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[Craniosynostosis and faciocraniosynostosis]
E Arnaud1, D Marchac, D Renier
1Unité de Chirurgie Cranio-Faciale, Hôpital Necker-Enfants Malades, Paris, France.
Insights
This review details craniostenosis treatment for 1321 patients, covering embryology, classification, surgical techniques, and outcomes. Optimal results for craniostenosis surgery require multidisciplinary teams in specialized centers.
Area of Science:
- Craniofacial surgery
- Pediatric neurosurgery
- Developmental biology
Context:
- Craniostenosis, a premature fusion of cranial sutures, presents significant challenges in pediatric neurosurgery.
- Understanding craniofacial embryology is crucial for classifying and managing these complex conditions.
- A large series of 1321 operated craniostenoses provides a robust dataset for evaluating treatment strategies.
Purpose:
- To review the aetiopathogenesis and treatment of craniostenosis.
- To describe morphological classifications and their consequences.
- To detail surgical techniques and outcomes for various craniostenosis types.
Summary:
- The review covers craniostenosis embryology, classification, and consequences.
- Specific surgical techniques (e.g., H-craniotomies, fronto-orbital advancement) are described for scaphocephaly, plagiocephaly, oxycephaly, and brachycephaly.
- Results, complications, and mortality rates from a series of 1321 operations are presented, emphasizing multidisciplinary care.
Impact:
- Provides comprehensive insights into surgical management of craniostenosis.
- Highlights the importance of specialized centers and multidisciplinary teams for optimal patient outcomes.
- Informs future surgical planning and treatment protocols for craniostenosis.
Abstract:
The authors present a review of the aetiopathogenesis and treatment, based on a series of 1321 craniostenoses operated by the Enfants Malades team. After briefly reviewing the embryology of craniofacial growth, the authors describe the morphological classification of craniostenoses and their morphological and functional consequences. The main neurosurgical problems related to craniofacial surgery are described. The surgical techniques currently used by the unit are described for each type of craniostenosis, according to age: H or flap transposition craniectomies for scaphocephaly, unilateral advancement of a bilateral head-band for plagiocephaly, anterior transposition for oxycephaly, and fronto-orbital adbancement for brachycephaly. The results are presented with a follow-up of several years. The principles of one-stage or two-stage surgical treatment for the main types of faciocraniostenosis are recalled: initial fronto-orbital advancement then secondary treatment of maxillary recession. The prospects of one-stage combined treatment with early maxillary distraction are proposed. Surgical indications are described. The complications, morbidity and mortality are indicated for the series. It must be remembered that craniostenosis surgery is a form of plastic surgery with neurosurgical complications. To obtain optimal results with the lowest risk, craniofacial must be performed by multidisciplinary teams in specialized centres.