The surgical correction of non-syndromic and syndromic craniosynostoses (CS) presents several challenges mainly related to the complexity of skull reconstruction, along with the risk of blood loss. Moreover, the surgical team has the commitment to achieve pleasant cosmetic results while minimizing morbimortality. Additionally, several strategies and instruments have been developed to handle this concern, such as technical surgery with minimal bleeding and piezo surgery and technique to obtain more bone autografts and minimize bone healing disturbances. This study was designed to present such techniques in a comprehensive revision of literature and describe them in a step-by-step fashion according to the current state of the art and the experience of pediatric neurosurgery in a single Brazilian institution.

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Resumo S?ndrome do trefinado ? atualmente uma complica??o comum na neurotraumatologia, sendo descrita como uma s?ndrome na qual ocorre deteriora??o neurol?gica acompanhada de sinais e sintomas ap?s a remo??o de uma parte consider?vel de osso do cr?nio, assim como ocorre na hemicraniectomia. Neste artigo, juntamente com a revis?o de literatura, ser? relatado o caso de um paciente adulto, v?tima de acidente automobil?stico, com hist?ria de traumatismo cranioencef?lico (TCE) grave que foi submetido ? craniectomia terap?utica, cursando com a s?ndrome do trefinado.

Introduction: Wormian bones (WB) are accessory bones positioned within the sutures or fontanelles. Although several studies have associated them with genetic disorders, ethnicity, and skull deformations, their relationship with nonsyndromic craniosynostosis (CS) has not been established, especially among Brazilians. Therefore, this study was conducted to analyze the incidence and association of WB with nonsyndromic CS in Brazilian children. Methods: An observational and retrospective study was conducted using computed tomography with 3D reconstruction in Brazilian children aged <3 years to compare the incidence and number of WB between regular children (group 1) and those with nonsyndromic CS (group 2). Results: A total of 140 children, comprising 62.9% boys (p < 0.001) with a mean age of 8.78 months, were included in this study. The most common types of CS were trigonocephaly (34; 48.6%), scaphocephaly (25; 35.7%), anterior plagiocephaly (5; 7.1%), posterior plagiocephaly (3; 4.2%), and brachycephaly (3; 4.2%). WB were more common in regular children (41; 58.6%) than in children with CS (28; 40.0%) (p = 0.028). Regular children had an average of 2.12 WB versus 1.32 WB in children with nonsyndromic CS (p = 0.024). Conclusion: The significantly less incidence of WB in Brazilian children with nonsyndromic CS was quite different from that reported in other studies and could indicate the tendency of this disease to have disturbance in ossification of the cranial vault, the impact of ethnicity, and probably the lack of additional compensatory skull growth.  

Intracranial abscess is a life-threatening disease that is uncommon in paediatric populations. Although there have been few reports in the literature, some aetiologies, such as mastoiditis and sinusitis, have been proposed. The pathophysiology is not completely known, and there are no data regarding the long-term follow-up of these patients. Herein, we present a case of a newborn affected with a mass in the suboccipital region due to an extracranial and intracranial abscess that had no clear association with infections except for a transient fever episode 1 month earlier. Isolation of Staphylococcus aureus from an open-surgery sample identified the cause of the mass. The patient achieved excellent recovery with no recurrence even after 8 years of follow-up. To our knowledge, this rare pattern of infection highlights the importance of early diagnosis in combination with a surgical approach as an effective diagnosis and treatment approach that provided a good outcome.