Controversies in the management of craniosynostosis

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 post-operative 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.

Duke Scholars

Author Gerald Arthur Grant Neurosurgery