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The following outlines the latest evidence and recommendations from the 2021 update to the treatment guidelines for craniosynostosis, published in the Journal of Craniofacial Surgery (Updated Guideline on Treatment and Management of Craniosynostosis. J Craniofac Surg 2021 Jan-Feb 01;32(1):371-450. Available at www.ncbi.nlm.nih.gov/pmc/articles/PMC7769187/).
The literature review does not clearly discuss surgical indications for sagittal craniosynostosis. Whether surgery is needed should be determined based on specialist advice.
According to most specialists, since sagittal craniosynostosis does not improve head shape with age, surgical correction is recommended.
Many parents of affected children opt for surgery after considering factors like aesthetic outcomes, neurocognitive function, and vision.
Only surgery can improve appearance, reduce risks of neurocognitive issues, and lower chances of vision problems.
Current studies show that minimally invasive cranial surgery involves less blood loss, fewer transfusions, shorter procedures, shorter hospital stays, and similar aesthetic results compared to total cranial reshaping.
Minimally invasive options include endoscopic surgery (requiring a helmet post-operation) or spring-assisted expansion, depending on surgeon preference and experience.
Research on aesthetics for minimally invasive surgery versus total reshaping is limited to one year post-operation. Long-term studies (e.g., five years) lack sufficient evidence, with no comparisons of future neurocognitive or visual issues.
Minimally invasive surgery should be done before the baby is six months old, as shaping becomes harder after that age.
Total cranial surgery must be performed after six months, due to potential skull development risks.
The current recommendation is minimally invasive surgery before 5.5 months, and total surgery after six months.
One study indicates that infants with sagittal craniosynostosis are most likely to develop optic disc edema (indicating increased intracranial pressure), suggesting surgery before six months. However, this is based on a single study, so evidence is limited.
The rationale for early surgery is that risks of optic disc edema increase with age, so guidelines recommend surgery before six months if possible.
Monitoring is essential, regardless of surgery.
Perform annual fundoscopy for optic disc edema or OCT until age 6.
Studies show optic disc edema in children with sagittal craniosynostosis before age 9, most commonly between 3 and 6.
Based on this, annual checks for optic disc edema or OCT are needed until age 6, with further monitoring only if required afterward, as risks decrease after that age.