History of Open Cranial Vault Reconstruction for Craniosynostosis, the Impact of Virtual Surgical Planning, and Future Directions

Introduction: Craniosynostosis is defined as the premature closure of the sutures of the skull. It can cause deleterious effects on brain growth and increased intracranial pressure. The history of the surgical correction of craniosynostosis and its future development is addressed.

Methods: Current and past literature was reviewed to understand the beginning of craniosynostosis surgical techniques, current methods, and future directions.

Results: The surgical correction of the misshapen skull was first described in 1890 by Lannelongue, as he attempted to provide a solution for “microcephalic idiocy”. Craniectomy for severely developmentally delayed children took hold momentarily at the turn of the century but then quickly fell out of favor due to high patient mortality, dubious clinical benefit, and opposition from the pediatric medical community. This misguided early foray into cranial vault reconstruction paused any further development on surgical skull correction for decades. It was pioneering work of Paul Tessier, a French maxillofacial surgeon, and Gerald Guiot a French neurosurgeon, who in the 1960’s brought surgery for the correction of craniosynostosis into the modern era. Continued refinement of their techniques has drastically reduced the morbidity and mortality initially associated with large reconstructive surgeries. Now, there are as many varieties of cranial vault reconstruction as there are surgeons who perform the procedure. Recent advancements include endoscopic suturectomy with concurrent helmet orthosis, spring assisted craniectomy, vault distraction, and virtually assisted open procedures. Even with so many varied techniques the goal has remained as Tessier famously stated: “If it’s not normal it’s not enough.”

Conclusion : The future of surgery for craniosynostosis will continue to push the boundaries of operative techniques. The utilization of virtual reality for pre-operative planning and intra-operative assistance, novel pharmaceuticals to decrease blood loss, and development of predictive AI models to create optimal individualized plans for each patient are all areas of promising future development.