Surgical treatment of craniosynostosis

Abstract

An infant skull is made up of several separate bones that are not yet fused together. Because the brain grows quickly in the first two years of life, it is important that the skull bones remain open. Craniosynostosis is the prematurely fusion of one or more sutures of the skull. Synostosis interferes with normal growth of the brain and skull. There are several types of craniosynostosis. Different names are given to the various types, depending on which suture, or sutures, are involved. Scaphocephaly is an early closure of fusion of the sagittal suture and causes a long, narrow skull. Anterior plagiocephaly involves fusion of either the right or left side of the coronal suture and exhibits an asymmetrical distortion of the skull. Trigonocephaly is a fusion of the metopic suture. Early closure of this suture results in a triangular shape of skull. Syndromic cranio-synostosis, including Apert syndrome, Crouzon syndrome, Pfeiffer syndrome, Saethre-Chotzen syndrome are caused by genetic mutations. Besides craniosynostosis, other conditions also may accompany with disturbance of facial bone growth and/or hand and foot deformities. Craniosynostosis is treated by surgery. There are two major objectives of surgery for craniosynostosis. The first objective is to expand the cranial vault volume and prevent or reduce the raised intracranial pressure (ICP), while the second objective is to make an aesthetically prominent skull shape. Although a variety of surgical procedures may be used, early surgery within one year of age is recommended. Recently, distraction osteogenesis was introduced into the field of craniofacial surgery. Distraction osteogenesis is useful for midface advancement in syndromic craniosynostosis and posterior cranial vault expansion in brachycephaly.