History of Craniosynostosis Surgery and the Evolution of Minimally Invasive Endoscopic Techniques

Abstract

Craniosynostosis is the premature and abnormal fusion of 1 of the 6 suture lines that form the living skull and can occur as part of a syndrome or as an isolated defect (nonsyndromic). The first reported surgical procedure for correction of craniosynostosis was performed in 1890 by Lannelongue who advocated releasing, but not resecting, the fused suture. Craniofacial surgery has developed its own identity in the last 3 decades, with the Frenchman Tessier seen as the founding father. There have been many new developments such as distraction osteogenesis, biodegradable miniplate fixation, and the development of minimally invasive endoscopic techniques. Through the pioneering work of Jimenez and Barone, minimally invasive approaches to the surgical correction of craniosynostosis are now gaining wider acceptance. Here the authors review the history of craniosynostosis, the current literature and technique for endoscopic repair of craniosynostosis, as well as their own experience at the University of Florida, with minimally invasive endoscope-assisted techniques.

Bilateral squamosal suture synostosis: A rare form of isolated craniosynostosis in Crouzon syndrome

“…The squamosal suture arches posteriorly from the pterion and connects the temporal squama with the inferior border of the parietal bone [10] . The treatment of craniosynostosis syndromes requires a multidisciplinary team including plastic surgeons, pediatricians, ENT specialist, radiologists, neurosurgeons, and clinical genetic specialist [23,24] . Surgical correction is undertaken to correct craniofacial deformities and functional problems such as elevated intracranial pressure, airway obstruction, ocular exposure and malocclusion.…”

Comparison of Craniofacial Phenotype in Craniosynostotic Rabbits Treated with Anti–Tgf-β2 at Suturectomy Site

“…Surgical therapy in coronal craniosynostosis routinely involves complete remodeling of the skull, due to the ineffectiveness of strip craniectomy in producing a normal head shape, although other surgical techniques have grown in popularity in recent years (Jane and Persing, 2000;Yano et al, 2006;Clayman et al, 2007). Even after total reconstruction of the skull, the area representing the suture may re-fuse shortly after surgery, requiring further surgical correction in some cases (Mommaerts et al, 2001;Panchal and Uttchin, 2003).…”

Harvey Cushing's experience with cranial deformity

“…16 With the safety of surgical procedures established, cosmetic benefits as indications for surgery received increasing emphasis in the 1960s and 1970s. 2 In 1976, Venes and Sayers 17 noted that "it is generally accepted that scaphocephaly does not significantly alter brain growth and consequently the single indication for operative correction is cosmetic improvement." It is this emphasis on cosmetic improvement that lead to the development of many new techniques to replace the simple craniectomy.…”

“…2,6 At that time, further recognition of the risk to normal brain function and vision associated with craniosynostosis was used to justify these early surgeries.…”