title: Surgical treatment of single-suture craniosynostosis: an argument for quantitative methods to evaluate cosmetic outcomes.
abstract: The traditional reasons for surgical intervention in children with single-suture craniosynostosis (SSC) are cosmetic improvement and the avoidance/treatment of intracranial hypertension, which has been thought to contribute to neurocognitive deficits. Despite considerable work on the topic, the exact prevalence of intracranial hypertension in the population of patients with SSC is unknown, although it appears to be present in only a minority. Additionally, recent neuropsychological and anatomical literature suggests that the subtle neurocognitive deficits identified in children with a history of SSC may not result from external compression. They may instead reflect an underlying developmental condition that includes disordered primary CNS development and early suture fusion. This implies that current surgical techniques are unlikely to prevent neurocognitive deficits in patients with SSC. As such, the most common indication for surgical treatment in SSC is cosmetic, and most patients benefit from considerable subjective cosmetic normalization following surgery. Pediatric craniofacial surgeons have not, however, agreed upon objective means to assess postoperative cranial morphological improvement. We should therefore endeavor to agree upon objective craniometric tools for the assessment of operative outcomes, allowing us to accurately compare the various surgical techniques that are currently available.
authors.affiliation: Division of Pediatric Neurosurgery, Children's Hospital of Alabama, University of Alabama, Birmingham, Alabama, USA. tch12@columbia.edu
authors.forename: Todd C
authors.initials: TC
authors.lastname: Hankinson
authors.forename: Elizabeth J
authors.initials: EJ
authors.lastname: Fontana
authors.forename: Richard C E
authors.initials: RC
authors.lastname: Anderson
authors.forename: Neil A
authors.initials: NA
authors.lastname: Feldstein
mesh_terms: D002508:Cephalometry; D002675:Child, Preschool; D003072:Cognition Disorders / Q000175:diagnosis / Q000517:prevention & control; D003393:Cranial Sutures / Q000002:abnormalities / Q000601:surgery*; D003398:Craniosynostoses / Q000175:diagnosis* / Q000601:surgery*; D002658:Developmental Disabilities / Q000175:diagnosis / Q000517:prevention & control; D004954:Esthetics; D006801:Humans; D007223:Infant; D019586:Intracranial Hypertension / Q000175:diagnosis / Q000601:surgery; D008279:Magnetic Resonance Imaging; D009483:Neuropsychological Tests; D011183:Postoperative Complications / Q000175:diagnosis*; D011379:Prognosis