The incidence of subsequent high intracranial pressure in patients undergoing early, open, and wide strip craniectomy for sagittal synostosis

OBJECTIVE Secondary bone closure following single-suture craniosynostosis (SSCS) correction has been previously reported. However, the incidence of such secondary closure, which leads to increased intracranial pressure (ICP), following strip craniectomy for sagittal synostosis (SS) has not been systematically described. The possibility of secondary closure must be taken into account when determining the optimal long-term follow-up regimen after the procedure. Secondary closure leading to high ICP can cause silent papilledema, optic atrophy, and even blindness. In this study, the authors investigated the long-term follow-up of children who underwent early, open, and wide strip craniectomy for SS. They analyzed the incidence of secondary closure that led to increased ICP and the subsequent need for surgical or medical intervention. METHODS This was a single-center, retrospective, observational study with a follow-up of 2 to 25 years (9.1 ± 6.2 years). The study cohort included 286 children who underwent strip craniectomy for SS at the age of 2–4 months. RESULTS Three of 286 patients developed papilledema with documented increased ICP (formal ICP monitoring for 3 days). Two of them required cranial vault expansion at the ages of 1.8 and 1.9 years. The third patient was diagnosed with papilledema and borderline high values of ICP at the age of 2.8 years. He was treated with acetazolamide, resulting in persistent normalization of his fundoscopic examination findings, even after the acetazolamide treatment was stopped (8 months). CONCLUSIONS This study verifies that the incidence of secondary closure is very low following early, open, and wide strip craniectomy for SS. However, careful clinical and ophthalmological follow-up is advised during the first few years following surgery.