Preservation versus Structural Cranioplasty: A New Concept for Craniosynostosis Treatment

Craniosynostosis, a condition characterized by the premature closure of one or more cranial sutures, can be classified based on the affected suture, the number of sutures involved, or the presence of syndromic features. Although numerous surgical techniques have evolved to address cranial deformities, there remains a need for systematic categorization of these approaches. This review aims to explore current craniosynostosis treatments, evaluate their respective advantages and disadvantages, and propose a new classification distinguishing preservation cranioplasty from structural cranioplasty. The choice between preservation and structural cranioplasty is influenced by factors such as patient age, complexity of suture involvement, and resource availability. Preservation cranioplasty techniques, including suturectomy and distraction osteogenesis, prioritize maintaining cranial vault integrity and minimizing dural detachment, thus reducing surgical risks and facilitating natural cranial growth. Conversely, structural cranioplasty involves extensive bone displacement and dural exposure, offering effective correction for complex deformities and syndromic cases but with increased procedural risks. We propose categorizing craniosynostosis surgical treatments into two primary approaches: Preservation and structural cranioplasty. Preservation cranioplasty focuses on minimal invasion to support natural brain and skull development, while structural cranioplasty involves extensive remodeling necessary for severe or syndromic cases. Understanding these paradigms enables better-tailored treatment strategies and may improve long-term craniofacial outcomes.