Un paradosso solo apparente: metopismo associato a craniostenosi. Trattamento chirurgico originale

AN ONLY APPARENT PARADOX: METOPISM AND CRANIOSYSNOSTOSIS. AN ORIGINAL SURGICAL TREATMENT. Since tha dawn of civilty skull deformities have been considered as a sign fo Divinity, as they were a privilege, so that they have been also induced by sophysticated technique of asymmetrical skull compression. Gerolamo Cardano (1501-1576) descibed the art of divining the future by the study of the forehead and defined metopism the middle skull bones discontinuity due to diastais of the metopic and sagittal sutures. Craniosysnostosis is a premature fusion of one or more craniofacial sutures' systems, leading to craniofacial deformities. These malformation can be treated through a surgical technique that is undergoing continuous evolution. In the two cases reported, an Apert syndrome and brachycefaly both associated with metopism, we thought that decompression and remodelling wouldn't be adequate enough. The two little girls have been operated early (two months old) using an original technique which allowed decompression and remodelling of the volt, bases and orbits, in order to leave them room to develop. We also performed a sort of "bone synthesis" of the metopic suture using autologous bone fragments (acquired from the decompressive craniectomy) and human dura mater sterilized with gamma-rays for this purpose. Careful neuroradiologic study, especially 3D Computed Axial Tomography, enabled us to demonstrate the aesthetic and functional excellence of our results, since the very postoperatory time until more than five years of follow-up. We demonstrated re-expansion, the total remodelling and the correction of metopism with a good calcification of th metopic suture.