This paper argues for a re-examination of the indications for an operation that has become the accepted first-line surgical treatment of many units treating children with syndromic forms of Craniosynostosis. The "modern" era of management of patients with syndromic and other complex forms of Craniosynostosis can be said to have started with the work of Tessier in the 1950's and 60's. At much the same time it became appreciated that the defective vision often affecting these patients (sometimes complete blindness) was due not to constriction of the optic nerves in abnormally narrowed optic canals but to chronic raised intracranial pressure (ICP). The fron-to-orbital advance (FOA) as described and advocated by Marchac and Renier for the routine early surgical management of children with Crouzon, Pfeiffer and Apert syndromes was designed to deal with this problem by increasing the intracranial volume (ICV). It also provided a degree of protection for proptosed eyes and finally it had some cosmetic benefit - particularly in less severely affected children.
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