The peaked head shape is a specific type of aesthetic head deformity in which the midline of the skull is appreciably higher than that of the sides. This creates an inverted V-shape to the head in front view. Thus can be caused by an isolated high sagittal ridge, a normal sagittal ridge with parasagittal-temporal line deficiency or a combination of both.
In determining the treatment of the peaked head shape the key is preoperative computer imaging. I like to review with the patient the options of sagittal ridge reduction only, parasagittal or parasagittal-temporal line augmentation only or some combination of the two. Which one of the three looks best to the patient is the right choice. The only caveat is that there are limits as to how much sagittal ridge reduction can be done and often in the peak head shape there is an upper back of the head deficiency as well.
The most common treatment for the peaked head shape is a combination of posterior sagittal ridge reduction and parasagittal-temporal-parietal augmentation. Up to 5mms or so of the sagittal crest can be reduced while the augmentation can be more significant in thickness.
The key in the custom skull implant design is that it must wrap around the sagittal ridge like a horseshoe. While my initial skull implants had this design I have subsequently evolved to have a very thin layer of implant material cross over the reduced sagittal ridge. By so doing there is no risk of implant edging between the reduced sagittal ridge and the implant as well as no risk of the parasagittal part of the implant bending during placement. With a 1mm connection across the sagittal ridge this is a negligible put back of ridge thickness.
Dr. Barry Eppley