Moderne Behandlung von Kraniosynostosen
Open accessAbstract
Zusammenfassung: Hintergrund: Bei 13–48 % aller Lebendgeborenen treten Auffälligkeiten der Schädelform auf. Meistens ist ein lagerungsbedingter Plagiozephalus ursächlich. Bei vorzeitigem Verschluss von Schädelnähten resultieren pathognomische Deformitäten durch das kompensatorische Wachstum der umgebenden Schädelknochen. Es muss zwischen Einzelnahtsynostosen und Kraniosynostosen im Rahmen syndromaler Erkrankungen unterschieden werden. Ziel: Diese Arbeit soll einen Überblick über Diagnostik, konservative und chirurgische Therapie von Kraniosynostosen geben. Methoden: Narratives Review. Ergebnis: Bei Verdacht auf eine Kraniosynostose erfolgt zunächst die klinische Beurteilung und Einschätzung durch erfahrene Untersucher. Die pathognomische Schädelform ergibt die Arbeitsdiagnose. Bestätigt wird diese durch Verfahren wie 3D-Stereofotografie und Sonographie. In komplexen Fällen können CT oder MRT notwendig sein. Die Indikation für eine Therapie ergibt sich aus ästhetischen Gesichtspunkten und der Vorbeugung psychosozialer Folgen. Bei syndromalen Formen besteht diese insbesondere zur Vermeidung möglicher Folgen eines erhöhten Hirndrucks. Besteht die Indikation zur Operation muss zwischen endoskopischer und offener Technik unterschieden werden. Unterschiede bestehen hier hinsichtlich Invasivität und möglichem Korrekturausmaß. Im Anschluss an die operative Behandlung schließt sich häufig eine Helmtherapie an, um das bestmögliche Ergebnis zu erreichen. Die anschließende Follow-up-Periode erstreckt sich mindestens bis zum 12. Lebensjahr. Insgesamt sollte die Behandlung im Team mit Neurochirurgen, Mund‑, Kiefer‑, Gesichtschirurgen, Kinderärzten, Augenärzten und Humangenetikern stattfinden.
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Diagnosis of craniosynostosis is typically based on clinical examination focused on skull shape, with additional methods such as head circumference, cranial ultrasound, and 3D stereophotography, and CT or MRI reserved for complex cases.
“The diagnosis of craniosynostosis is typically based on a clinical examination focused on skull shape. Additional methods, such as head circumference measurement, cranial ultrasound (CUS), and 3D stereophotography, may be used, with computed tomography (CT) or magnet resonance imaging (MRI) reserved for complex cases [2, 7, 8].”
From Developments in diagnostic and surgical techniques in children with sagittal suture craniosynostosis: a systematic review spanning the last 30 years (2025) · cites this paper as [2]
In “Als erster” (page unavailable), the paper says the working diagnosis usually follows clinical assessment of skull shape; it also describes 3D stereophotography and cranial ultrasound, with CT or MRI used for complex or syndromal cases. It does not identify head-circumference measurement as an additional diagnostic method. “Nachbehandlung und Outcome” discusses head-circumference percentiles as a postoperative outcome measure instead. (LLM, conf=0.87)
Experimental — accuracy not yet measuredEarly diagnosis through detailed physical examination enables timely surgical intervention and helps minimise healthcare costs.
“Early diagnosis through a detailed physical examination not only enables timely surgical intervention but also helps minimise healthcare costs, underscoring the value of clinical expertise in managing this condition [2, 27].”
From Developments in diagnostic and surgical techniques in children with sagittal suture craniosynostosis: a systematic review spanning the last 30 years (2025) · cites this paper as [2]
The paper’s “Als erster” section describes clinical examination by an experienced examiner as the first diagnostic step. Its “Indikation” and “Nachbehandlung und Outcome” sections recommend early assessment and, in most cases where surgery is chosen, early correction. Our copy does not say that early diagnosis minimises healthcare costs (searched for Kosten and related terms). Page numbers were not available in the indexed passages. (LLM, conf=0.87)
Experimental — accuracy not yet measuredSonography up to 13 months of age can distinguish an open from a closed suture with a reported sensitivity of 100% and specificity of 86-98%, without anaesthesia.
