Laboratory Studies
Patients undergoing surgical treatment have their coagulation profiles, hemoglobin, and electrolyte levels checked to ensure that these levels are within the reference range so that they can be submitted to general anesthesia.
Cranial remodeling operations are often associated with significant blood loss, and the usual practice is to secure suitable crossmatched blood before surgery.
Imaging Studies
Plain radiography initially, computed tomography (CT) subsequently, and magnetic resonance imaging (MRI) more recently have been used in clinical practice for both preoperative planning and postoperative follow-up. These modalities are also used in research and for exploring the pathophysiologic mechanisms implicated in causing the skull deformity.
Three-dimensional (3D) CT (3D-CT) scans, though typically not necessary to diagnose craniosynostosis, are capable of providing useful anatomic information. These clearly demonstrate the abnormally fused suture(s) and allow accurate preoperative planning. Of surgical importance is the configuration of the bony skeleton of the orbits, the anterior fossa floor, and the temporal regions. These are the sites at which osteotomies are commonly performed during corrective surgery.
Using reconstructed 3D-CT scans (see the images below), surgeons can readily appreciate the morphology of the sites of interest and can formulate a suitable operative plan—for instance, to determine how far the supraorbital bar must be advanced to correct the orbits. CT venography can be helpful in planning occipital craniotomies that will expose portions of the torcula and transverse sinuses.
3D reconstruction of child with left lambdoid craniosynostosis. 3D-reconstructed CT venography of same child with left lambdoid craniosynostosis demonstrating dominant right transverse sinus.
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Normal anatomic suture configuration.
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Metopic craniosynostosis (trigonocephaly).
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Sagittal craniosynostosis (scaphocephaly).
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Unilateral coronal craniosynostosis (anterior plagiocephaly).
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Lambdoid craniosynostosis (posterior plagiocephaly).
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3D reconstruction of child with sagittal craniosynostosis.
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3D reconstruction of child with right unilateral coronal craniosynostosis.
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3D reconstruction of child with bilateral coronal (bicoronal) craniosynostosis.
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3D reconstruction of child with metopic craniosynostosis.
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3D reconstruction of child with left lambdoid craniosynostosis. 3D-reconstructed CT venography of same child with left lambdoid craniosynostosis demonstrating dominant right transverse sinus.
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Bilateral coronal craniosynostosis repair. 3D rendering of standard CT performed on postoperative day 1 after consolidation and then months later. Note lengthening of skull, as well as decrease in vertical height.
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Bilateral coronal craniosynostosis repair. 3D rendering of standard CT performed on postoperative day 1 after subsequent fronto-orbital advancement.
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Lambdoid craniosynostosis repair. 3D rendering of standard CT performed on postoperative day 1 following reconstruction. Bilateral parietal craniotomies were performed, leaving sagittal suture in place. Bioccipital craniotomy was accomplished, and overgrown mastoid bone was removed and then elevated with bone grafts from craniotomies. Bone from contraleral parietal bone was used for occipital reconstruction. Ipsilateral partietal bone was placed contralaterally, and bone from bioccipital craniotomy was used to reconstruct ipsilateral parietal bone.
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Preoperative view of patient with metopic craniosynostosis (supine position). Note bifrontal narrowing and posterior parietal widening giving triangular shape (trigonocephaly) to skull on top-down view.
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Preoperative CT of patient with metopic craniosynostosis. Note bifrontal narrowing and posterior parietal widening giving triangular shape (trigonocephaly) to skull on top-down view. Note fused (absent) metopic suture anteriorly at midline with other sutures patent (visible).
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Intraoperative view of released fronto-orbital bandeau (top-down) prior to remodeling. Note triangular shape with flattening laterally.
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Intraoperative view of metopic craniosynostosis skeletal deformity after scalp flap reflection.
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Completion of repair for metopic craniosynostosis with scalp closed.
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Preoperative view of sagittal craniosynostosis with bicoronal incision marked. Prone position. Note biparietal narrowing and occipital narrowing.
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Intraoperative view of sagittal craniosynostosis after scalp flap reflection. Note Raney clips on skin edges. Markings designate sites of craniotomy with exception of central marking, which identifies fused sagittal suture at midline. Central segment of bone including suture will be removed. Prone position.
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Intraoperative view of sagittal craniosynostosis after removal of bone. Parietal bones on each side have been divided into segments and widened. Occiput has been flattened, as demonstrated by surgeon's finger. Prone position.
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Sagittal craniosynostosis after repair with scalp closed. Prone position.
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Preoperative top-down view of patient with unilateral (right) coronal craniosynostosis. Note flattened right forehead with elevated orbit and contralateral left side prominence (bossing) of forehead.
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Preoperative top-down CT view of same patient with unilateral (right) coronal craniosynostosis. Note flattened right forehead with elevated orbit and contralateral left side prominence (bossing) of forehead.
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Intraoperative view of same patient with unilateral (right) coronal craniosynostosis, looking directly down onto forehead. Top of head is at bottom of picture. Two sides of forehead were exchanged, placing prominent left side on right and flattened right side on left after contouring. Right side is overcorrected in position as compared with left.
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Intraoperative top-down view of same patient with unilateral (right) coronal craniosynostosis at completion of repair. Right side is overcorrected in position as compared with left at orbital rim (upper right portion of image).
Tables
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- Overview
- Presentation
- DDx
- Workup
- Treatment
- Approach Considerations
- General Principles of Surgical Therapy
- Sagittal Craniosynostosis Repair
- Unilateral Coronal Craniosynostosis Repair
- Bilateral Coronal Craniosynostosis Repair
- Metopic Craniosynostosis Repair
- Lambdoid Craniosynostosis Repair
- Postoperative Care
- Complications
- Long-Term Monitoring
- Show All
- Media Gallery
- References
