The Snails: A Simple Technique for Reduction of Frontal Bossing in Children With Scaphocephaly

Area of Science:

• Craniofacial Surgery
• Pediatric Neurosurgery
• Plastic Surgery

Background:

• Scaphocephaly, the most common single-suture craniosynostosis, often presents with prominent frontal bossing (sphenocephaly), a significant aesthetic concern, particularly in older children.
• Existing surgical techniques for frontal bossing correction typically involve extensive frontal bone exposure and reconstruction.
• A less invasive approach is sought for severe sphenocephaly, applicable across different age groups.

Purpose of the Study:

• To describe and evaluate the efficacy of the "Snail technique" for correcting frontal bossing in patients with scaphocephaly.
• To compare the outcomes of the Snail technique with conventional methods regarding invasiveness, cosmetic results, and transfusion rates.

Main Methods:

• The Snail technique, involving spiral frontal impacted craniotomies, was performed on 13 children (aged 3.5–22 months) alongside primary craniosynostosis treatment.
• Surgical duration and transfusion rates were recorded and compared to 15 control patients treated without the Snail technique.
• Postoperative follow-up extended to approximately 1 year.

Main Results:

• The Snail technique demonstrated rapid and stable cosmetic improvement in frontal bossing, confirmed by parental/clinician satisfaction and objective assessments.
• Surgical outcomes showed no significant difference in transfusion rates compared to the control group.
• While operative time was longer, the Snail technique proved effective for severe sphenocephaly.

Conclusions:

• The Snail technique is a simpler, less invasive method for correcting frontal bossing in scaphocephaly.
• It avoids additional craniotomies over the superior sagittal sinus and does not lead to increased blood loss.
• This technique provides a valuable alternative for managing frontal bossing in scaphocephaly patients.