ABSTRACT
The surgical management of raised intracranial pressure and abnormal head shape in craniosynostosis has focused on interventions that increase the cranial vault volume to allow the brain space to develop. Historically, procedures that addressed the anterior part of the skull were utilised predominantly. This chapter describes the early experiences with posterior skull surgery by the Craniofacial Surgery Unit, Queen Elizabeth and Children's Hospitals, Birmingham, UK. The circumferential occipital craniectomy was employed in all the syndromic patients, with the bilateral flap technique utilised in non-syndromic patients. The inadequacy of fronto-orbital advancement as the primary treatment modality for complex craniosynostosis patients is believed to be due to the relatively small gains in intracranial volume achieved with these procedures when compared to procedures on the posterior skull. Procedures for expansion of the posterior cranial vault were developed to increase intracranial volume, address intracranial hypertension, and redirect cerebral expansion posteriorly.
