Evolution of craniosynostosis treatment methods

Various skull deformities have long been known to mankind. The first descriptions of such conditions date back to antiquity and were provided by Gallen and Hippocrates. By the 16th century, an understanding of the role of the cranial suture had developed among anatomists. However, it was only at the end of the 19th century that S.T. von Semmering became the first to move from a simple description of cases to the application of scientific principles to study abnormal growth of the skull. He recognized the importance of cranial sutures in the growth of the skull and the consequences of their premature closure within our current understanding of craniosynostosis and the subsequent treatment. Later, in 1851, R. Virchow published a landmark article in the history of the study of craniosynostosis, in which he described the fundamental rules for the growth of the skull when sutures are affected, which are called Virchow’s law. This rule has become a fundamental principle in understanding the processes of craniosynostosis. For the first time, the results of surgical treatment of craniosynostosis were published at the end of the 19th century by O.M. Lannelongue in 1890 and L.C. Lane in 1892, linear craniectomy was performed in the area of the affected suture. However, their attempts were unsuccessful. Subsequently, a neurosurgical approach was used in the treatment of craniosynostosis, consisting in excision of the affected sutures, and materials were searched for to prevent their repeated fusion. In the 70s of the XX century, P. Tissier revolutionized the concept of treatment of this pathology by scientifically substantiating and successfully applying the tactics of craniofacial modeling. The improvement in diagnostic methods, studying the pathogenesis of craniosynostosis and the morphological and functional changes of the skull and brain resulted in the emergence of the earliest possible treatment concept. The improvements in minimally invasive surgery techniques and the development of surgical technologies and techniques made it possible to correct craniosynostoses using endoscopy followed by orthotic therapy. The treatment is also carried out with the use of distraction devices, based on the method of compression-distraction osteosynthesis proposed by G.A. Ilizarov.

Conclusion. Assessing the global experience in the treatment of craniosynostoses, we can say that the evolution of craniosynostosis surgery techniques is evolving towards shorter operative times, minimally invasive interventions, minimized blood loss, reduced hospital stay, reduced perioperative risks and complications, such as infection, postoperative liquorrhea, dura mater sinus damage, perioperative brain injury. However, there is quite a significant number of patients older than 2 years of age having nonsyndromic craniosynostoses. Studying the peculiarities of the course of the disease at this age, the possibility of using the same diagnostic and surgical techniques as in young children and evaluating the effectiveness of the existing surgical techniques is an important objective to develop adequate management strategy for these patients, which will improve their social status and quality of life.

Key words: nonsyndromic craniosynostosis, sagittal craniosynostosis, scaphocephaly, craniofacial surgery, surgical treatment of craniosynostoses 

Conflicts of interest. The author have no conflicts of interest to declare.
Funding. There was no funding for this study