Long-term parental satisfaction and cosmetic, ophthalmological, and cognitive outcomes after sagittal strip craniectomy with barrel stave osteotomies and occipital release.

Objective: Craniosynostosis is ideally treated within the 1st year of life to correct the physical deformity, achieve optimal aesthetic head shape, and facilitate normal neurocognitive development. While objective aesthetic assessments have been widely studied, limited reports on long-term parent-reported outcomes (PROs) exist. The authors herein report long-term follow-up after open midline strip craniectomy with barrel stave osteotomies (BSOs) and occipital release of nonsyndromic sagittal craniosynostosis (SC), including parental satisfaction; cosmetic, ophthalmological, and neurocognitive outcomes; and health-related quality of life (HRQOL).

Methods: Patients younger than 12 months of age who underwent surgical reconstruction of isolated SC between March 2014 and March 2019 with a minimum follow-up period of 3 years were included in this study. The primary outcome was parental satisfaction assessed by PROs. Secondary outcomes were neurocognitive development using the Vineland Adaptive Behavior Scale (VABS), ophthalmological and cosmetic outcomes based on clinical examination, and HRQOL and 3D imaging of the patients.

Results: Included were 25 patients (16% female) with a median age of 5.91 (IQR 4.97-6.55) months. Parental satisfaction was excellent, with 96% reporting satisfaction with the overall surgical outcome. Cosmetic outcomes assessed by the treating surgeons were considered good in 94.7% of the cases, while the cephalic index was within the mesocephalic range in 78.22% of the cases. The aesthetic perception of parents and surgeons was concordant in 89.5% of cases. Children of all age groups showed an age-appropriate adaptive level on the VABS (mean score 108.21 ± 9.60). The median HRQOL score was 87.5 (IQR 75-91.66), which was above the normal range. Ophthalmological examinations were unremarkable in all patients.

Conclusions: These results suggest that open midline strip craniectomy with BSO and occipital release for isolated SC yields high levels of satisfaction among both parents and clinicians, along with HRQOL surpassing norms and no reported ophthalmological or developmental disability.