Premature closure of cranial sutures, also known as cranial stenosis or narrow skull syndrome, is a collective term for a group of disorders in which the premature closure of cranial sutures in different areas affects the normal development of the skull and brain. How should premature closure of cranial suture be prevented and treated? Surgical treatment is the only effective method. The main purpose of surgery is to recreate a new bone groove through suture reconstruction or craniotomy to increase the size of the cranial cavity to ensure normal brain development. The two basic goals of surgical treatment are to repair the normal anatomy of the skull and to take advantage of the strong impetus of brain development during the first year of infancy. Therefore, the earlier the surgery is performed, the better the results are theoretically. Surgery should be performed within 7 months of birth for a better prognosis. The later the surgery, the worse the outcome. It is generally believed that if the child is physically capable, surgery should be performed as early as possible after birth to release the narrowed cranial cavity as soon as possible to facilitate the development of brain tissue. If only one or two cranial sutures are ossified, surgery can be performed 4-6 weeks after birth; if multiple cranial sutures are ossified and there is an increase in intracranial pressure, surgery should be performed 1 week after birth so that it can be successful. When optic nerve atrophy and mental retardation appear, even if surgery is performed, the neurological recovery is not satisfactory. At present, there is no unified standard for the indication of surgical treatment for narrow craniosynostosis. Because the purpose of surgery is different, the indications are also different. The indications for surgery include orthopedic indications, functional recovery indications, psychological and sociological indications, and so on. Sometimes psychological and sociological factors determine the indication of surgery, and full consent of the family is required for surgery. 1, early cases of surgical indications Early surgery is ideal, especially within 1 year of age, because this time the brain is growing vigorously, the cranial frontal has a greater impetus to facilitate postoperative reconstruction, playing a good role in shaping. If it is not an emergency, the most appropriate age for early surgery is 6 to 9 months after birth. The cranial deformities that can be operated on include oblique head deformity, triangular head deformity and navicular head deformity. In acute cases, this age limit may be disregarded and the main consideration is to ensure that neurological function is not compromised. Severe craniosynostosis, such as certain triangular head deformities with high frontal stenosis, navicular head deformities, and diffuse microcephaly, should be operated within the first few weeks of life. Short head deformity and craniofacial stenosis should be operated within 6 months after birth, preferably within 2 to 3 months after birth, and facial surgery should be operated after 2 to 3 years. It is emphasized that surgery within 1 year of age has the following advantages: ① it is convenient to cut and shape the bone flap; ② it is easy to assemble the bone flap, and the cranial defect will be repaired rapidly by reossification; ③ early surgery for craniofacial stenosis before facial deformity appears can improve or prevent future facial deformity; ④ it can prevent neurological damage and the occurrence of increased intracranial pressure. 2.Surgical indications for late cases Children within 1 to 3 years of age can take advantage of the continuing brain’s impetus for cranial reshaping and seek surgical treatment as early as possible. For children over 3 years old, the purpose of surgery is to rectify the craniofacial deformity or solve the functional problems because the brain growth phase is over. Therefore, the indications for surgery should be considered in terms of the degree of craniofacial deformity and functional impairment. There are objective indications for determining the degree of deformity, but the psychological and social impact of the deformity on the patient must be understood by the psychologist in direct interviews with the patient and family and by examination. The child’s self-perception of the craniofacial deformity is one of the main indications for the decision to operate. In cases of pre-existing neuroatrophic blindness and severe mental retardation, careful consideration should be given, as these secondary lesions are irreversible and not indicated for surgery. As for mild visual and intellectual impairment caused by mild intracranial pressure increase, surgical relief can be expected. The surgical approach is to incise the scalp and then first identify the ossified bone suture, then make a linear incision at the suture and over the adjacent normal bone suture, and insert polyethylene plastic in the suture to prolong the time for both sides of the skull to heal from each other. Another method is to open a groove at the original bone suture, about 1cm wide, remove the prematurely closed bone suture, both sides of the skull broken end, wrapped with polyethylene film, the length of both the bone groove and the wrapping film should exceed the adjacent bone suture, the effect of this method is more certain. 3, frontal suture premature closure surgery Surgery face up, coronal skin incision after hairline, from one side of the zygomatic arch to the other side, skin flap turned forward to expose the root of the nose, from the coronal suture to the root of the nose along the frontal suture to remove 3cm wide periosteum, remove 1cm wide cranial bone, which includes the frontal suture, proper hemostasis. Some scholars also used biting forceps or saws to bite open the skull from the midpoint of the coronal suture to both sides and turn to the supraorbital via the temporal area, converging at the nasal root and freeing both frontal bones. The cranial bones at the frontal suture and supraorbital rim were wrapped with polyethylene film, reset, and fixed 1 to 2 stitches on each side of the supraorbital, and 1 stitch was also loosely fixed between the two bone pieces, so that the bone flap would not be displaced and could expand forward with the growth of brain tissue to maintain the normal shape of the skull. 4.Coronal suture premature closure surgery The position and surgical incision are the same as above. 3cm wide periosteum is peeled off along the coronal suture, 1cm wide skull is removed, the length exceeds both sides of the squamous suture, and then both sides of the skull are wrapped with polyethylene film. 5.Sagittal suture premature closure surgery Lateral position, scalp incision along the sagittal suture, peeling along the sagittal suture, excision of 3cm wide periosteum, excision of 1cm wide skull, the anterior part should exceed the coronal suture and the posterior part should exceed the herringbone suture. Since the upper sagittal sinus is below the sagittal sulcus, the operation needs to be very careful and meticulous to prevent sinus rupture and bleeding. Instead of opening a bone groove at the sagittal suture, a 1 cm wide bone groove can be opened on each side of the sagittal suture, which should exceed the coronal suture and the herringbone suture, and the bone edges are wrapped with polyethylene film, which can avoid hemorrhage caused by injury to the superior sagittal sinus. 6.Human suture premature closure surgery Prone position, incision from the posteriormost side of the sagittal suture to the posterior side of both sides of the squamous suture, the same 3cm of periosteum is excised, a 1cm wide bone groove is bitten or sawed, preferably a hole is made on each side of the superior sagittal sinus and the posterior bite is opened to avoid injury to the superior sagittal sinus, care is needed near the papillae on both sides to avoid injury to the guiding vein, the bone edge is wrapped with polyethylene film, the bone groove must pass through the superior sagittal suture and exceed both sides the squamous suture. In recent years, some doctors perform total cranial reconstruction for patients with narrow skull, firstly, the frontal bone is truncated and removed, and then fixed in normal position after correction, which can effectively correct the deformity of frontal bone, supraorbital rim and frontal-nasal angle. This can effectively correct the deformities of the frontal bone, supraorbital rim and frontal-nasal angle. By freeing the large skull flap and rearranging it as desired, a normal anatomical skull can be shaped, thus opening a new and practical way for surgical treatment of craniosynostosis.