New perspectives in the treatment of craniosynostosis

The history of ideas on the pathogenesis and treatment of craniosynostosis syndromes is discussed, with special reference to the emerging role of cranio-facial units. Emphasis has changed from correction of established deformities, to early surgery to prevent such deformities, as well as relief of existing pathology such as exorbitism and raised intracranial pressure. These early operations, best performed in the first three months of life, essentially involve unilateral or bilateral fronto-orbital advancements. The coronal suture is released with a craniectomy, extended to the squamosal suture, and a wide temporal decompression performed. The frontal bone and superior orbital margin are mobilized and moved to their new position, and wired in place. Intermediate and late stage operations are also discussed, together with complications.