About the operative management and post-operative neural development of patients with cloverleaf skull deformity.

INTRODUCTION

We present our treatment concept for cloverleaf skull deformity on the basis of two representative cases that had been presented to our multidisciplinary skull deformity board.

METHODS

Perioperatively, we monitored electrophysiologic parameters with median nerve somatosensory-evoked potentials (SSEP), tibial nerve (T) SSEP, brainstem acoustic-evoked potential and flush-elicited visual-evoked potential, as well as intracranial pressure. Both patients underwent decompressive bilateral vault craniectomy, frontal and occipital reshaping at an age of four months.

RESULTS

Secondary fronto-orbital advancement and cranial vault reshaping was performed after maximal vault reossification was reached at an age of 8 and 12 months, respectively. Additionally, one of the patients underwent treatment of a Chiari malformation via suboccipital decompressive craniectomy and tonsillary resection, as well as ventriculoperitoneal shunting for hydrocephalus.

DISCUSSION: The patients showed nearly unrestrained neural and neurophysiological development over a follow-up period of 5 years.