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Twenty-year experience with early surgery for craniosynostosis: I. Isolated craniofacial synostosis--results and
J G McCarthy1, S B Glasberg, C B Cutting
1Variety Center for Craniofacial Rehabilitation, New York University Medical Center, New York, USA.
Insights
Early surgery for craniosynostosis in 104 infants improved craniofacial form and psychosocial development. Most patients achieved satisfactory results with minimal complications, though some required secondary procedures.
Area of Science:
- Pediatric Neurosurgery
- Craniofacial Surgery
- Developmental Pediatrics
Background:
- Craniosynostosis, premature fusion of skull sutures, impacts a child's morphology, function, and psychosocial development.
- Early surgical intervention aims to correct skull deformities and support healthy development.
Purpose of the Study:
- To evaluate the outcomes of early fronto-orbital advancement and calvarial vault remodeling in infants with isolated craniosynostosis.
- To assess surgical results, complication rates, and long-term craniofacial form in a pediatric cohort.
Main Methods:
- Retrospective analysis of 104 patients with isolated craniosynostosis (coronal, metopic, sagittal) treated before 18 months.
- Primary fronto-orbital advancement-calvarial vault remodeling, with evaluation of secondary procedures and follow-up.
- Assessment of craniofacial form using the Whitaker et al. classification system.
Main Results:
- 87.5% of patients achieved satisfactory craniofacial form (Category I-II) post-surgery.
- Low perioperative complication rate (5.0%) and no mortality.
- Low incidence of hydrocephalus (3.8%), shunt placement (1.0%), and seizures (2.9%).
Conclusions:
- Early fronto-orbital advancement and vault remodeling are effective for treating isolated craniosynostosis.
- The procedure yields good aesthetic and functional outcomes with a low complication profile.
- Unilateral coronal synostosis presents unique challenges requiring careful management.
Abstract:
Early surgery for isolated craniosynostosis is designed to improve morphology, to prevent functional disturbances, and equally important, to enhance the psychosocial development of the child. As the first of a two-part series, 104 patients with isolated craniofacial synostosis were retrospectively analyzed. Diagnoses included bilateral coronal (10), unilateral coronal (57), metopic (29), and sagittal synostosis (8). All patients underwent primary fronto-orbital advancement-calvarial vault remodeling procedures at less than 18 months of age (mean 8.1 months). Thirteen percent of patients (14) required a secondary cranial vault operation (mean age 22.6 months) to address residual deficits in craniofacial form. Perioperative complications were minimal (5.0 percent), and there was no mortality. Average length of postoperative follow-up was 46.0 months. By the classification of Whitaker et al., which assesses surgical results, 87.5 percent of patients were considered to have at least satisfactory craniofacial form (category I-II) at latest evaluation. Overall rates of hydrocephalus, shunt placement, and seizures (3.8, 1.0, and 2.9 percent, respectively) were low. Among the isolated craniosynostoses, unilateral coronal synostosis/plagiocephaly poses the most complex problems, including vertical orbital dystopia, nasal tip deviation, and residual craniofacial asymmetry; there is also a wide spectrum of findings and growth patterns in this subgroup.