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John Persing, William Babler, H. Richard Winn, John Jane, and George Rodeheaver

✓ The effect of timing of the surgical release of prematurely immobilized coronal sutures was studied in rabbits. At 9 days of age, the coronal suture was mechanically immobilized by the application of methyl cyanoacrylate adhesive. These animals and a control group then received metallic implants on each side of the suture to monitor growth. At 30, 60, or 90 days after suture immobilization, separate groups of animals underwent a linear suturectomy to release the restriction. In animals in which the suture was not released, growth at the coronal suture was significantly restricted and resulted in severe deformities in the neurocranium. The benefits derived from surgical release were time-dependent. Suturectomy at 30 days of age resulted within 60 days in achievement of 100% of the growth in sham-treated controls. In contrast, delayed surgery at 60 or 90 days of age resulted in achievement of only 38% and 17% of normal growth, respectively. Angular measurements of the vault and base of the cranium showed a similar graded response toward normality, with the greatest correction occurring with the earliest operation. These results support the clinical impression that early surgical correction of craniosynostosis results in superior cosmetic appearance. A further implication of this work is that abnormality at a single suture strongly influences the development of other areas in the craniofacial complex.

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George Tyson, W. Ellis Strachan, Peter Newman, H. Richard Winn, Albert Butler, and John Jane

✓ A consecutive series of 48 adult patients with a chronic subdural hematoma is reported. These patients were treated according to a protocol consisting of a sequence of conventional surgical procedures ranging from simple burr-hole drainage to craniotomy and subdural membranectomy. Seven patients (15%) continued to demonstrate severe neurological dysfunction, or suffered acute neurological deterioration after completion of this protocol. However, after undergoing excision of the cranial vault overlying the hematoma site, six of these seven patients demonstrated a significant clinical improvement. Based on analysis of these seven cases, the authors suggest that craniectomy be considered in those patients who suffer a symptomatic reaccumulation of subdural fluid following craniotomy and membranectomy, or who demonstrate further neurological deterioration as a result of cerebral swelling subjacent to the hematoma site. However, this procedure probably has no efficacy once extensive cerebral infarction has occurred.