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Fronto-orbital Advancement Using an En Bloc Frontal Bone Craniectomy

Guzman, Raphael MD*; Looby, Joseph F DO†; Schendel, Stephen A MD†; Edwards, Michael S B MD*

doi: 10.1227/NEU.0b013e31820780cd
Operative Technique

BACKGROUND: Fronto-orbital advancement is a procedure commonly performed in craniofacial centers for coronal and metopic suture synostosis. Several variations of the technique have been reported.

OBJECTIVE: To describe our modifications to the anterior cranioplasty procedure and the results of our surgical series.

METHODS: Using our craniofacial database, we retrospectively analyzed the records of all patients undergoing fronto-orbital advancement for craniosynostosis. The same team of neurosurgeons and plastic surgeons performed all procedures. Demographic data, operative time, blood loss, length of stay, and clinical outcome were analyzed.

RESULTS: Of 248 patients treated for craniosynostosis, a total of 70 patients underwent fronto-orbital advancement. Nineteen presented with metopic, 26 with unilateral coronal, 17 with bilateral coronal, and 8 with multiple synostosis. Median age at surgery was 6.5 months. Mean operative time was 210 minutes; mean blood loss was 167 mL; and length of stay was 4.5 days. A positive correlation was found between operative time and blood loss (r = 0.1, P < .01) and age at surgery and blood loss (r = 0.3, P < .0001). There was a minor morbidity rate of 2.9%. A good reconstruction was obtained in all patients using our en bloc fronto-orbital advancement without any midline osteotomies at a mean follow-up of 15 months.

CONCLUSION: A team approach and the application of a standardized surgical technique should make it safer to operate in young children, shorten the surgical time, and lead to a reduction in blood loss. Reconstructing the frontal bone as an entire unit yielded excellent correction for coronal and metopic synostosis.

Divisions of *Pediatric Neurosurgery and †Pediatric Plastic Surgery, Lucile Packard Children's Hospital, Stanford University School of Medicine, Stanford, California

Received, April 8, 2010.

Accepted, August 1, 2010.

Correspondence: Raphael Guzman, MD, Department of Neurosurgery, Division of Pediatric Neurosurgery, Stanford University School of Medicine, 300 Pasteur Dr, R211, Stanford, CA 94305-5327. E-mail:

Copyright © by the Congress of Neurological Surgeons