Key Points for the Neurosurgeons and Management Principles (Diagnosis, Surgical Principles, Their Rationale, and Timing)

Metopic craniosynostosis, causing trigonocephaly, accounts for approximately 5–10% of all single-suture synostoses. Initial diagnosis of metopic suture synostosis is based on clinical exam findings; diagnosis can be confirmed with a 3D CT scan. Given the 8–13% risk of developing elevated intracranial pressure (ICP), early surgical intervention is generally advised. Most craniofacial centers of excellence offer both open cranial vault remodeling (fronto-orbital advancement) and endoscopic techniques. Often the decision is based on the age of the patient at the time of diagnosis, as well as surgeon and family preference. Overall outcomes are excellent for both cosmetic results and neurocognitive development; though long-term, standardized studies are lacking comparing the various techniques.