The Faith of a Coronal Suture Grafted onto Midline Synostosis Inducing Dura and Deprived from Tensile Stress

Abstract

Objective: To discuss possible reasons for the synostosis of a coronal suture that was transplanted onto synostosis inducing dura in a scaphocephalic human cranium. Design: Case report. Setting: Supraregional teaching hospital, center for craniofacial anomalies. Patient: A bathmocephalic boy, followed from age 7½ to 26 months. Intervention: Radical synostosectomy, radial osteotomies in the parietal bone with outward fracturing of the barrel staves, and left-sided coronal suture transplantation onto the midline was undertaken at the age of 11 months. Methods: Computer tomography and clinical follow-up. Results: The sutural graft, initially deprived from tensile stress and quickly exposed to the anomalous dura, turned synostotic in one year. Conclusions: Both cell signaling and biomechanical theories on calvarial morphogenesis, sutural development, and synostosis can apply. An animal experiment is recommended to test which hypothesis prevails.

Postoperative Anti-Tgf-β2 Antibody Therapy Improves Intracranial Volume and Craniofacial Growth in Craniosynostotic Rabbits

“…2,4Y6,70 Although these surgical procedures are successful in meeting their objectives, the craniectomy sites frequently reossify (in 30% to 100% of reported cases), 31,34Y40 and this may occur very rapidly (in some cases as early as 6 months postoperatively), especially in sporadic or isolated cases in which simple suturectomies or linear craniectomies are used. 34,35,40 Fusion of all the cranial vault sutures (pancraniosynostosis), even those previously unaffected, has even been reported after surgical correction for single suture synostosis. 41 This rapid resynostosis can increase intracranial pressure, further restricting the growing brain and cranial base, and alter craniofacial growth.…”

“…43,86,87 Suturectomy site patency increased with the use of these techniques, but seizures and neurologic problems occurred, probably as a result of the toxicity of the chemical adjuvants. 23,43 Auto-or allotransplantation of normal sutures into the suturectomy site have also been used to replace missing growth sites, but rapid resynostosis of the transplanted suture was also seen in both human infants 40 and rabbits with familial craniosynostosis. 42 Another approach involves the radical surgical repositioning of the calvarial bones, performed in part to keep the margins of the craniectomy sites from physically reapproximating and resynostosing.…”

“…Although many surgical therapies have been successful in achieving these goals, the suturectomy site frequently resynostoses, 31,34Y40 especially in cases managed with simple suturectomies or linear craniectomies. 34,40 Pancraniosynostosis has even been reported after surgical correction for single suture synostosis. 41 This rapid resynostosis can increase intracranial pressure and further restrict the growing brain and cranial base.…”

Noggin Inhibits Postoperative Resynostosis in Craniosynostotic Rabbits

“…Although current surgical strategies often allow for normal brain growth and development, re‐establish normal intracranial volume and pressure, and correct cosmetic deformities, the suturectomy site frequently reossifies very rapidly after surgery (in 30–100% of reported cases and as early as 6 mo after surgery). Reossification of the suturectomy site leads to the reapproximation of the osteotomy margins and the refusion of the extirpated suture, termed “resynostosis.”( 14–17 ) Such resynostosis can lead to a secondary increase in intracranial pressure and further restrict craniofacial growth,( 18–20 ) necessitating additional surgical procedures( 21 ) and increasing the risk of patient morbidity and mortality.…”

Role of the osteoclast in cranial suture waveform patterning

“…6). This author posits mechanical forces resulting from mastication to play a more pivotal role in patterning cranial sutures than encephalization, as previously suggested (Behrents et al,1978; Steenvoorden et al,1990; Katsaros et al,1994; Moss,1997a; Kobayashi et al,1999; Mommaerts et al,2001; Kopher and Mao,2003; Byron et al,2004). This is supported by previous research by this author and colleagues (Byron et al,2004) that demonstrate significantly increased bone formation rates and suture complexity in knockout mice with enhanced muscle function.…”