Isolated bilateral coronal synostosis: early treatment by peri-fronto-orbital craniectomy
Thomas Schouman1, Matthieu Vinchon, Blandine Ruhin-Coupet
1Department of Plastic and Reconstructive Surgery, National Center for Treatment of Rare Cranio-maxillo-facial Diseases, Roger Salengro University Hospital, CHRU de Lille, Lille Cedex, France. thomas.schouman@neuf.fr
Insights
Early extensive perifrontal craniectomy improves skull length in infants with nonsyndromic brachycephaly. This surgical technique offers good functional and morphological outcomes, with potential for secondary procedures if needed.
Area of Science:
- Pediatric Neurosurgery
- Craniofacial Surgery
- Developmental Biology
Background:
- Strip craniectomy for craniosynostosis can yield disappointing results, especially for bilateral coronal synostosis.
- Nonsyndromic brachycephaly requires effective early intervention to optimize cranial development.
Purpose of the Study:
- To detail an early extensive perifrontal craniectomy technique for nonsyndromic brachycephaly.
- To evaluate the long-term functional and morphological outcomes of this surgical approach.
Main Methods:
- The study involved 12 infants (1-3 months old) with nonsyndromic brachycephaly undergoing extensive perifrontal craniectomy.
- Cranial diameter growth was analyzed over a mean 10-year postoperative period.
- Functional and morphological outcomes were assessed, noting the need for secondary surgeries.
Main Results:
- The procedure resulted in significant skull lengthening, approaching normal ranges.
- No notable improvement was observed in transversal cephalic development.
- 10 out of 12 patients achieved good morphological results, with normal functional outcomes in all cases.
- Two patients required additional surgery for focal correction.
Conclusions:
- Early extensive peri-fronto-orbital craniectomy is an effective treatment for selected cases of nonsyndromic brachycephaly.
- The technique promotes favorable cranial lengthening and preserves function.
- Its minimally invasive nature allows for early intervention and does not exclude future corrective surgeries.
Abstract:
Early strip craniectomy is commonly used for the treatment of craniosynostosis, but its effect on bilateral coronal synostosis remains disappointing. The technique developed in our institution of early (1-3 months of age) extensive perifrontal craniectomy that provides liberation of the anterior skull base is detailed, and its results in 12 cases of nonsyndromic brachycephaly are presented. Analysis of the growth of the cranial diameters of these children over a mean postoperative period of 10 years revealed a noticeable lengthening of the skull similar to the normal range, whereas no effect was noted on transversal cephalic development. Two patients needed additional surgery for focal correction despite a good morphologic result. The functional outcome was normal in all cases. For a number of carefully selected patients, early peri-fronto-orbital craniectomy provides an excellent result with functional preservation and morphologic improvement in most cases (10/12) in nonsyndromic brachycephaly. Its limited dissection and bleeding, as well as its short operating time, allow to have the procedure at a very young age and do not preclude the possibility of secondary surgery when needed.
Related Concept Videos
01:22Sutures of the Skull
Sutures are immobile joints between adjacent bones of the skull. The narrow gap between the bones is filled with dense, fibrous connective tissue that unites the bones. The long sutures located between the skull bones are not straight but instead follow irregular, tightly twisting paths. These twisting lines tightly...
01:14Cranial Bones: Superior and Posterior View
The frontal bone is the single bone that forms the forehead. At its anterior midline, between the eyebrows, there is a slight depression called the glabella. The frontal bone also forms the supraorbital margin of the orbit. Near the middle of this margin is the supraorbital foramen, the opening that provides passage for a sensory nerve to the forehead. The frontal bone is thickened just above each supraorbital margin,...