Test on Nonsyndromic Craniosynostosis: Diagnosis and Treatment

Question 1: In the skull vault remodeling technique for lambdoid synostosis, the transposed bone flaps are primarily fixed using non-resorbable plates.

A. Yes

B. No

Explanation: The study materials state that the transposed bone flaps "are fixed anteriorly with resorbable plates."

Question 2: According to the study materials, which of the following are objectives in surgically correcting bicoronal synostosis using a bifrontal craniotomy and bilateral frontal bandeau?

A. To position the supraorbital rim 2–3 mm ahead of the corneal zenith.

B. To advance the anterior dimension, creating greater forehead prominence.

C. To narrow the width by creating a midline endocranial flexion.

D. To replace the abnormal supraorbital bar with reshaped frontal bone from the contralateral side.

Explanation: For bicoronal synostosis, current techniques involving a bifrontal craniotomy and creation of a bilateral frontal bandeau aim to advance the anterior dimension for greater forehead prominence, position the supraorbital rim 2–3 mm ahead of the corneal zenith, and narrow the width by creating a midline endocranial flexion or median ostectomy. The option about replacing the supraorbital bar with bone from the contralateral side is described for unicoronal synostosis, not bicoronal synostosis.

Question 3: Is biparietal widening promoted by the use of spring devices when placed along the sagittal suture?

A. Yes

B. No

Explanation: The study materials state that biparietal widening is promoted by the use of spring devices when placed along the sagittal suture.

Question 4: According to the study materials, which of the following factors are indicated as influencing the need for reoperation in nonsyndromic craniosynostosis?

A. The age of the patient at the time of the initial operation.

B. The type and severity of the original synostosis.

C. The specific surgical technique employed during the primary procedure.

D. The patient's diet and nutritional status post-surgery.

Explanation: The study materials state: 'The need for secondary surgery depends on the type and severity of the original synostosis, the age of operation, and the technique used.' It also mentions 'reoperation was required more often in infants treated sooner than 6 months compared to 6–12 months' and that bicoronal synostosis and sagittal fusion can have high reoperation rates, and asymmetric deformities are more prone to secondary adjustments. There is no mention of diet or nutritional status influencing reoperation rates.

Question 5: The most common early complication following cranial vault remodeling is severe meningitis with a persistent CSF leak.

A. Yes

B. No

Explanation: The study materials state that early complications following vault remodeling are rare, and wound infection and dehiscence occur in less than 1% of cases. Meningitis is also infrequent. Therefore, severe meningitis is not described as the most common early complication.