“sonography up to 13 months of age can distinguish an open from a closed suture with a reported sensitivity of 100% and specificity of 86–98% [2, 32], without any necessary anaesthesia.”
From Developments in diagnostic and surgical techniques in children with sagittal suture craniosynostosis: a systematic review spanning the last 30 years (2025) · cites this paper as [2]
In “Redaktion > Als erster” (page unavailable), the paper describes sonography distinguishing open from ossified sutures, reports sensitivity of approximately 100% and specificity of 86–98%, and says it can be performed without sedation. It does not give a 13-month age limit, and its sensitivity figure is approximate rather than exactly 100%. (LLM, conf=0.88)
Experimental — accuracy not yet measuredClinical evaluation alone can accurately identify craniosynostosis, eliminating the need for imaging and reducing associated risks.
“Both Agrawal et al. and Schmidt et al. highlighted that clinical evaluation alone can accurately identify the condition, eliminating the need for imaging and reducing associated risks.”
From Developments in diagnostic and surgical techniques in children with sagittal suture craniosynostosis: a systematic review spanning the last 30 years (2025) · cites this paper as [2]
In “Als erster” (page not provided), the paper says clinical examination usually yields a working diagnosis from the characteristic skull shape. It does not say clinical evaluation eliminates imaging: the authors use suture ultrasound for final confirmation and reserve CT or MRI mainly for complex cases. They note that avoiding CT where possible reduces radiation exposure. (LLM, conf=0.90)
Experimental — accuracy not yet measuredDiagnostic confirmation typically involves measurement of head circumference, ultrasonography and, if required and technically possible, three-dimensional stereophotography.
“Diagnostic confirmation typically involves the use of methods such as measurement of the head circumference, ultrasonography and if required and technically possible three-dimensional stereophotography.”
From Developments in diagnostic and surgical techniques in children with sagittal suture craniosynostosis: a systematic review spanning the last 30 years (2025) · cites this paper as [2]
The diagnostic section (‘Als erster’; page unavailable) describes 3D stereophotography as established imaging and says the centre uses cranial-suture ultrasonography for final diagnostic confirmation. It describes measuring the cephalic index, not head circumference, during initial assessment; ‘Nachbehandlung und Outcome’ mentions head-circumference percentiles only as a postoperative outcome measure. The source also describes 3D scans at initial visits rather than limiting them to cases where they are required and technically possible. (LLM, conf=0.87)
Experimental — accuracy not yet measured
Endoscopic approaches are preferred in infants younger than 6 months, while open surgical techniques are typically used in older children.
“Endoscopic approaches are preferred in infants younger than 6 months, while open surgical techniques are typically used in older children [2, 50, 85].”
From Developments in diagnostic and surgical techniques in children with sagittal suture craniosynostosis: a systematic review spanning the last 30 years (2025) · cites this paper as [2]
The Indikation section recommends endoscopic surgery at about 3 months and says open surgery is particularly suitable for children first presenting at 6 months or older. But the Nachbehandlung und Outcome section says this centre also tends to choose open surgery when a child first presents after 4 months, so the paper does not support a general preference for endoscopy throughout the entire under-6-month group. Page numbers were not available in our copy. (LLM, conf=0.87)
Experimental — accuracy not yet measuredSchmidt et al. (2023) recommended determining cephalic index as particularly appropriate for scaphocephaly and for follow-up assessment after surgery.
“Another recommended method of assessment would be to determine the CI. This parameter is particularly appropriate for the presence of scaphocephaly and for follow-up assessment, even after surgery [2].”
From Developments in diagnostic and surgical techniques in children with sagittal suture craniosynostosis: a systematic review spanning the last 30 years (2025) · cites this paper as [2]
Schmidt et al. (2023) reported that sonography shows an echo-poor gap in intact sutures and a missing gap in ossified sutures, with sensitivity almost 100% and specificity 86-98% compared to CT.
“In the article published in 2023, Schmidt et al. explained that in sonography an echo-poor gap between the adjoining cranial bones can be recognised in an intact suture, which corresponds to the fibrous unclosed suture; in an ossified cranial suture, however, a corresponding gap is missing [2].”
