Introduction: Continued fusion and synostosis of unaffected sutures has been noted after both traditional calvarial vault remodeling and endoscopic-assisted synostosis repair[1,2]. Agrawal and identified reformation of the sagittal suture after strip craniectomy in 17% of their cases[3]. We have also observed neosuture formation in patients after endoscopic-assisted strip craniectomy and molding helmet therapy. We aim to identify the rate of a neosuture in patients with craniosynostosis treated after endoscopic–assisted strip craniectomy.

Methods: A total of 146 endoscopic-assisted cases for nonsyndromic craniosynostosis were retrospectively reviewed between 2006 and 2013. Syndromic and multi-suture synostosis other than bicoronal were excluded. Pre and one year postoperative head CT scans were reviewed to identify patients that developed a neosuture. The Neosuture was classified as complete or incomplete. 3D reconstructions of the CT were used to measure cephalic index (ratio of head width and length) of patients with sagittal synostosis.

Results: Seventy-six patients (61 sagittal, 6 bilateral coronal, 5 unilateral coronal, 4 lambdoid) treated by endoscopic-assisted technique with pre and one year postoperative scans were identified. Neosuture development occurred in 21 patients (28%): 12 sagittal, 2 bicoronal, 5 unicoronal and 2 lambdoid synostosis (Fig. 1). Complete neosuture formation was seen in 12 of 21 patients (7 of 12 sagittal, 2 of 2 bicoronal, 1 of 5 unicoronal, 2 of 2 lambdoid). Pre and postoperative cephalic index in the complete neosuture group was 67.6% and 76.1% and in the fused suture group it was 70.9% and 75.5%. No statistical difference in cephalic index was seen between neosuture and fused suture groups pre or 1-year postoperatively in patients with sagittal synostosis.

Conclusions: Neosuture development can occur after endoscopic-assisted strip craniectomy and molding helmet therapy for patients with craniosynostosis. Long term outcome as well as the clinical or cosmetic relevance of neosuture formation require further studies.

Patient Care: For the first time, we describe thr formation of neosutures in patients who underwent endoscopic assisted stip-craniectomy for craniosynostosis and discuss the radiographic relevance of this phenomenon.

Learning Objectives: Readers should become aware of the phenomenon of neosuture formation, become aware of the rate of neosuture development, and hopefully become interested in studying the long-term outcome it patients.

References: 1.Seruya M, Tan SY, Wray AC, et al. Total cranial vault remodeling for isolated sagittal synostosis: part I. Postoperative cranial suture patency. Plastic and reconstructive surgery 2013;132:602e-10e. 2.Yarbrough CK, Smyth MD, Holekamp TF, et al. Delayed synostoses of uninvolved sutures after surgical treatment of nonsyndromic craniosynostosis. The Journal of craniofacial surgery 2014;25:119-23 3.Agrawal D, Steinbok P, Cochrane DD. Reformation of the sagittal suture following surgery for isolated sagittal craniosynostosis. Journal of neurosurgery 2006;105:115-7.