Related Experiment Videos
Posterior skull surgery in craniosynostosis
S Sgouros1, J H Goldin, A D Hockley
1Craniofacial Surgery Unit, Queen Elizabeth and Children's Hospitals, Birmingham, UK.
Insights
Posterior skull surgery can effectively manage craniosynostosis, reducing the need for re-operation in infants with raised intracranial pressure. This approach helps prevent recurrent deformities and avoids anterior surgery in many cases.
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.
Abstract:
In 1984, two young infants with unusual "clover-leaf" patterns of skull deformity were treated by posterior skull-releasing surgery that dramatically improved their overall skull shape, to the extent that further operative intervention was not required. This focused our attention on the posterior skull and its role in craniosynostosis. In cases of multi-suture craniosynostosis and craniofacial syndromes severely raised intracranial pressure is frequent, demanding early surgery. One of the problems identified with such surgery undertaken before 6 months of age is recurrent craniosynostosis needing later re-operation. This occurred in 15 (5%) of 275 patients treated between 1978 and 1994. Since 1986, in the presence of significant raised intracranial pressure it has been our policy to do an initial posterior skull release or decompression. This takes the pressure of the growing brain away from the orbits, allowing us to defer fronto-orbital advancement until the age of 12 months or later. Three patients managed in this way completely avoided anterior surgery, while in another 9 patients re-operation for recurrent anterior deformity has not been required. The exception to this policy has been the presence of severe exorbitism posing a threat to vision. Under these circumstances early fronto-orbital advancement is mandatory, and an additional posterior skull release may be helpful later. Debate continues especially on the management of unilateral lambdoid synostosis. The recent increase in positional posterior plagiocephaly. possibly related to supine nursing of newborns, has emphasised the need to differentiate between a fixed deformity, which might require surgical correction, and positional moulding of the occiput, which improves spontaneously. This paper reports our experience with 22 patients treated by posterior skull surgery, either alone or as an additional procedure, which we believe has a definitive role in the management of craniosynostosis.