Management of Craniosynostosis : Opinions based on the Experience of Plastic Surgeons

Abstract

The aim of craniosynostosis surgery is to release the increased intracranial pressure and normalize the cranial shape. The procedure has developed considerably from a simple strip craniectomy of the fused suture before the 1960s to total calvarial remodeling after the 1970s and other advanced methods of the 1990s, such as distraction and its modifications that are applied to the posterior cranium. According to the literature, craniofacial surgeons change their methods depending on the case to apply more effective and less invasive. For a mildly distorted cranium, an earlier diagnosis can be obtained and conservative surgical treatment must be chosen. Currently, syndromic craniosynostosis is being treated with posterior distraction to achieve cranial volume expansion effectively. For this, distractors need certain hardness and thickness of the bone ； hence, the surgery has to be postponed until 5 ‒ 6 months of age. The modified Jimenez procedure is another option for the early stage of syndromic craniosynostosis. It has been applied in some cases and proven to be more effective than expected. As plastic surgeons have treated craniosynostosis for approximately three decades with neurosurgeons, we have presented our latest strategies and opinions by illustrating representative cases. three ‒ dimensional image shows orbital distortion and temporal depression （ A ） . Endoscopy ‒ assisted wider suturectomy was performed at 7 months of age （ B , C ） . Total calvaria has been remodeled for 15 months （ D ） .