Q: Dr. Eppley, I am a young male (27 years old) who is self-diagnosed with sagittal craniosynostosis. I want to have sagittal crest reduction by a significant amount. (approximately 1.5cm) I know sagittal crest reduction is possible up to a maximum of 7mm. But if you suffer from sagittal craniosynostosis isn’t it logical to think that there is more sagittal crest bone and therefore more to reduce?
A: In reality, having a sagittal crest from a limited form of sagittal craniosynostosis may or may not make the bone along its midline length thicker. That speculation can be answered by a CT scan in which the bone thickness can be directly seen and measured. However, I doubt very much the bone is thick enough that would allow a sagittal crest skull reduction of 15mms. Having done many sagittal crest skull reduction procedures, I have not found them to be extraordinarily thick or substantially thicker than that of the surrounding skull bone. Usually they are in the order of 5mm to 7mms thicker before the inner cranial table is seen and/or violated.
When one thinks they need as much as over a centimeter of sagittal crest bone skull reduction done, they may likely be suffering from a parasagittal deficiency along side the sagittal crest as well. In these cases the best treatment is a combined sagittal crest reduction and bilateral parasagittal bone augmentation.
Dr. Barry Eppley