Abstract
The operative benefits and goals in the treatment of craniosynostosis were considered mainly from the cosmetic standpoint before the 1960s. In the last 25 years, two major clinically critical points have been added to the consideration of an operative method. One is the associated increased intracranial pressure (ICP) and the other is the newly recognized pathophysiology of associated premature closure of skull base sutures. Thus, classical linear craniectomy, which used to be the only accepted operative method for craniosynostosis, has been reconsidered with its unsuccessful and unsatisfactory results both for cosmetic and decompressive purposes.
Twenty-five cases were analyzed in the light of operative procedures and discussed with the results of pre and postoperative ICP monitoring in treatments for craniosynostosis. Only 13 out of 25 children were treated before 1 year of age. Simple suture closure was seen in 13 patients, namely, six sagittal, four coronal, and three metopic. Multiple involvements were seen in the other 12 patients, namely, five Crouzon's disease, two Apert's syndrome, one cloverleaf skull, and four other multiple cranial suture closures. The signs and symptoms and radiological evidence of increased ICP with or without continuous ICP monitoring were checked in all cases. All children over 2 years of age or with multiple suture involvements revealed the evidence of increased ICP before the operation. All six patients over 3 years of age had one or more symptoms of decreased visual acuity, headaches, psychomotor developmental delay, or convulsion. Pre and postoperative pressure monitoring confirmed satisfactory improvement in ICP in advanced elderly cases treated with bilateral wide flap operations or in infantile craniofacial dysostosis, plagiocephaly, or trigonocephaly treated with lateral canthal advancement with radical forehead remodeling. This study strongly emphasizes that ICP is an extremely important factor in considering operative procedure for craniosynostosis.
