Craniosynostosis

Fig. 25.6. Posterior sagittal synostosis. a Occipital knob, pathology (left) and correction (right). b Golf tee deformity, pathology (left) and correction (right). c Bathrocephaly, pathology (left) and correction (right).

In a prone position, a bi-parieto-occipital craniotomy is performed and remodeled using radial osteotomies and controlled out-fractures (Fig. 25.8b). Bilateral occipital barrel-stave osteotomies are performed. Controlled out-fractures are fashioned ipsilateral, and in-frac-tures contralateral to the fused lambdoidal suture.

What had once been called lambdoid synostosis is now recognized as positional plagio-cephaly. In positional plagiocephaly, the skull affects a parallelogram shape (Fig. 25.8c). The ear and frontal bones are forward, creating an ipsilateral occipital flattening and frontal bossing. Unless severe, this entity does not require surgery. Some patients, however, with severe positional molding have significant ipsi-lateral frontal bossing and are unlikely to correct with conservative treatment. These patients are placed in a modified prone position. The posterior correction proceeds as with true lambdoid synostosis. The anterior correction is

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