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Arquivos de Neuro-Psiquiatria

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ALMEIDA, Gilberto Machado de  and  BARROS, Nélio Garcia de. The surgical management of craniostenosis: Analysis of 25 cases. Arq. Neuro-Psiquiatr. [online]. 1965, vol.23, n.4, pp.231-252. ISSN 0004-282X.

Craniostenosis is know since Hippocrates but its pathology began to be correctly understood only a hundred years ago, with Virchow's papers. Surgical attempts for its treatment started in 1888, and were well standardized since 1920. In order to avoid some confuse expressions used in the literature the authors employed the classification based on the affected suture and the associated malformations. From 1959 until 1964 40 patients were examined, and 25 of them were surgically treated. These cases were specially analysed and regarding its type they were divided as follows: premature fusion of the sagital suture (10 cases), premature fusion of the coronary suture (4), premature fusion of the sagital and coronary sutures (2), premature fusion of the metopic suture (2), unilateral premature fusion of the lambdoid suture (1), Apert's syndrome (2), Crouzon's disease (1). Clinical, radiological and therapeutic aspects of each type were commented. Recently, some authors do not indicate surgery in cases with only one fused suture. We will continue to indicate early surgery with prophylactic aim, in such cases. We believe that the surgery in the earliest months not only prevents sequels, but is less traumatic and leads to better plastic results. There is not a good technique to be employed with the aim of preventing bone regeneration and re-establishment of craniostenosis. We obtained unsatisfactory results with the lining of the bone edges with polyethilene or silicone. In some cases the newly formed bone grew over the plastic material and re-established the craniostenosis. In two cases the plastic material had to be removed because of local infection. It is not yet an established fact that the use of special solution can avoid the periosteum osteoblastic activity of the periosteum. We have no personal experience with these solutions and intend to test them from now on.

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