Staged Surgical Strategies in Syndromic Craniosynostosis

This chapter focuses on the variety and timing of craniofacial surgical treatments in patients with syndromic craniosynostosis. It begins with a discussion of the management of cephalocranial disproportion and increased intracranial pressure in the first 2 years of a patient’s life using the “bone-pressure wave” concept. This is followed by a summary of surgical techniques that have been described to manage the syndromic craniofacial skeletal dysmorphology, including strip craniectomy, posterior and anterior cranial expansion using either open fixation, distraction or springs, and management of the midface, including recognition of the resurgence of segmental osteotomies, such as monobloc bipartition and Le Fort II distraction with zygomatic repositioning. The chapter concludes with a discussion on how these different surgical techniques can be employed within an expectant or staged team approach to 12 defined sequences of treatment that address the full spectrum of syndromic synostosis craniofacial dysmorphology.