Surgical Management of Craniosynostosis—Between the Past and the Future: A Comprehensive Review of the Literature

Abstract

Cranial sutures are fibrous joints between the bones of the cranial vault, acting as centers of osteogenesis of the embryonic mesenchyme. Skull growth is a strictly regulated process, controlled by several genetic pathways. A minor perturbation of these pathways may lead to premature fusion of the cranial sutures. Craniosynostosis occurs as a result of the premature fusion of the cranial sutures. The incidence of craniosynostosis is approximately 1 in 2,500 live births. Syndromic craniosynostoses such as Apert, Crouzon, and Pfeiffer comprise 15% of patients, while nonsyndromic craniosynostosis represents 85% of all patients. By the late 1800s, Lannelongue (Paris, 1890) and Lane (San Francisco, 1892) attempted the first surgical intervention (strip craniectomy) for the management of craniosynostosis. The inadequacy of simple suturectomies and strip craniectomies in the management of craniosynostosis led to the innovation of more complex procedures such as fronto-orbital advancement and posterior cranial vault distraction. However, these extensive surgical interventions are lengthy procedures and associated with more blood volume loss which requires blood transfusion. These limitations led to the modern era of minimally invasive endoscopic techniques. In this paper, we reviewed the body of the literature on the evolution of surgical management of craniosynostosis over the last century and the possible future directions.

Integrated Endoscopic Craniosynostosis Surgery and Cranial Orthosis Program

“…9 The major advantage of the endoscopic technique is the reduced requirement for blood transfusion. 10 In some series, they have shown the total avoidance of blood transfusion. In our series, we have not completely avoided the need for transfusion.…”

“…Some strategies that help reduce blood loss involve the use of an insulated diathermy postbone cutting, using a burr to cut the bone, that simultaneously coagulates the bone edges. 2,10 We aim to remove the fully involved suture, even though only a partial segment of the suture may be fused. Barrel staving the lateral segments has been shown to be effective.…”