TURRIBRACHYCEPHALY - A TECHNICAL NOTE

We describe a technique for early correction of the so-called towering skull deformity, or turribrachycephaly. The technique makes use of th e natural elasticity and plasticity of cranial bone, and it is best ap plied during the first year of life. Surgery consists of routine expos ure of the cranial bone via a coronal incision. The frontal bone flap is elevated and removed, On either side, a bony osteotomy is then made , commencing low down in the temporal region and running posteriorly a nd superiorly toward the occiput, This approach leaves a superior bone flap, which may be left attached to the occipital bone via a flexible posterior hinge region, or completely detached by continuing the oste otomy across the midline. After the osteotomy, the bone flap is elevat ed up to the sagittal sinus on either side of the midline. The bone fl ap is not removed, but pushed down, compressing the brain along the cr aniocaudal axis. The lateral edge of the flap overlaps the temporal bo ne, and it can be fixed in the desired position by means of simple pos itional screws or Vicryl sutures. A standard fronto-orbital advancemen t is performed prior to lowering the skull vault, which permits the br ain to be moved down and forward, filling the dead space in the anteri or cranial fossa. The frontal bone flap is then shaped appropriately a nd fixed by means of plates and screws to the advanced fronto-orbital bar, Posteriorly, the frontal bone is left ''floating.'' To date, we h ave performed this technique on 5 patients, and we find it both faster and simpler than other techniques. Short-term results in terms of cra nial shape are good, In older infants (>2 years of age), this techniqu e may not prove useful because of the loss of plasticity of the bone.