Optimal duration of postoperative helmet therapy following endoscopic strip craniectomy for sagittal craniosynostosis

Rajiv R. Iyer, Xiaobu Ye, Qiuyu Jin, Yao Lu, Luckmini Liyanage, Edward Ahn

Research output: Contribution to journalArticlepeer-review


Objective: Many infants with sagittal craniosynostosis undergo effective surgical correction with endoscopic strip craniectomy (ESC) and postoperative helmet therapy (PHT). While PHT is essential to achieving optimal cosmesis following ESC, there has been little comprehensive analysis of the ideal PHT duration needed to attain this goal. Methods: The authors retrospectively reviewed the charts of infants undergoing ESC and PHT for sagittal synostosis at our institution between 2008 and 2015. Data collected included age at surgery, follow-up duration, and PHT duration. Cephalic index (CI) was evaluated preoperatively (CIpre), at its peak level (CImax), at termination of helmet therapy (CIoff), and at last follow-up (CIfinal). A multivariate regression analysis was performed to determine factors influencing CIfinal. Results: Thirty-one patients (27 male, 4 female) were treated in the studied time period. The median age at surgery was 2.7 months (range 1.6 to 3.2) and the median duration of PHT was 10.4 months (range 8.4 to 14.4). The mean CImax was 0.83 (SD 0.01), which was attained an average of 8.4 months (SD 1.2) following PHT initiation. At last follow-up, there was an average retraction of CIfinal among all patients to 0.78 (SD 0.01). Longer helmet duration after achieving CImax did not correlate with higher CIfinal values. While CImax was a significant predictor of CIfinal, neither age at surgery nor CIpre were found to be predictive of final outcome. Conclusions: Patients undergoing ESC and PHT for sagittal synostosis reach a peak CI around 7 to 9 months after surgery. PHT beyond CImax does not improve final anthropometric outcomes. CIfinal is significantly dependent on CImax, but not on age, nor CIpre. These results imply that helmet removal at CImax may be appropriate for ESC patients, while helmeting beyond the peak does not change final outcome.

Original languageEnglish (US)
Pages (from-to)610-615
Number of pages6
JournalJournal of Neurosurgery: Pediatrics
Issue number6
StatePublished - Dec 2018
Externally publishedYes


  • Cephalic index
  • Craniofacial
  • Craniosynostosis
  • Endoscopic
  • Helmet therapy
  • Helmeting
  • Metopic index
  • Orthosis
  • Orthotic molding
  • Regression
  • Strip craniectomy
  • Suturectomy

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health
  • Clinical Neurology


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