An Overcorrective Modification of Cranial Vault Reconstruction for Non-Syndromic Metopic Suture Synostosis: Shiraz Technique

Trigonocephaly reconstruction: Shiraz Technique




craniosynostosis, Trigonocephaly, Cranial vault reconstruction, Metopic suture


Introduction: Growth  restriction  of  frontal  bones  due  to  premature  closure  of metopic suture leads to the “Trigonon” shape of the skull, introduced by Welcker in  1862.  Paul  Tessier  introduced  cranial  vault  reconstruction  (CVR),  a  common craniofacial  procedure  for  treating  this  condition.  The  present  study  aims  to introduce a modified version of this procedure.

Methods: In this study, we present our experience with a modified version of CVR, named the Shiraz technique, used as asingle-stage overcorrective reconstructive method  for  isolated  metopic  suture  synostosis  with  limited  unique  threesome osteotomies. We also report 35 cases treated with this technique.

Results:The patient population comprised 26 males (74.3%) and 9 females (25.7%) with a mean age of 8.4 months (range: 3-13). The mean duration of the operation and  anesthesia  was  175.0  minutes  (range:  60-300).  The  mean  intraoperative bleeding and blood transfusion volumes were 95.6 ml (range: 20-250) and 75.3 ml (range:  0-320),  respectively.  The  main  complications  during  the  follow-up  were epidural   hematoma   (n=3,   8.6%;   one   case   needed   reoperation),   temporal hollowing  (n=2,  5.7%),  raised  intracranialpressure  (n=2,  5.7%),  wound  infection (n=2, 5.7%), and mortality in one of the cases, which was presumed to be due to air emboli.

Conclusions:The  Shiraz  technique,  as  a  novel  modified  version  of  CVR,  is  a  safe and  effective  technique  for  the  treatment  of  non-syndromic  metopic  suture synostosis with  low mean intraoperative blood  loss and transfusion. In the long-term  follow-up,  the  occurrence  of  temporal  hollowing  was  decreased,  and  the outcome showed a smooth anterior skull base


Download data is not yet available.

Additional Files



How to Cite

Masoudi MS, Zoghi S, Ansari A, Taherpour S, Shahriarirad R, Taheri R. An Overcorrective Modification of Cranial Vault Reconstruction for Non-Syndromic Metopic Suture Synostosis: Shiraz Technique: Trigonocephaly reconstruction: Shiraz Technique. Arch Pediatr Neurosurg [Internet]. 2024 May 1 [cited 2024 Jul. 25];6(2):e2312024. Available from: