**1. Introduction**

Simple craniosynostosis is a cranial deformity that occurs secondary to a premature closure of one or more sutures, with a consequent alteration in cranial growth and cerebral expansion. It develops during the first years of life and affects 1 in every 2000 to 2500 births worldwide [1]. The cranial alteration presents as flattening parallel to the compromised suture, with compensatory bulging in a perpendicular vector [2, 3].

The surgical treatment consists in cranial decompressions with suturectomies and simultaneous cranioplasties. Dynamic multiple revolution osteotomies allow the design of bone flaps that can help with decompression and correct secondary deformities caused by the synostosis. This multicenter descriptive case series study assessed 52 patients (12 plagiocephaly, 29 scaphocephaly, 7 brachycephaly

and 4 trigonocephaly) operated in Cali, Colombia. In each case, suturectomy and telescoping with multiple revolution cranial osteotomies were designed to correct each particular deformity. No clinical complications were observed in the postoperative period (1, 90, and 180 days), and excellent outcomes with no re ossification of sutures and maintenance of the cranioplasty, based on clinical observation and findings in the 3D reconstruction scans.

Craniosynostosis surgical techniques have evolved over time. Initially extensive craniotomies with or without the use of alloplastic substances between bone gaps were described to release de compromised suture and allow cerebral decompression. Uncertain and inconsistent results were observed, that usually required reoperations and ended in poor esthetic results [4–7]. Developing techniques included the addition of bone remodeling for the compensatory defects using cranial bone grafts (static remodeling) and the use of different osteosynthesis materials. Given the evidence around the rapid ossification during the first year of life, nowadays gradual osteogenic distraction is one of the preferred procedures associated to skull osteotomies and cranial bone flap remodeling [8]. Osteotomies that remove bone segments and relocate them as bone grafts for cranial remodeling, increase the possibility of complications due to dead space formation between dura mater and bone grafts [9].

Over time, distraction osteogenesis has become very important in the surgical treatment of craniosynostosis. In 1998, Lauritzen et al. [10] proposed the dynamic cranial remodeling technique with expansive springs, placed between the osteotomies (without dural dissection) thereby promoting expansive forces that prevented deformity recurrence. Salyer & Bardach [11] proposed, for the correction of scaphocephaly, posterior bi-parietal osteotomies molding bone grafts after separating them from the skull. Similar proposals were made by Tullous et al. [12] and Solís-Salgado & Anaya-Jara [13]. Cardim [14] presented excellent results with the use of springs and dynamic osteotomies (Nautilus), however, the maintenance of postoperative expansion was sometimes affected by the scalp flap or by positional effects.

The primary aim and motivation of our craniofacial surgery team in Cali, Colombia, is to find a stable maintenance option of the postoperative expanded shape. The proposal is to maintain the bone expansion achieved by telescoping (dynamic spiral) osteotomies with 2-center spirals, by placing absorbable plates at 180 degrees from each other, arranging them with a level-based organization according to each circumvolution (**Figure 1**).

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interventions.

*Telescoping with Multiple Revolution Cranial Osteotomies in Patients with Simple Craniosynostosis*

Two methods of classifications of craniosynostosis are used: anatomical and etiological. Anatomical classifications identify the fused cranial suture. There are four major sutures, and they can be altered as single metopic or sagittal sutures or as

Single suture synostosis most commonly involve the sagittal suture (45%), followed by coronal (22%), metopic (22%), and lambdoid (5%). Alternatively, an etiological classification emphasizes the primary cause of craniosynostosis. The two most common causes of craniosynostosis are restriction of fetal head movement during pregnancy and single gene disorders that predispose to suture fusion. Bilateral coronal and multiple suture synostosis occur with disproportionate

The indications for surgery and inclusion criteria were patients diagnosed with simple craniosynostosis without previous surgical treatment and who had evident cranial deformity verified with X-ray and tomography. Children between 3 months and 4 years old. Excluded patients were those with syndromic craniosynostosis, children with previous surgical treatments, and patients with indication of mini-

A multidisciplinary medical group consisting of a plastic surgeon, pediatric neurosurgeon and anesthesiologist asses all patients. To support the best surgical plan, 3D imaging Ct scans are performed. Its required to guarantee for all patients a strict monitoring of the anesthesia including colocation of central catheter, arterial route, bladder catheter ant temperature monitoring. It's also required to have guaranteed intraoperative blood transfusion. After the intervention all patients are transferred to intensive care unit. The first follow up of the patients are done every 3 months and then 3 more follow ups every 6 months until the second year after the

Patients that had cranioplasty surgery with a telescopic osteotomy, were divided in subgroups according to their alterations for surgical purposes. These subgroups are: Diagnosis of scaphocephaly, brachyophaly, plagiocephaly, and trigonecephaly. Patients with the scaphocephaly diagnosis are intervined with the "PI" technique

*DOI: http://dx.doi.org/10.5772/intechopen.94926*

**2. Classification of Craniosynostosis**

paired coronal and lambdoid sutures.

frequency in syndromic cases.

**3. Presurgical preparation**

mally invasive cranial correction.

**Figure 1.** *(A) 2 centered spiral shape; (B) Representation of the spiral osteotomies.* *Telescoping with Multiple Revolution Cranial Osteotomies in Patients with Simple Craniosynostosis DOI: http://dx.doi.org/10.5772/intechopen.94926*
