Radical Cranio-orbital Reconstructive Procedures for Cloverleaf Skull Deformity in Adult: Operative Technique for the Longest Survivor

Cosmetic cranio-orbital reconstructive surgery was carried out on a 22-year-old male, the longest surviving case of cloverleaf skull syndrome reported. He previously underwent classical linear suturectomy for synostotic sutures and temporal cranioplasty. Fortunately, hydrocephalus became arrested so did not require continuous cerebrospinal fluid drainage through shunt tube. His intelligence quotient was in the 40s. The present problem was mainly of cosmetic cranio-orbital corrections of shallow orbits with resultant exophthalmos, frontal dysgenesis, and marked temporal bossings. Bilateral orbital advance, lateral canthal/pterional reshaping, frontal remodeling, and temporal reduction cranioplasty were performed. The postoperative outcome was satisfactory. The cloverleaf skull deformity is etiologically and pathologically heterogeneous, so radical surgical reconstructive procedures should be planned and designed individually.