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Total Calvarial Reconstruction for Metopic cranial synostosis (Trigonocephaly)

1/9/2015

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Preoperative view
Note the triangular forehead deformity
Marking for the bicoronal incision
Craniotomy using Advanced, self-stopping, rotatory craniotome
Intraoperative view showing the manner in which bone has been cut
Dissected bone fragment with multiple releasing cuts for future growth
Dissected specimen for reassembly
Fixing of bone fragments using resorbable plates and screws using special screw driver
Assembly of bone fragment
Reapproximated bone fragments with proper positioning
Reorientation of entire skull cap
Post operative view
Picture
Post operative view
A 3 year old girl from Iraq reported with triangular shaped forehead deformity. Patient was evaluated and diagnosed as a case of nonsyndromic trigonocephaly, which is a premature fusion of the bone joint along the middle of the forehead called the metopic suture. As the early fusion of bone does not permit the growth of the brain it will lead to the increased pressure causing cognitive impairment & delayed mile stones. Owing to these dangerous effects with the progressive growth, her parents brought her to our hospital. Maxillofacial Surgeon Dr. S.M. Balaji successfully performed Craniotomy with Total Calvarial Reconstruction with the goal of aligning the midsutural fused area thereby preventing all associated complication.

Using an advanced, self-stopping, rotatory craniotome, the cranium is cut in to several pieces. The entire skull crown is dissected in several pieces and reassembled to accommodate the growth of the brain with suitable repositioning. Then the re-approximated bones are held together by a bioresorbable plate and screws. The specially designed screw driver is used which creates a small electric discharge creating a strong anchorage holding the bone in place. The entire skull cap is reoriented, approximated and fixed. The change in skull is visible in the immediate post-operative period. The usage of bioresorbable screw and plate removes the requirement of a re-surgery to remove the plates.

In future, the brain would be accommodated in the enlarged, spacious cranial vault thus all the dangerous complications have been evaded.
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