Isolated bilateral coronal synostosis: early treatment by peri-fronto-orbital craniectomy

Early strip craniectomy is commonly used for the treatment of craniosynostosis, but its effect on bilateral coronal synostosis remains disappointing. The technique developed in our institution of early (1-3 months of age) extensive perifrontal craniectomy that provides liberation of the anterior skull base is detailed, and its results in 12 cases of nonsyndromic brachycephaly are presented. Analysis of the growth of the cranial diameters of these children over a mean postoperative period of 10 years revealed a noticeable lengthening of the skull similar to the normal range, whereas no effect was noted on transversal cephalic development. Two patients needed additional surgery for focal correction despite a good morphologic result. The functional outcome was normal in all cases. For a number of carefully selected patients, early peri-fronto-orbital craniectomy provides an excellent result with functional preservation and morphologic improvement in most cases (10/12) in nonsyndromic brachycephaly. Its limited dissection and bleeding, as well as its short operating time, allow to have the procedure at a very young age and do not preclude the possibility of secondary surgery when needed.