Surgery of craniosynostosis: a historical review

Calvarial sutures and skull-shape deformities have been recognized since ancient times, but their direct link to premature suture fusion was first established in the 19th century. The earliest surgical attempts for craniosynostosis emerged in 1890 with strip craniectomy, though early outcomes were largely unsuccessful. Surgical progress stagnated for decades due to complications and skepticism surrounding these techniques. The 20th century brought significant advancements, beginning with successful strip craniectomies in the 1920s and later attempts to prevent re-ossification through material barriers. The late 1960s marked a pivotal shift with the introduction of cranial vault remodeling, followed by the integration of external cranial vault devices and helmet therapy in the 1980s. By the 1990s, endoscopic strip craniectomy revolutionized treatment by minimizing invasiveness and blood loss. Despite these innovations, debates persist regarding optimal surgical timing, long-term outcomes, and patient adherence to treatment. Emerging technologies such as 3D imaging, artificial intelligence, and personalized medicine hold promise for the future of craniosynostosis management.