Pediatric craniofacial surgery for craniosynostosis: Our experience and current concepts: Part -1

Abstract

Craniostenosis is a disease characterized by untimely fusion of cranial sutures resulting in a variety of craniofacial deformities and neurological sequelae due to alteration in cranial volume and restriction of brain growth. This involves vault sutures predominantly, but cranial base is not immune. Association with a variety of syndromes makes the management decision complex. These children need careful evaluation by multiple specialists to have strategic treatment options. Parental counseling is an important and integral part of the treatment. Recent advancements in the surgical techniques and concept of team approach have significantly enhanced the safety and outcome of these children. We had an opportunity of treating 57 children with craniostenosis in the last 15 years at our craniofacial service. Out of them, 40 were nonsyndromic and 17 were syndromic variety. We describe our successful results along with individualized operative technical modifications adopted based on the current understanding of the disease.

Keywords: Nonsyndromic craniostenosis; operative results; pediatric craniofacial surgery.

Figure 1

Paul Tesseier

Figure 2A-B

Major cranial sutures. B: Growth of the brain that is refl ected in expansion of the cranial vault is always perpendicular to cranial sutures as demonstrated by arrow

Figure 2C

Clinical appearance

Figure 3

Plagiocephaly

Figure 4A

Plagiocephaly

Figure 4B

Evaluation of cranial/orbital volume

Figure 4C

3-D OF CORONAL SUTURES (frontal)

Figure 4D

Oblique view

Figure 4E

Evaluation of other sutures/defects

Figure 4F

Basal view

Figure 5

Metopic stenosis

Figure 6

Bench remodeling fronto –orbital segment

Figure 7

Sagittal stenosis

Figure 8

Barrel Steeve osteotomies

Figure 9A

Exposure-Sagittal stenosis

Figure 9B

Bench remodelling

Figure 9C

Bench osteo synthesis

Figure 9D

Final osteo synthesis and fixation

Figure 11

(A) positioning for surgery, (B) bicoronal fl ap exposure, (C) marking, bifrontal craniotomy, (D) fronto orbital craniotomy

Figure 11 E

Removal frontal bone fl ap and marking FIG

Figure 11 F

Deformity

Figure 11 G

Removal of orbital ridge

Figure 11 H

Hypo plastic orbital ridge

Figure 11 I

Expanding middle cranial fossa

Figure 11 J

Bench remodeling

Figure 11K

(A,B) Bone flap repositioning

Figure 11L

Final fixation

Figure 12 A

Early post-op

Figure 12B

Long term follow-up

Figure 13

Complex Lambdoid stenosis

Figure 10

Plagiocephaly

Figure 14

CSF leak treated conservatively