patients between the ages of 3 and 7 months underwent surgical correction of sagittal craniosynostosis using our institutional adaptation of the modified pi technique. Twenty-five patients underwent exposure via a subgaleal (SG) approach, 10 patients had a subpericranial (SP) exposure. Compared with the SP group, the SG group had significant lower estimated blood loss and a shorter operating time (P < 0.05). There were no significant differences with regard to hospital length of stay or postoperative complications (P ≥ 0.48). At 2 years postoperatively, 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.ConclusionsOpen 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 SG plane is a minor technical modification that can reduce blood loss and operative times.Copyright © 2020 Elsevier Inc. All rights reserved.

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