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Seminars in Neurosurgery 2002; 13(1): 081-096
DOI: 10.1055/s-2002-35250
Copyright © 2002 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

Controversies in the Management of Craniosynostosis

Richard A. Hopper1 , Gerald A. Grant2 , Richard G. Ellenbogen2
  • 1Division of Craniofacial, Plastic and Reconstructive Surgery, Children's Hospital and Regional Medical Center and Department of Plastic and Reconstructive Surgery, University of Washington School of Medicine, Seattle, Washington
  • 2Division of Neurological Surgery, Children's Hospital and Regional Medical Center, Department of Neurological Surgery, University of Washington School of Medicine, Seattle, Washington
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Publication History

Publication Date:
04 November 2002 (online)

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ABSTRACT

This article updates the general neurosurgeon on the current issues and controversies in craniofacial surgery. Topics discussed include differential diagnosis of posterior plagiocephaly, timing of craniosynostosis surgery, technical advances, intracranial pressure in craniosynostosis, and new technologies.

In the past decade, lambdoid synostosis has been overdiagnosed as a surgically treatable form of posterior plagiocephaly. Careful clinical examination can distinguish true lambdoid synostosis, which is rare, from nonsynostotic, deformational plagiocephaly which is much more common. The more common deformational plagiocephaly does not require surgical treatment.

Early surgery for craniosynostosis offers the benefit of secondary skull base improvements, by using the growing brain to mold the calvarium. There is also a decreased risk of persistent bone defects. These benefits must be balanced against data suggesting lower recurrence rates of suture closure with later or delayed surgery. There is also a growing trend in craniofacial centers toward more aggressive cranial remodeling with ancillary techniques to optimize the postoperative esthetic result. Endoscopic craniectomy is an exception to this rule, but in many cases this evolving technique requires intensive postoperative molding.

Bioresorbable plates and hydroxyapatite cements have a distinct role in craniofacial surgery; however, further analysis is required to understand the potential complications and appropriate indications for these new technologies.

KEYWORDS

Craniosynostosis - posterior plagiocephaly - deformational plagiocephaly - hydrocephalus - intracranial pressure - bioresorbable plates - bone substitutes

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