Simple craniosynostosis: Scaphocephaly, brachycephaly and trigonocephaly

Patients with simple craniosynostosis operated on in the department of Plastic and Reconstructive surgery of School of Medicine of Keio University for the last twenty years since 1979 were 52 cases. Diagnoses included scaphocephaly (15), plagiocephaly (14), trigonocephaly (9), brachycephaly (5) and multiple synostosis (9). In these patients, cases of plagiocephaly was excluded, and 43 cases were retrospectively analyzed. Patients with trigonocephaly and relatively mild craniosynostosis underwent front-orbital advancement and partially cranial vault remodeling. Other patients underwent total skull remodeling by bamboo ware method basically. Average age at operation was 17 months. Postoperative complications were infection of two cases. Postoperatively, intracranial volume in all cases increased, and coursed within the normal range. Re-operation rate by recurrence of deformity and increasing intracranial pressure was 6% (2 cases). All patients including complex craniosynostosis (n=86) showed a re-operation rate of 9% (8 cases) in those where initial surgery was performed before the age of 12 months. 6 of the 8 patients (75%) underwent initial surgery in the first 6 months of life. Accordingly, age at initial operation was considered to become an important factor for re-operation. Recently, we have developed a new method of total skull remodeling by combination of morcellatoin craniotomy and distraction osteogenesis instead of the bamboo ware method, and 10 patients underwent the new operation. This method was considered to lead previous surgical concepts for craniosynostosis to a new one.