Craniosynostosis Frontoorbital Advancement and Cranial Vault Reshaping (Open and Endoscopic)

Indications

• The main indications for surgical intervention for craniosynostosis are the prevention of potential neurologic impairment and correction of deformity. Increased intracranial pressure, hydrocephalus, mental retardation, visual abnormalities, and learning disabilities all can be associated with craniosynostosis. Generally, the more sutures that are fused (as in the syndromic forms of craniosynostosis), the greater the likelihood of neurologic compromise. If there is any evidence of neurologic compromise, urgent surgical intervention should be performed.

• A secondary indication for surgical intervention is esthetic improvement of the skull shape, although for many patients this is the primary indication for treatment. Deformities of the skull as a result of craniosynostosis are best treated with cranial vault reshaping, preferably at an early age, before the calvarial bones have fully ossified.

• We prefer to perform open cranial vault reshaping on patients with multiple suture synostoses or metopic, coronal, or lambdoid suture synostosis deformities or very severe sagittal suture deformities in older children. The open approach of the affected skull via bicoronal incision provides the necessary exposure to address these deformities properly.

• We prefer to perform endoscopic cranial vault reshaping on patients with mild to moderate sagittal suture synostoses between 2 to 4 months of age. The main benefits of this approach are diminished blood loss, limited incisions, and shorter hospital stays.

• We perform open cranial vault reshaping with or without frontoorbital advancement for patients with syndromic craniosynostosis or multiple suture–involved nonsyndromic craniosynostosis.

• Treatment of midface deformity and associated hypertelorbitism is beyond the scope of this chapter, but such treatments are critical aspects of care in most patients with syndromic craniosynostosis.