Sagittal Synostosis
Sagittal synostosis causes predictable malformations depending on the specific suture location that fuses. Anterior fusion causes frontal bossing, whereas posterior fusion causes an occipital knob. Complete sagittal synostosis results in deformity both anteriorly and posteriorly. Variants of each type exist and therefore surgical correction must be tailored to the individual patient. Examples of the different forms of sagittal synotsosis are discussed, and the various surgical techniques available are detailed.
The first reported surgical procedure for correction of craniosynostosis was performed in 1890 by Lannelongue who advocated releasing, but not resecting, the fused suture (see also Cohen). Two years later, Lane described the first strip craniectomy with extraction of the fused suture. The child in this case died postoperatively, and there followed a period during which surgical correction fell out of favor, until Mehner in 1921 described the first successful use of strip craniectomy to remove a fused suture. Concurrently, and in contrast, Faber and Towne expounded a more radical craniectomy. However, these early procedures were performed not for cosmesis but to improve or salvage intellectual function. It was not until the work of Tessier and Rougerie, et al., in the late 1960s and early 1970s that cosmetic objectives began to be receive primary emphasis.
Over the past 30 years, various techniques for craniosynostosis have been refined considerably. Although a number of principles are universally accepted, techniques are not standardized. The individual surgeon's preferences, born of training, experience, and collegial interaction, continue to typify the surgical correction of synostoses. The methods and preferences described in this article are a distillation of experience most notably that of Milton Edgerton, John Persing, Kant Lin, and John Jane, Sr. gained over the last three decades at a single institution, the University of Virginia.
Abstract
Sagittal synostosis causes predictable malformations depending on the specific suture location that fuses. Anterior fusion causes frontal bossing, whereas posterior fusion causes an occipital knob. Complete sagittal synostosis results in deformity both anteriorly and posteriorly. Variants of each type exist and therefore surgical correction must be tailored to the individual patient. Examples of the different forms of sagittal synotsosis are discussed, and the various surgical techniques available are detailed.
Introduction
The first reported surgical procedure for correction of craniosynostosis was performed in 1890 by Lannelongue who advocated releasing, but not resecting, the fused suture (see also Cohen). Two years later, Lane described the first strip craniectomy with extraction of the fused suture. The child in this case died postoperatively, and there followed a period during which surgical correction fell out of favor, until Mehner in 1921 described the first successful use of strip craniectomy to remove a fused suture. Concurrently, and in contrast, Faber and Towne expounded a more radical craniectomy. However, these early procedures were performed not for cosmesis but to improve or salvage intellectual function. It was not until the work of Tessier and Rougerie, et al., in the late 1960s and early 1970s that cosmetic objectives began to be receive primary emphasis.
Over the past 30 years, various techniques for craniosynostosis have been refined considerably. Although a number of principles are universally accepted, techniques are not standardized. The individual surgeon's preferences, born of training, experience, and collegial interaction, continue to typify the surgical correction of synostoses. The methods and preferences described in this article are a distillation of experience most notably that of Milton Edgerton, John Persing, Kant Lin, and John Jane, Sr. gained over the last three decades at a single institution, the University of Virginia.