Sagittal synostotic twins: reverse pi procedure for scaphocephaly correction gives superior result compared to endoscopic repair followed by helmet therapy.

A unique situation of twins with similar sagittal synostosis pathology who underwent different surgical corrective procedures allowed us an opportunity to compare an endoscopic technique to the more traditional technique of a modified cranial vault remodeling (CVR). At 4 months of age, 1 twin underwent an endoscopic-assisted extended strip craniectomy with postoperative helmet therapy for 12 months, and the other underwent a reverse pi CVR procedure. Cephalic index, the Whitaker Aesthetic score, and developmental tests were used for comparison during a 6-year follow-up. The modified CVR had a superior outcome compared to the endoscopic procedure with regard to cephalic index measurements (CVR = 77; endoscopic = 63; P < 0.05) and the Whitaker score (CVR = 1 or no revisions necessary; endoscopic = 2.3 or minor to major bony work required for correction). Patients had similar intelligence quotient test scores; however, the endoscopic patient had lower scores in both preschool tests and global evaluations compared with the normal scores of the CVR patient. The modified CVR procedure was superior to the endoscopic procedure, at least in these twins with sagittal synostosis.