Posterior skull surgery in craniosynostosis

Area of Science:

• Neurosurgery
• Pediatric Surgery
• Craniofacial Surgery

Background:

• Craniosynostosis, particularly multi-suture types and craniofacial syndromes, often presents with elevated intracranial pressure requiring early surgical intervention.
• Early surgery before six months of age for craniosynostosis can lead to recurrent deformities, necessitating re-operation in approximately 5% of cases.
• Positional posterior plagiocephaly is increasing, highlighting the need to distinguish between fixed deformities and positional molding.

Purpose of the Study:

• To evaluate the role and effectiveness of posterior skull surgery in managing craniosynostosis, especially in cases with raised intracranial pressure.
• To assess the impact of posterior skull release on preventing recurrent craniosynostosis and avoiding anterior surgical procedures.
• To differentiate between surgically correctable fixed deformities and spontaneously resolving positional molding.

Main Methods:

• Retrospective review of 22 patients treated with posterior skull surgery, either as a primary or additional procedure.
• Implementation of a policy since 1986 involving initial posterior skull release for significant intracranial pressure, deferring fronto-orbital advancement.
• Comparison of outcomes, including the need for re-operation and avoidance of anterior surgery, in patients managed with posterior skull release.

Main Results:

• Posterior skull surgery dramatically improved skull shape in infants with clover-leaf skull deformity, eliminating the need for further surgery.
• In patients with raised intracranial pressure, initial posterior skull release allowed deferral of fronto-orbital advancement, with 3 patients avoiding anterior surgery entirely and 9 not requiring re-operation for recurrent deformity.
• Posterior skull surgery alone or as an adjunct procedure was effective in managing craniosynostosis in the studied cohort.

Conclusions:

• Posterior skull surgery plays a definitive role in the management of craniosynostosis, particularly when associated with raised intracranial pressure.
• This surgical approach can effectively decompress the growing brain, prevent recurrent deformities, and potentially obviate the need for anterior procedures.
• Careful differentiation between fixed and positional deformities is crucial, with posterior skull surgery indicated for fixed craniosynostosis.