Two-Year Progressive Cranial Changes Following the Melbourne Technique for Sagittal Craniosynostosis.

Abstract

Objective: The Melbourne technique for total cranial vault remodeling aims to address all aspects of scaphocephaly in sagittal craniosynostosis. These features include anterior-posterior excessive length, anteriorly displaced vertex position, frontal bossing, vertex narrowing, and occipital bulleting. This study aimed to determine the progressive cranial changes that occur following the Melbourne technique for sagittal craniosynostosis.

Design: Retrospective review of 3-dimensional images collected preoperatively and postoperatively at 3 weeks, 3 months, 1 year, and 2 years.

Setting: Tertiary care pediatric institution.

Participants: Twenty-five patients with sagittal craniosynostosis.

Interventions: The Melbourne technique for total cranial vault remodeling.

Main outcome measure(s): Head circumference, cephalic index, frontal bossing index, occipital bulleting index, vertex narrowing index, and vertex-nasion-opisthocranion (VNO) angle were evaluated.

Results: The cephalic index significantly increased postoperatively (P = .04) with a subsequent relapse at 3 months followed by progressively increased growth. The frontal bossing index significantly decreased postoperatively (P = .02) with a progressive decrease. The occipital bullet index had a relative decline postoperatively with relapse at 3 months, followed by a progressive decrease. The vertex narrowing index significantly decreased postoperatively (P < .001), with a plateau and slight relapse. The VNO angle showed a relative decline over time with a significant decrease by 1 year of age (P = .002).

Conclusions: The Melbourne technique improved the cephalic index, frontal bossing, vertex narrowing, occipital bulleting, and vertex positioning at 2 years of age. Cephalic index and occipital bulleting showed slight relapse at 3 months, followed by progressive improvement over time.