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. 2025 Apr 13;17(4):e82179.
doi: 10.7759/cureus.82179. eCollection 2025 Apr.

Craniosynostosis: Experience From a Single Tertiary Center in India

Manraj Singh  1 , Mehak Nibber  1 , Gurjinder Kaur  2 , Uday S Raswan  3 , Ariana Joseph  2 , Brittany Zaita  2 , Jake Singh  2 , Adityabikram Singh  4 , Akshi Talwar  2 , Harkanwal Kaur  2 , Deepti Taneja  5 , Altaf U Ramzan  6 , Sarabjit S Chhiber  7
Affiliations

Craniosynostosis: Experience From a Single Tertiary Center in India

Manraj Singh et al. Cureus. .

Abstract

Introduction Premature fusion of one or more cranial sutures results in a diverse set of conditions collectively known as craniosynostosis. It is primarily responsible for cosmetic issues and occasionally associated with complications like brain growth restriction, raised intracranial pressure (ICP), and blindness. Management ranges from conservative surgical procedures such as suturectomies to more extensive procedures, including frontal bone remodeling with fronto-orbital advancement (FBR with FOA) and total calvarial reconstructions (TCVR). Currently, there is no consensus on an ideal procedure for a particular type of surgery for this condition. Methods A retrospective review of 26 consecutive patients treated at a single tertiary center in India was performed. Sloan's surgical outcome class and parent satisfaction score to compare different forms of intervention. Transfusion requirements, length of hospital, and increase in head circumference post-operation were also used. Results The mean age in our cohort was 10.9 months, with a ratio of 9:4 male-to-female. The overall assessment of pre- vs. post-operative head circumference revealed a strong significant mean improvement from 42.85 cm to 44.73 cm (p<0.001). A comparison of measured variables for all 26 patients revealed a significant difference in Sloan's surgical outcomes class (5.4 vs 1.2, p<0.001), Parent satisfaction score (5.1 vs 9.1, p<0.001) and increase in head circumference (cm) post-operation (0.74 vs 2.39, p<0.001) when comparing suturectomies vs extensive procedure like FBR with FOA and TCVR. Conclusion Our results favored FBR with FOA and TCVR over simple suturectomies for more satisfactory and long-lasting results with acceptable mortality and morbidity.

Keywords: frontal bone remodeling; metopic suture; neurosurgical intervention; non-syndromic craniosynostosis; suturectomy.

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Conflict of interest statement

Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Institutional Review Board at Sher-I-Kashmir Institute of Medical Sciences Ethics issued approval 09/01/2015. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Supine neutral position for FBR with FOA
FBR with FOA - frontal bone remodeling with fronto-orbital advancement
Figure 2
Figure 2. Creation of Bone Flaps for FBR with FOA
FBR with FOA - frontal bone remodeling with fronto-orbital advancement
Figure 3
Figure 3. Remodeling of supra-orbital bandeau in FBR with FOA
FBR with FOA - frontal bone remodeling with fronto-orbital advancement
Figure 4
Figure 4. Out-fracturing of bone strip in TCVR
TCVR - total calvarial reconstruction
Figure 5
Figure 5. Flattening of the TPO flaps in TCVR
TPO - temporo-parieto-occipital, TCVR - total calvarial reconstruction
Figure 6
Figure 6. Inferior edges of TPO flaps tied loosely to inferior rim of bone laterally
TPO - temporo-parieto-occipital
Figure 7
Figure 7. Transfusion requirement
FBR - frontal bone remodeling, FOA - fronto-orbital advancement, TCVR - total calvarial reconstruction Data is shown as mean ± standard error of sample mean. A triple asterisk indicates a statistically significant difference with a p-value ≤ 0.001.
Figure 8
Figure 8. Operative time
FBR - frontal bone remodeling, FOA - fronto-orbital advancement, TCVR - total calvarial reconstruction Data is shown as mean ± standard error of sample mean. A triple asterisk indicates a statistically significant difference with a p-value ≤ 0.001.
Figure 9
Figure 9. Hospital stay time
FBR - frontal bone remodeling, FOA - fronto-orbital advancement, TCVR - total calvarial reconstruction Data is shown as mean ± standard error of sample mean. A single asterisk indicates a statistically significant difference with a p-value ≤ 0.05.
Figure 10
Figure 10. Comparison of pre-and postoperative head circumference
FBR - frontal bone remodeling, FOA - fronto-orbital advancement, TCVR - total calvarial reconstruction Data is shown as mean ± standard error of sample mean.
Figure 11
Figure 11. Parent Satisfaction Score
FBR - frontal bone remodeling, FOA - fronto-orbital advancement, TCVR - total calvarial reconstruction A higher number indicates greater satisfaction. Data is shown as mean ± standard error of sample mean. A triple asterisk indicates a statistically significant difference with a p-value ≤ 0.001.
Figure 12
Figure 12. Sloan's Surgical Outcome Class
FBR - frontal bone remodeling, FOA - fronto-orbital advancement, TCVR - total calvarial reconstruction A lower number indicates a more favorable outcome [4]. Data is shown as mean ± standard error of sample mean. A triple asterisk indicates a statistically significant difference with a p-value ≤ 0.001.
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