From Developments in diagnostic and surgical techniques in children with sagittal suture craniosynostosis: a systematic review spanning the last 30 years (2025) · cites this paper as [2]
The effective use of these technologies requires specialized expertise for accurate interpretation.
“The effective use of these technologies still requires specialized expertise for accurate interpretation and further appropriate treatment recommendations based on the latest research findings [2, 6].”
From Developments in diagnostic and surgical techniques in children with sagittal suture craniosynostosis: a systematic review spanning the last 30 years (2025) · cites this paper as [2]
Today the most common approach for evaluating suspected craniosynostosis is a detailed clinical examination by skilled professionals, where characteristic skull morphology serves as the primary indicator for provisional diagnosis.
“Today the most common approach for evaluating suspected craniosynostosis is a detailed clinical examination by skilled professionals, where characteristic skull morphology serves as the primary indicator for provisional diagnosis.”
From Developments in diagnostic and surgical techniques in children with sagittal suture craniosynostosis: a systematic review spanning the last 30 years (2025) · cites this paper as [2]
Two primary surgical approaches are utilized for treatment of craniosynostosis: the (flexible) endoscopic-assisted technique and the conventional open surgical approach, with the choice depending on individual surgical planning and case specifics.
“Two primary surgical approaches are utilized for the treatment of craniosynostosis: the (flexible) endoscopic-assisted technique and the conventional open surgical approach, with the choice depending on individual surgical planning and case specifics.”
From Developments in diagnostic and surgical techniques in children with sagittal suture craniosynostosis: a systematic review spanning the last 30 years (2025) · cites this paper as [2]
In more challenging or atypical cases, additional imaging techniques like CT and MRI may be employed.
“In more challenging or atypical cases, additional imaging techniques like CT and MRI may be employed [2, 7, 8, 37].”
From Developments in diagnostic and surgical techniques in children with sagittal suture craniosynostosis: a systematic review spanning the last 30 years (2025) · cites this paper as [2]
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Cited by
Sorted by citations
Hermann, J., Raak, C. K., Ostermann, T., & Scharbrodt, W. (2025) · Orphanet Journal of Rare Diseases · doi:10.1186/s13023-025-03978-9 · Cited by 2 · see citing works
“Additional methods, such as head circumference measurement, cranial ultrasound (CUS), and 3D stereophotography, may be used, with computed tomography (CT) or magnet resonance imaging (MRI) reserved for complex cases [2, 7, 8].”
InfluentialSchneider, D. T., Weber, L. T., & Zepp, F. (2023) · Monatsschrift Kinderheilkunde · doi:10.1007/s00112-023-01786-8
- Authors
- Schmidt, L., Fassl, V., Erhardt, L., Winter, J., Lollert, A., Heider, J., & Ottenhausen, M.
- Affiliations
- Johannes Gutenberg University Mainz (DE)
- University Medical Center of the Johannes Gutenberg University Mainz (DE)
- Corresponding author
- Schmidt, Leon
- Venue
- Monatsschrift Kinderheilkunde
- Published
- 2023-01-20
- ISSN
- 0026-9298 (ISSN-L)
- 1433-0474
- OpenAlex
- W4317597426
- Cited by
- 2
- References
- 40
- Citations by year
- 2025: 1 · 2023: 1
- FWCI
- 0.33
- Type
- journal article
- Language
- de
- Open access
- hybrid
- doi.org
- Locations
- Monatsschrift Kinderheilkunde (publishedVersion, cc-by)
- Gutenberg Open Science (submittedVersion, cc-by-nd)
- Gutenberg Open Science (cc-by)
- Funders
- Universitätsmedizin der Johannes Gutenberg-Universität Mainz
- Topics
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Craniofacial Disorders and Treatments
- Health Sciences › Medicine › Surgery › Pectus Deformity Diagnosis and Treatment
- Health Sciences › Medicine › Surgery › Reconstructive Facial Surgery Techniques
- Keywords
- craniosynostosis, plagiocephaly, cranial sutures, syndromic craniosynostosis, endoscopic craniosynostosis surgery, helmet therapy, cranial deformity, cranial ultrasound, multidisciplinary care
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