Abstract:

Non-syndromic craniosynostosis (NSC) is a common congenital developmental malformation in childhood. It is characterized by the premature fusion of one or more cranial sutures, which in turn leads to abnormal skull morphology, increased intracranial pressure, and a series of neurodevelopmental problems. Depending on the different cranial sutures involved, NSC can present with various abnormal head shapes, such as scaphocephaly, trigonocephaly, anterior plagiocephaly, brachycephaly, and posterior plagiocephaly. Currently, surgical treatment remains the only effective intervention for NSC, aiming to release the fused cranial sutures, expand the cranial cavity volume, and restore normal cranio-maxillofacial morphology. In recent years, surgical concepts and techniques have been continuously evolving. The main surgical procedures include endoscopic-assisted strip craniectomy for prematurely closed cranial sutures, cranial vault remodeling (such as the Pi procedure and traditional extensive calvarial vault incision, release, and remodeling), and spring-assisted cranial vault remodeling. Endoscopic-assisted strip craniectomy is suitable for infants diagnosed within 3 months of age. This procedure is minimally invasive and allows rapid recovery; however, postoperative cranial remodeling depends on helmet therapy. The Pi procedure and total cranial vault remodeling can achieve immediate and significant expansion of cranial cavity volume and morphological correction during the operation, and are currently the most widely used surgical procedures for children over 3 months old. Spring-assisted cranial vault remodeling achieves gradual expansion of the cranial cavity through continuous traction forces, but a second operation is required to remove the implanted devices. The selection of surgical procedures needs to comprehensively consider factors such as the child′s age, type of deformity, intracranial pressure level, and the technical conditions of the institution, and also relies on the evaluation and collaboration of a multidisciplinary team. Although NSC surgery is generally highly safe, during long-term follow-up, postoperative recurrence and skull defects are still the most critical and clinically significant complications. Abnormalities in the reossification process are regarded as the key mechanisms leading to these complications. Future research should, on the basis of clarifying the mechanism of postoperative reossification, further integrate individualized surgical planning, the application of new biomaterials, and the evaluation of long-term neurocognitive and quality-of-life outcomes, so as to promote the transformation of NSC treatment from morphological correction to long-term functional optimization.

Key words: non-syndromic craniosynostosis (NSC), surgical procedure, postoperative complication, skull defect, reossification