The Pantheon Variant of the Classic Cathedral Dome Procedure for Parieto-Occipital Skull Deformities.

OBJECTIVE: To describe a new technique for the reconstruction of parieto-occipital skull deformities. METHODS AND RESULTS: The technique is a variant of the previously described "cathedral dome procedure" used for frontal skull deformities. The authors apply the same principle of remodeling by making meridional slat craniotomies surrounding the depressed dome of the posterior skull deformity, followed by "green-stick fracture-reshaping" of the meridional slats to elevate and support the excised depressed dome. The authors present an illustrative patient with a follow-up of 2 years and an excellent cosmetic result. CONCLUSION: The authors introduce a new operative technique for the reconstruction of parieto-occipital skull deformities with excellent long-term results. The freshly reconstructed occiput resembles the dome of the pantheon in Rome, Italy, whose unique features inspired us to name this procedure the "Pantheon" variant of the cathedral dome operation.

Parallel angulated frontal bone slat cuts for treatment of metopic synostosis and other frontal skull deformities: the "cathedral dome procedure".

PURPOSE: This study aims to describe a new procedure for the treatment of metopic synostosis and other frontal skull deformities. METHOD: The procedure comprises a supraorbital bandeau widened with an interpositional graft and rounded laterally to eliminate the acute angle, and parallel angulated slat cuts in the frontal bones. Greenstick fracturing of the medial bases of these slats along a parasagittal hinge line causes fanning of the slats and expansion of the frontal flap both anteriorly and laterally making the forehead contour wider and more rounded. We performed this procedure on six infants (four with severe trigonocephaly from metopic synostosis, one with brachycephaly from bicoronal synostosis, and one with multiple suture synostosis and parietal flattening) for whom only the angulated slat cuts (without bandeau) were used. Each patient had preoperative three-dimensional computed tomography (3D-CT) and postoperative 3D-CT at 1 week, 3 months, and 12 months, to follow the result. RESULT: The cosmetic improvements are dramatic in eliminating the midfrontal keel, hypotelorism, frontal-lateral retrusion, and temporal hollowing seen in severe metopic synostosis. In coronal synostosis, the procedure corrects the brachycephaly and gives a balanced, well-rounded frontal contour. The end results of the fronto-orbital correction resemble the ribbed dome of a cathedral; hence, the moniker the "cathedral dome procedure". No patient needed a second procedure to fill in cranial defects or recorrect deficient areas. CONCLUSION: The parallel angulated frontal slat cuts technique (the "cathedral dome procedure") is a straightforward and easily mastered method that reliably produces excellent result for the correction of trigonocephaly and other frontal skull deformities.