Sagittal Synostosis Facts

The sagittal suture is located on the midline, on top of the skull and extends from the soft spot towards the back of the head. Sagittal suture synostosis is the most common type of single suture synostosis and predominantly affects males. The suture is located at the midline, on top of the skull and extends from the soft spot towards the back of the head. Sagittal synostosis causes a shape that’s long and narrow, known as scaphocephaly. As the head grows in this long and narrow direction, the back of the head becomes prominent, pointed and the forehead protrudes. There is a low risk of abnormal brain growth and development. This form of synostosis is generally easy to diagnose.

The sagittal suture is located in the midline and behind the soft spot as demonstrated by the red area.

Back view of a normal newborn skull shows the back extension of the sagittal suture as it reaches the lambdoid sutures.

Upon premature closure of the suture, the skull cannot grow in the direction of the red arrows. The normal brain grows in the path of the other open sutures and of least resistance as shown by the green arrows.

Presentation

The classical presentation consists of a narrow and elongated skull with very prominent and protruding forehead. Additionally, the back of the head becomes pointed and tapered. This condition is known as scaphocephaly. However, the head may look different depending on whether the entire suture is closed or only parts of it and when the closure occurs. Additionally, the head can become tall and narrow.

Endoscopic Surgery

The goal of the surgery is to simply release and open the closed suture to allow the brain to resume its normal growth pattern and revert to a normal shape. Since the brain of an infant grows very rapidly, doubling in size during the first year of life, performing the procedure at an early age is of utmost importance. By using minimally invasive, endoscopic assisted techniques, such procedure can be done safely in very young babies. Once released, normalization of the head is aided with the use of custom made helmets (cranial orthosis) during the following year.

Positioning in Surgery

The patient is placed in the "sphynx" position as seen below. This allows access to the front and the back of the head without having to change positions.

Skin Incisions

Two small incisions are placed on top of the head in order to access the suture. One in made across the midline and behind the soft spot. The second one is made in the back of the head where the sagittal suture ends and meets the lambdoid sutures.

Craniectomy (Resection of skull) and removal of closed suture is done after cutting alongside of the stenosed suture. The bone is removed through one of the incisions. The closed suture is evident upon inspection. Once the prematurely closed suture is removed, the brain is allowed to grow as genetically programmed.