Controversies in the Indications for Surgery

It has been said “good surgeons know how to operate, better ones when to operate, and the best, when not to operate.” In addressing the treatment of craniosynostosis, this adage holds for both neurosurgeons and plastic surgeons. The nature and mechanisms of neurologic dysfunction in nonsyndromic craniosynostosis are subjects of great debate. Even in cases where there is a clear indication to operate, nuances of surgical management such as optimization of timing and technique are vigorously debated. This chapter discusses the controversies in management of craniosynostosis, including the role of genetics and bony compression on neurologic outcome, the advisability, timing, and type of surgery, and the optimization of perioperative supports.