Minimally Invasive Versus Open Cranial Vault Remodeling Procedures for Single-Suture Craniosynostosis What Do We Know?

Cranial vault expansion successfully improves phenotype in the short and long terms and reduces the risk of intracranial hypertension in patients with single-suture craniosynostosis. Multiple surgical techniques can achieve reasonable results for each of these conditions, and decision-making among them out incorporate patient age and deformity phenotype, family preferences and potential for compliance, and surgeon technique familiarity. Scar burden and perioperative morbidity of blood transfusion, operative length, and hospital length of stay are all decreased with the minimally invasive approaches to cranial vault expansion. However, spring-assisted cranioplasty and distraction osteogenesis necessitate the removal of the hardware and postoperative helmeting requires regular visits to the orthotist for helmet refitting for the first year of life. Neurocognitive outcomes between surgeries are heterogeneous and divergent, reflecting the complexity of cognitive evaluations. For sagittal craniosynostosis, both open cranial vault remodeling and minimally invasive techniques effectively reduce intracranial pressure and improve cranial shape, though long-term outcomes need further study. In metopic craniosynostosis, traditional FOA remains the gold standard, with minimally invasive alternatives having mixed esthetic outcomes with difficult reproducibility thus far. Coronal craniosynostosis can be addressed with traditional FOA or minimally invasive suturectomy with helmeting or the use of distraction osteogenesis. Lambdoid craniosynostosis, the rarest form, requires differentiation from deformational plagiocephaly and timely intervention to prevent any lasting asymmetries. While the short-term esthetic outcomes for minimally invasive techniques are promising, true success rates will need to be determined with long-term follow-up to skeletal maturity. In order to ensure the most effective and individualized care for children with craniosynostosis, our field needs more multicenter collaboration to find the best solutions for each diagnosis, phenotype, and patient.