An Overcorrective Modification of Cranial Vault Reconstruction for Non-Syndromic Metopic Suture Synostosis: Shiraz Technique

Abstract

Objective: Growth restriction of frontal bones due to premature closure of metopic suture leads to the “Trigonon” shape of the skull, introduced by Welcker in 1862. Paul Tessier introduced cranial vault reconstruction (CVR), a common craniofacial procedure for treating this condition. The present study aims to introduce a modified version of this procedure. Methods: In this study, we present our experience with a modified version of CVR, named the Shiraz technique, used as a single-stage overcorrective reconstructive method for isolated metopic suture synostosis with limited unique threesome osteotomies. We also report 35 cases treated with this technique. Results: The patient population comprised 26 males (74.3%) and 9 females (25.7%) with a mean age of 8.4 months (range: 3-13). The mean duration of the operation and anesthesia was 175.0 minutes (range: 60-300). The mean intraoperative bleeding and blood transfusion volumes were 95.6 ml (range: 20-250) and 75.3 ml (range: 0-320), respectively. The main complications during the follow-up were epidural hematoma (n=3, 8.6%; one case needed reoperation), temporal hollowing (n=2, 5.7%), raised intracranial pressure (n=2, 5.7%), wound infection (n=2, 5.7%), and mortality in one of the cases, which was presumed to be due to air emboli. Conclusions: The Shiraz technique, as a novel modified version of CVR, is a safe and effective technique for the treatment of non-syndromic metopic suture synostosis with low mean intraoperative blood loss and transfusion. In the long-term follow-up, the occurrence of temporal hollowing was decreased, and the outcome showed a smooth anterior skull base.