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Author Spotlight: Development and Application of a Novel Suture Technique for Annular Fibrosus Repair in Percutaneous Transforaminal Endoscopic Discectomy
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Posterior Cranial Decompression in ERF-Mutated Multisuture Craniosynostosis.

Sarut Chaisrisawadisuk1,2, Achara Sathienkijkanchai3, Inthira Khampalikit4

  • 1Division of Plastic Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.

The Journal of Craniofacial Surgery
|January 21, 2026
PubMed
Summary

Early posterior decompression effectively treated multisutural craniosynostosis in an infant with an ERF gene mutation, reducing intracranial pressure and promoting normal development. This approach may reduce the need for further surgeries.

Keywords:
Craniosynostosiscranial decompressioncraniofacial abnormalitiesmutation

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Area of Science:

  • Pediatric Neurosurgery
  • Clinical Genetics
  • Developmental Biology

Background:

  • Multisutural craniosynostosis causes abnormal skull shape and elevated intracranial pressure (ICP), risking neurodevelopment.
  • Syndromic craniosynostosis often involves genetic mutations, such as in the ERF gene.
  • Elevated ICP in infants requires timely intervention to prevent neurological damage.

Purpose of the Study:

  • To report a case of multisutural craniosynostosis associated with an ERF gene mutation.
  • To evaluate the efficacy of early posterior decompression in managing elevated ICP and skull deformities.
  • To highlight the long-term neurodevelopmental outcomes and cranial morphology following surgical intervention.

Main Methods:

  • A case report of a 6-day-old infant diagnosed with multisutural craniosynostosis.
  • Diagnostic imaging to confirm elevated ICP and assess cranial morphology.
  • Surgical intervention involving posterior cranial and foramen magnum decompression at 2 months of age.
  • Long-term follow-up to assess developmental milestones and cranial stability.

Main Results:

  • The infant presented with multisutural craniosynostosis and an ERF gene mutation, with confirmed elevated ICP.
  • Posterior decompression successfully reduced ICP and stabilized cranial morphology, allowing deferral of fronto-orbital advancement.
  • By age 2, the child exhibited normal developmental milestones, stable cranial shape, and no Chiari I malformation.

Conclusions:

  • Early posterior decompression is a safe and effective first-line treatment for syndromic craniosynostosis with elevated ICP.
  • This surgical approach facilitates natural bone reformation and may reduce the necessity for secondary reconstructive surgeries.
  • Multidisciplinary management is crucial for optimizing outcomes in complex pediatric craniofacial anomalies.