Early operation in premature cranial synostosisfor the prevention of blindness and other sequelae

Identifying Reproducible Patterns of Calvarial Dysmorphology in Nonsyndromic Sagittal Craniosynostosis May Affect Operative Intervention and Outcomes Assessment

“…Despite over 100 years of sagittal craniosynostosis surgery, the type of operation and the timing of operation remain actively debated by craniosynostosis surgeons. [12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] Several recognized factors contribute to this ambiguity: absence of long-term follow-up reports and lack of consensus regarding morphology outcome assessment tools. Both of these variables are the focus of current research.…”

The evolution of surgical management for craniosynostosis

“…Additionally, based on their observations of outcomes, they pioneered the concept of early and prophylactic linear synostectomy for preservation of neurological function and improvement of cosmesis, commenting "it is probable that the evil effects of synostoses are largely preventable by a suitable operation performed sufficiently early in life." 16 By the 1940s, strip craniectomies and suturectomies were once again widely accepted and the critical importance of early intervention-which they describe as the period before 2 months of age-leading to better functional and cosmetic outcomes was beginning to be appreciated. However, despite advances in surgical management in this era, a new challenge in the management of these children became apparent.…”

Craniosynostosis surgery: the legacy of Paul Tessier

“…With multiple suture involvement, complications including, but not limited to, brain growth restriction, hydrocephalus, and blindness constitute medical indications for surgery, in addition to aesthetic restoration. Early operative intervention (in patients prior to 6 months of age) has been reported to achieve good results 1,6,8,9,12,19,29,40 but is associated with an increased incidence of reoperation. Conversely, late operative intervention less frequently requires reoperation and enables intraoperative correction, but often involves more extensive reconstruction.…”

“…The high failure rate and mortality burden in these early cases had two possible antecedents: 1) microcephaly was misdiagnosed as craniosynostosis or 2) the surgery was performed late; they were possibly less associated with a high surgical risk itself. 7,8 These early surgical techniques were less than ideal, rarely achieving a satisfactory cosmetic outcome in patients with craniosynostosis. More severely affected patients, such as those with craniofacial dysostosis (CFD), were simply left untreated, being deemed "inoperable.…”