Abstract
There is currently no consensus on the surgical attitude to be adopted for late management of sagittal synostosis or for revision scaphocephaly surgeries without prolapse of the cerebellar tonsils. We present here a monocentric retrospective study of nine patients operated consecutively by a fixed expansion method of the cranial vault which may be associated with a fronto-orbital remodeling. The procedure consists in the realization of multiple parietal tongue-in-groove osteotomies fixed by resorbable plates. Simultaneous fronto-orbital remodeling have been performed when needed. No intraoperative complication was noted. The average operating time was 141min. Six patients (66.7%) had a blood transfusion during the perioperative period. The average hospital stay was 4.8days. With a mean follow-up of 26,7months, no surgical revision was noted. In all patients with clinical or ophthalmologic signs of intracranial hypertension, we highlighted a disappearance of signs within 4months. No protective helmet has been used. The craniofacial remodeling was judged very good by the family and the surgical team. Multiple tongue-in-groove tenons remolding cranioplasty associated or not with a fronto-orbital advancement is a safe technique. It seems to us to be a good alternative to floating or fixed bi-parietal or bi-parieto-frontal cranial flaps because of the very large increase in endocranial volume and the possibility of physiologically and aesthetically remodeling the parietal and fronto-orbital regions.