Unoperated craniosynostosis patients: correction in adulthood

The purpose of this project was to determine whether adult patients with frontal deformities caused by untreated craniosynostosis can undergo successful surgical correction.

Thirteen unoperated adult craniosynostosis patients are reported: seven women and six men, with a mean age of 24 years. There were four plagiocephalies, four scaphocephalies, three oxycephalies, and two brachycephalies. Computed tomographic scans with cerebral contrast were obtained, and the projected computerized correction was discussed with the patients. Frontocranial remodeling with an intracranial approach was used in 11 cases, and a frontal implant plus nasal en bloc realignment was used in two.

No significant perioperative complications occurred in this series. There were two late revisions for bony irregularities, through a limited approach. The morphologic correction was very satisfactory, emphasizing how important correct anatomy of the forehead and upper cranial vault is for the equilibrium of the face.

Unoperated craniosynostosis creates a significant to severe disfigurement because of the frontal deformation. Therefore, only in mild cases can one propose a limited operation or an implant, avoiding an intracranial approach. In most cases, a radical intracranial approach is the only effective operation. Risks must be discussed with the patient, but the psychological impact of the disfigurement is so great that these young adults are usually willing to undergo a radical approach. Early operation in infancy is of course preferable, but if this was not performed for various reasons, it is still possible to correct the deformity, despite it being a much more complicated operation.