Surgery: Modified Pi with Triple-Bonnet Flap and Fronto-Orbital Advancement

Abstract

Introduction: Craniosynostosis is the premature fusion of one or more of the cranial sutures and can occur as part of a syndrome or as an isolated defect. Pansynostosis is a rare form of craniosynostosis that involves premature fusion of all the cranial sutures (coronal, sagittal, metopic, and occipital). Particularly in cases of late presentation, there are heightened clinical concerns, both functional and aesthetic. In untreated cases of pansynostosis and increased intracranial pressure, optic nerve damage progresses to optic atrophy and then blindness. Objectives: Cranial vault reconstruction is the standard surgical treatment. We attempt to highlight the importance of modifying the osteotomies and reshaping of the cranial vault based on individual requirements in order to achieve the best possible result and to prevent catastrophic blood loss. Method and Results: We present a case of modified pi with triple-bonnet flap and fronto-orbital advancement, an individual modification of the techniques of cranial vault reconstruction, in a patient with pansynostosis with optic atrophy. Conclusion: The technical variation can be applied to any case of pansynostosis requiring cranial vault reconstruction.

Novel Method of Lateral Vault Modification in Scaphocephaly

“…The sagittal suture affectation results in a diminished cephalic index. Several surgical techniques have been described to remodel the calvarium in scaphocephaly 17,22,27,39,40,42,44,48,49,51,53,57,59,60,67–72 . The ultimate goal is to increase the biparietal diameter and to decrease the anteroposterior diameter.…”

“…Several surgical techniques have been described to remodel the calvarium in scaphocephaly. 17,22,27,39,40,42,44,48,49,51,53,57,59,60,[67][68][69][70][71][72] The ultimate goal is to increase the biparietal diameter and to decrease the anteroposterior diameter. Although the tendency to less invasive procedures such as endoscopic suturectomy and helmet molding and springs appears to be an attractive option there are certain caveats.…”