Clinician’s Corner: Sagittal Craniosynostosis and the Role of a Craniofacial Surgeon and Neurosurgeon

ACPAClinician's Corner

Francesco Gargano, MD, PhD

Craniosynostosis is the premature fusion of the cranial sutures leading to skull deformities and brain development issues. Sagittal craniosynostosis is the most common type of craniosynostosis, occurring when the sagittal suture (fibrous bands connecting bone in the skull) closes too early. This may result in scaphocephaly, causing the skull to appear long and thin with frontal bossing (protrusion of the forehead). In addition to abnormal skull growth, patients may potentially have elevated intracranial pressure (ICP). ICP may cause headaches, nausea, vomiting, increased crying and developmental delays in small children.

Diagnostic testing such as X-rays and CT scans may be useful in confirming the diagnosis of sagittal craniosynostosis. In many cases, surgical treatment of sagittal craniosynostosis may be necessary to allow for normal skull and neurophysiologic development of the growing child. Cranial vault remodeling is a surgical reconstructive procedure in which the bones of the skull are reshaped. The new bone construct is secured using synthetic plates, screws and sometimes, dissolvable sutures. Optimally, patients will be treated before 12 months of age.

Cranial vault remodeling is a combined effort, requiring the expertise of both a craniofacial surgeon and pediatric neurosurgeon. A pediatric neurosurgeon is involved with the temporary removal of skull bone (craniotomy). A craniofacial surgeon then works to remodel and reshape the skull bone. Together, the surgeons secure the reshaped bone. Coordination between a craniofacial surgeon and pediatric neurosurgeon at each step of this procedure, allows for the surgery to be completed as safely as possible.

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