Modification of the Melbourne Method for Total Calvarial Vault Remodeling

Abstract

Background: Sagittal synostosis is the most common form of single suture synostosis. It often results in characteristic calvarial deformities, including a long, narrow head, frontal bossing, a bullet-shaped occiput, and an anteriorly placed vertex. Several methods for correcting the phenotypic deformities have been described, each with their own advantages and challenges. In this study, we describe a modification of the Melbourne method of total calvarial remodeling for correcting scaphocephaly.

Methods: We conducted a retrospective review of all consecutive patients who underwent total calvarial remodeling using a modified version of the Melbourne technique from 2011 to 2015. We evaluated clinical photographs, computed tomographic imaging, and cephalic indices both pre- and postoperatively to determine morphologic changes after operation.

Results: A total of 9 patients underwent the modified Melbourne technique for calvarial vault remodeling during the study period. Intraoperative blood loss was 260 mL (range, 80-400 mL), and mean intraoperative transfusion was 232 mL (range, 0-360 mL). The average length of stay in the hospital was 3.9 days. The mean cephalic indices increased from 0.66 to 0.74 postoperatively (P < 0.01).

Conclusions: A modified Melbourne method for calvarial vault reconstruction addresses the phenotypic aspects of severe scaphocephaly associated with isolated sagittal synostosis and maintains a homeotopic relationship across the calvaria. It is associated with shorter operative times, lower blood loss, and lower transfusion requirements.

Fig. 1.

Bird’s eye (A) and lateral (B) views after scalp flap dissection and before osteotomies. Asterisk marks the coronal strip of cranium to be removed.

Fig. 2.

Bird’s eye (A) and lateral (B) views after osteotomies and remodeling. Asterisk marks the new position of the cranial strip, split and relocated to both widen and raise the occipital region.

Fig. 3.

Options for parietal segment barrel staving in the coronal (A) or sagittal (B) dimension. A, Calvarial reconstruction with barrel staving of parietal plates in the coronal plane. B, Calvarial reconstruction with barrel staving of the parietal segments in the sagittal plane and cantilevered anteriorly. C, Posterior view of calvarial reconstruction with barrel staving of the parietal segments in the sagittal plane.

Fig. 4.

Representative pre- (A) and postoperative (B) clinical photographs of a patient with isolated sagittal synostosis following calvarial reconstruction with the modified Melbourne technique. Note the more posteriorly positioned vertex and shorter A-P dimension.

Fig. 5.

Cephalic Index measured preoperatively and postoperatively (range, 1–54 months), found to be statistically significant between groups (*P < 0.01) using a paired t test.