A technique is described for the surgical correction of primary of secondary sagittal synostosis in the older child. This involves placing the patient in the modified prone position, reshaping the supraorbital bar, and reconstructing virtually the entire cranial vault with microplates. This technique of total cranial vault reconstruction has been performed successfully on 5 patients without mortality or significant morbidity, although blood loss is significant, averaging 1.8 blood volumes. Further experience will be needed to establish the proper indications for the procedure, the best method of fixation, and the optimal timing.