Abstract
Cranial sutures are fibrous joints between the bones of the cranial vault, acting
as centers of osteogenesis of the embryonic mesenchyme. Skull growth is a strictly
regulated process, controlled by several genetic pathways. A minor perturbation of
these pathways may lead to premature fusion of the cranial sutures. Craniosynostosis
occurs as a result of the premature fusion of the cranial sutures. The incidence of
craniosynostosis is approximately 1 in 2,500 live births. Syndromic craniosynostoses
such as Apert, Crouzon, and Pfeiffer comprise 15% of patients, while nonsyndromic
craniosynostosis represents 85% of all patients. By the late 1800s, Lannelongue (Paris,
1890) and Lane (San Francisco, 1892) attempted the first surgical intervention (strip
craniectomy) for the management of craniosynostosis. The inadequacy of simple suturectomies
and strip craniectomies in the management of craniosynostosis led to the innovation
of more complex procedures such as frontoorbital advancement and posterior cranial
vault distraction. However, these extensive surgical interventions are lengthy procedures
and associated with more blood volume loss which requires blood transfusion. These
limitations led to the modern era of minimally invasive endoscopic techniques. In
this paper, we reviewed the body of the literature on the evolution of surgical management
of craniosynostosis over the last century and the possible future directions.
Keywords
craniosynostosis - minimally invasive - endoscopic - fronto-orbital advancement -
posterior cranial vault distraction - springs - helmet therapy
