Principles and Technique of Anterior Vault Remodeling

Trigonocephaly as well as uni- and bicoronal synostosis are rare pathologies that are nonetheless common in pediatric setting. In this chapter, the authors will describe the principal of anterior vault remodeling as well as the more common procedures reported in the literature. While all surgical techniques share common goals (ICP increase prevention; cranial morphology normalization; prevention of neurodevelopmental injury; prevention of ocular movement disturbances), they differ mostly in the way of dealing with cranial reconstruction. Surgical techniques can then be divided into open field surgery, device-assisted procedures, and endoscopy-assisted suturectomy followed by postoperative cranial orthotic therapy or mini-invasive microscope-assisted suturectomy. In order to better describe the aforementioned techniques, in this chapter each of the surgical steps will be described from positioning to dressing.