Positional cranial deformities have been increasing worldwide for decades. The impact of the severity of plagiocephaly on the outcome of helmet therapy has been underreported. The aim of this study was to provide an updated summary of recommendations for the treatment of positional cranial deformities. In addition, own results on the influence of severity on the outcome of helmet therapy were considered.

In a retrospective analysis, 25 patients with positional cranial deformity who were treated with helmet therapy between 2016 and 2023 were included. The cranial vault asymmetry (CVA) was measured using a 3-dimensional camera. The patients were divided into moderate (CVA ≤ 12 mm, n = 5) and severe plagiocephaly (CVA > 12 mm, n = 20). The mean differences in the CVA of all patients before and after helmet therapy were tested for statistical significance using Student´s t-Test. The outcome results between the 2 groups were tested for statistically significant difference using Welch´s test.

Furthermore, the evidence-based guideline of the Congress of Neurological Surgeons for the treatment of positional cranial deformities from 2016 was updated, considering the age-dependent step therapy of Linz et al. as well as Jung and Yun.

Of the 25 patients, 15 were male and 10 female. Helmet therapy was initiated at an age of 6.6 months (SD 1.88) and lasted 5.8 months (SD 1.62) on mean. The mean CVA decreased in the entire study population from 13.85 mm (SD 4.88) before to 5.95 mm (SD 3.74) after helmet therapy (figure 1). The mean CVA in the mild plagiocephaly group reduced by 2.38 mm and in the severe group by 9.27 mm. The mean difference of -6.89 mm between the 2 groups was statistically highly significant (p < 0.001, 95 % CI -9.5 to -4.3).

The modified recommendation overview synthesizing the current data and including the own results was summarized in table 1.

When treating positional cranial deformities, various aspects must be considered. This overview is intended to simplify the treatment decisions.