1. Neurocranial suture transplantation in synostosis from experiment to clinical application

3. Hunter, 1798 Brash, 1934 Bair, 1954 Growth of the neurocranium

4. Growth stimulus - mechanical tension theory - biological signalling theory

5. Endosteal layer Meningeal layer

6. Growth factors TGF-beta, FGF, BMP Transcription factors Msx2, Twist, Runx2 Suture development Fusion or synostosis periosteum dura mater

7. Radical remodelling and suture transplantation Stricker & Raphael, 1993

8. but:

10. 10 days postoperatively

11. 5 months postoperatively

12. 15 months postoperatively

13. 14 days postoperatively 5 months postoperatively 15 months postoperatively Cleft Palate Craniofacial J 38: 533-537, 2001

14. Hypothesis A neurocranial suture autograft will, when shielded from dura, be incorporated into the calvarium and grow.

17. 2,5 cm

18. Postnatal day 9 Postnatal day 90

20. 5 does 6 siblings from each nest 10 “sham”-treated 10 with left coronal suture blocked at foetal age of 25 days 9 with blocked suture, and coronal suture transplantation from right to left, with interpositioning of platina foil on day 9 postnatally All with titanium “markers”

21. Measurements day 9 day 90 = doubled skull length

22. over left coronal suture over right coronal suture sham-treated 7 (0,2)7 (0,3) blocked left-sided suture 1,6 (0,2)5,8 (0,3) transplanted suture 6,6 (0,3)7,3 (0,3) mm, SD Child Nerv Syst 19: 211-216, 2003 Results

23. Conclusion A suture autograft grow when shielded from direct dural signals

24. (non-decalcified 30  m slice, van Stevenels blue & Von Giesons picrofuchsin staining X40)

26. J Craniofacial Surgery 12: 547-554, 2001 A

28. 4.5 mm 10 mm 12.5 mm 11.5 mm 10 mm 10 days 11 months 13.5 mm

29. 12 months difference

30. prior to surgery 2 j,7m postoperatively J Cranio-Maxillo-Facial Surgery 31:1-7, 2003 8j postoperatively

31. brachycephaly

33. 15-03-20059-2-200406-05-2004 4.35 4.54

34. 20-05-2005 09-11-200502-07-2007 1.77 2.16

35. no mechanical stimulus ! 12-02-200726-03-200709-07-2007 1.24 1.83

36. Prospectives  is a biomechanical stimulus (fixation and early incorporation) necessary as part of the concept? Animal research  is radical remodelling still required? Multicenter clinical audit