Occipital reduction-biparietal widening technique for correction of sagittal synostosis.

In the older infant with a marked skull deformation from sagittal synostosis a midline craniectomy will not produce an optimal cosmetic result as the brain grows at a much reduced rate and cannot provide the impetus for passive correction of the deformity. An operative technique is described whereby the occipital prominence is reduced, the biparietal diameter widened, and the height of the calvarium lowered at the vertex. Although the frontal bossing is not directly addressed the changes in the remainder of the calvarium render the bossing of little cosmetic relevance and has not been a long-term problem in the group of patients treated with this technique. The amount of manipulation, operative time, and blood loss with the procedure is comparable to others reported. This technique does not have the potential to raise intracranial pressure if one takes care to avoid undue compression on the major dural venous sinuses. There have been no significant bony defects and no patient has required reoperation. The cosmetic results have been excellent.