Endoscopic management of unilateral coronal synostosis: impact on the fronto-orbital growth

Unilateral coronal synostosis (UCS) is a disorder in which one of the six major cranial sutures are fused and can affect either the left or right side of the skull. Its clinical effects are quite significant, based on the degree of asymmetry it causes both in the cranium as well as the subcranial skull base and facial features, as well as significant ocular concerns. Open cranial vault reconstruction, often referred to as frontal orbital advancement, has long been considered the standard of care for the treatment of this condition. However, most experienced clinicians understand that it is imperfect because its effect on the facial features and ophthalmologic complications is variable, and the forehead symmetry seems to regress over time. Based on the work of Jimenez and Barone endoscopic release of the fused coronal suture has become an alternative treatment option, augmented by adjuvant care in the form of a helmet, springs, or distractors. In this review article, we discuss the relative outcomes on forehead and facial symmetry of the minimally invasive procedure as compared to the open procedure based on our experience with over 130 surgical cases of UCS, our direct detailed analysis of 60 cases, and review of the literature.