The goal of treatment is to position this bar together with the frontal bone in a plane three millimetres further forwards than the vertical plane of the cornea. A two-dimensional sagittal image is used to pre-operatively determine the extent of movement, which can vary between seven and fifteen millimetres depending on the severity of the deformity.The orbital asymmetry exists typically of a narrower and taller orbit at the ipsilateral side of the head. The contralateral orbit, however, is wider than usual. Symmetry is restored by extracting a small piece of bone from the supraorbital bar at the contralateral side, thereby reducing the width. This bone fragment is then introduced into the supraorbital bar on the ipsilateral side, thereby increasing width. The height of the orbit is altered at the ipsilateral side only, by extracting a piece of bone. Any correction of the nasal tip, which points towards the contralateral side, will not be performed during childhood. Unilateral lambdoid synostosis/posterior plagiocephaly
An excision of the flattened occipital bone with release of the fused suture tends to correct the cranial vault deformity. Bilateral coronal synostosis/brachycephaly
The treatment of bilateral coronal synostosis shows a high degree of overlap with treatment of unilateral coronal synostosis; in both surgical interventions is the forward advancement of the supraorbital rim together with the frontal bones is an important part of the procedure. Again, the plane three millimetres further forwards than the vertical plane of the [cornea] is the appropriate position to place the bone.
Elevated intracranial pressure
When the ICP is elevated the following symptomes may occur: vomiting, visual disturbance, bulging of the anterior fontanel, altered mental status, papilledema and headache.The main risks of prolonged elevated intracranial pressure may include cognitive impairment and impaired vision through prolonged papilledema and subsequent optic atrophy. These are the main reasons why fundoscopy should be performed during the physical examination of children with craniosynostosis.The causes of an elevation of the intracranial pressure are best understood using the Monro-Kellie doctrine. The Monro-Kellie doctrine reduces the cranial vault to a box with rigid walls. This box contains three elements: brain, intracranial blood and cerebrospinal fluid. The sum of volumes of these three elements is constant. An increase in one should cause a decrease in one or both of the remaining two, thereby preventing an elevation of the intracranial pressure.A compensatory mechanism involves the movement of cerebrospinal fluid from the cranial vault towards the spinal cord. The volume of blood in the cranial vault is auto-regulated by the brain, and will therefore not decrease that easily.Intracranial pressure will rise as a result of continued brain growth within the rigid skull. It appears that in children with craniosynostosis, the expected decrease of intracranial blood is probably not occurring as it should according to the Monro-Kellie hypothesis. This is shown when the brain expands in the fixed skull, which gives a faster rise in intracranial pressure than would be expected. Obstructive sleep apnea
The short stops in breathing during the sleep are the mainstay of OSA.