Extradural deadspace after infant fronto-orbital advancement in Apert syndrome

Infant fronto-orbital advancement is presently a management cornerstone of the craniosynostosis in Apert syndrome. This procedure is based on the premise that the expanding brain rapidly advances in support of, and to remodel, the new frontal facade. This series of infant patients with Apert syndrome undergoing fronto-orbital advancement with early postoperative computerized tomography assessment reveals a large extradural deadspace persistent through the first postoperative week, not obliterated consistently until the fourth week. Early deadspace effacement results from expansion of the prefrontal subarachnoid space, without any significant change in size or shape of the frontal brain substance or ventricles. Brain growth or expansion was particularly slow with brain shape distortions still evident at late follow-up.