Review of Past Reports and Current Concepts of Surgical Management for Craniosynostosis

Abstract

The purposes of surgery for craniosynostosis are to release increased intracranial pressure and to normalize cranial shape. The procedure was developed from a simple strip craniectomy in practice which ranged from the removal of the fused suture before the 1960s to total calvarial remodeling after 1970s and later methods of the 1990s, such as distraction and its modifications. According to its history, craniofacial surgeons might be changing their procedures with more effective, than less invasive ways. Since the late 1990s, when the distraction was applied to the craniofacial surgery, the gradual expansion, in particular of the anterior cranium, common in Japan, has long been controversial until the Caucasians accepted its use for the posterior cranium. Currently, the method may revert to the old procedure because a more sophisticated and better morphological result can be obtained depending on the types of deformity, even if a little more invasive maneuver is required. In other words, if treatment can be performed in optimal time, the procedures that were developed in the last half a century should be altered to each condition.

Keywords: craniosynostosis; distraction osteogenesis; intracranial pressure; mental development; suturectomy.

Fig. 1.

Representative case treated with conventional primary surgery and later mid facial correction; Crouzon disease female underwent a conventional forehead advancement (moved anteriorly in 2.1 cm) in 1 year and Le Fort III mid-face advancement in 10 years of age. X-ray of 1(pre-operatively), 4(3 years after forehead advancement), 12(2 years after mid-face advancement), 20 years of age (right to left in order).

Fig. 2.

Representative case treated with distraction; A 8 month-old female with brachycephaly underwent a forehead advancement with gradual distraction. X-ray of pre-ope, during distraction, full expansion (2.3 cm anteriorly) and 10 years after (right to left in order).

Fig. 3.

Illustrative case with posterior distraction; Follow-up conditions of before to 2 years after of posterior expansion applied to a 4 year-old male with oxycephaly who underwent a frontal advancement in 1 year. X-ray of pre-ope, during distraction, full-expansion (2.3 cm posteiorly) and 2 years after (right to left in order).

Fig. 4.

A proof of the earliest Japanese spring therapy; A 17 year-old female with Apert syndrome underwent a forehead and mid-face advancement in 1989. Pre and post-operative X-ray shows springs (yellow dot circle) on the calvarium.