20-YEAR EXPERIENCE WITH EARLY SURGERY FOR CRANIOSYNOSTOSIS .1. ISOLATED CRANIOFACIAL SYNOSTOSIS - RESULTS AND UNSOLVED PROBLEMS

Early surgery for isolated craniosynostosis is designed to improve mor phology, to prevent functional disturbances, and equally important, to enhance the psychosocial development of the child. As the first of a two-part series, 104 patients with isolated craniofacial synostosis we re retrospectively analyzed. Diagnoses included bilateral coronal (10) , unilateral coronal (57), metopic (29), and sagittal synostosis (8). All patients underwent primary fronto-orbital advancement-calvarial va ult remodeling procedures at less than 18 months of age (mean 8.1 mont hs). Thirteen percent of patients (14) required a secondary cranial va ult operation (mean age 22.6 months) to address residual deficits in c raniofacial form. Perioperative complications were minimal (5.0 percen t), and there was no mortality. Average length of postoperative follow -up was 46.0 months. By the classification of Whitaker et al., which a ssesses surgical results, 87.5 percent of patients were considered to have at least satisfactory craniofacial form (category I-II) at latest evaluation. Overall rates of hydrocephalus, shunt placement, and seiz ures (3.8, 1.0, and 2.9 percent, respectively) were low. Among the iso lated craniosynostoses, unilateral coronal synostosis/plagiocephaly po ses the most complex problems, including vertical orbital dystopia, na sal tip deviation, and residual craniofacial asymmetry; there is also a wide spectrum of findings and growth patterns in this subgroup.