Specific sutures
Sagittal craniosynostosis/scaphocephaly
There are two surgical procedures which are commonly used to treat sagittal synostosis. The matter of which procedure is superior is still heavily debated amongst the surgeons treating this condition, however it is generally agreed upon that the cephalic index should be used to assess the efficacy of the preferred surgical intervention. Firstly, the extended strip craniectomy will be discussed, which is a further developed form of the traditional craniectomy. The traditional procedure involved only the excision of the closed suture, with the intent that the compensatory skull deformations would automatically be corrected by the fast growth of the brain during the first year of life.This did not quite result in a true normalization of the cranial vault, causing the development of numerous modifications. One of those is the extended strip craniectomy. This procedure can be performed by using an endoscope, becoming more popular due to the resultant rapid recovery of the child and reduced need for blood transfusion. The patient is afterwards placed in a custom made molding helmet to correct the resting deformities of the skull. In the other widely used surgical procedure, total cranial vault remodelling, the compensatory deformities are corrected during the operation, with excision of the fused suture. Most of the bones that collectively form the cranial vault – i.e. the frontal, the parietal and the occipital bones – are removed and reshaped to normalize the contours.
In some cases, the plates have been observed to come into direct contact with the brain. Absorbable plates are now used instead. Timing of surgery
The prevention of post-surgical complications, including those mentioned above, plays an important role in discussions over the timing of potential surgery. The general consensus is to perform surgery in late infancy, i.e. between six and twelve months. Within this time frame the efficacy of surgery will be enhanced for several reasons:

The bone is still more malleable and can be remodelled relatively simply by greenstick fractures of the bone. At approximately one year of age the bone has become more mineralized and brittle and needs to be attached to the surrounding bone with sutures or an absorbable plate. Reshaping of the cranial vault most commonly means excision of the bones to allow shape adjustment. Replacement of cranial bones can leave gaps which are readily re-ossified before the age of one year, but will need bony filling thereafter.Most surgeons will not intervene until after the age of six months due to the heightened risk which blood loss poses before this age. It is generally preferable to wait until after three months of age when anaesthetic risks will also be decreased.Surgery is not performed in early childhood in every country; in some countries surgical intervention can take place in the late teens.It is important that families seek out a Pediatric Craniofacial Physician who has experience with craniosynostosis for proper diagnosis, surgical care, and followup.