The timing and extent of surgery continue to be a matter of discussion in current craniosynostosis management.
We retrospectively reviewed the first 159 children seen from 1996 to 2000 of a total of 243 patients presenting with suspected craniosynostosis. We did not establish a surgical indication in 74 children (47 %), either because their malformations were of different origin without associated craniosynostosis (11/7 %) or they presented with only mild clinical manifestations of sutural synostosis (63/40 %). In 85 cases (53 %), we established a surgical indication. Parents did not follow our recommendation in two cases (1 %). In 83 cases, we performed diagnosis-related remodeling at the age of 4-12 months. Demographic data, clinical follow-up findings, and regular photo documentation were analyzed.
After a mean follow-up of 3 years and 8 months, the results were satisfactory in 68 cases (82 %). Of 15 cases (18 %) with only limited improvement, two children were submitted to a second intervention. Another two children had to be reoperated on immediately for insufficient hemostasis. In the largest subgroup of children (47) with sagittal synostosis, there was no difference in outcome between surgery performed before and after 6 months of age.
Surgical indication and assessment of results are based on subjective criteria which limit the comparison with the literature. Our results correspond to those of similar published series. Most of the unfavorable results could be attributed either to inadequate adaptation of the surgical technique to the individual form of the malformation or to a significant secondary loss of correction in multi-sutural synostosis.
The overall results of surgery within the first year of life were satisfactory in 82 %. Standard procedures need to be adapted carefully to the individual form of craniosynostosis to avoid unfavorable results. We therefore propose a new surgical technique based on a statistically averaged modular system of skull models to replace freehand remodeling.