Management of craniosynostoses
D Renier1, E Lajeunie, E Arnaud
1Craniofacial Group, Department of Neurosurgery, Hôpital Necker Enfants-Malades, 149 Rue de Sèvres, 75015 Paris, France. dominique.renier@nck.aphop-paris.fr
Insights
Early surgery for craniosynostosis improves both functional and cosmetic outcomes. This is crucial as untreated craniosynostosis can lead to increased intracranial pressure and developmental issues.
Area of Science:
- Pediatric Surgery
- Neurosurgery
- Developmental Pediatrics
Background:
- Craniosynostosis, premature fusion of skull sutures, is often treated for cosmetic reasons.
- However, functional consequences like increased intracranial pressure and developmental delays can occur even in single-suture fusions.
Purpose of the Study:
- To evaluate the functional and cosmetic outcomes of craniosynostosis surgery.
- To determine the impact of age and craniosynostosis type on functional risks.
- To assess operative risks in infants versus older children.
Main Methods:
- Analysis of a personal series of 2,137 craniosynostosis cases.
- Prospective studies on intracranial pressure and mental development in affected children.
Main Results:
- Functional and cosmetic results are superior with early surgical intervention.
- Increased intracranial hypertension and mental impairment risks vary with age and craniosynostosis type.
- Syndromic cases like Crouzon and Apert syndromes present higher risks for intracranial hypertension and mental retardation, respectively.
Conclusions:
- Early surgical treatment of craniosynostosis yields better functional and cosmetic outcomes.
- Operative risks are comparable between infants and older children, supporting early intervention.
Abstract:
Although it is currently thought that surgery is indicated mainly for cosmetic reasons in isolated craniosynostoses, the functional aspects of the treatment must not be underestimated. Prospective studies on intracranial pressure and mental evolution of these children have shown that there were functional consequences in a significant proportion of cases even of single suture fusion. The frequency of increased intracranial hypertension and the risk of mental impairment depend on the age of the child and the type of craniosynostosis. In nonsyndromic cases, the higher risks are observed in multisutural craniosynostoses (brachycephaly, oxycephaly). In syndromic cases, the risk of intracranial hypertension is higher in Crouzon syndrome, and Apert syndrome carries the higher risk of mental retardation. The study of a personal series of 2,137 craniosynostoses shows that the functional and the cosmetic results are better after early surgery, and that the operative risks are not higher in infants than in older children.
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