# Personalized Bone Reconstruction and Regeneration in the Treatment of Craniosomiasis
### Craniosynostosis: A Heterogeneous Condition
(**b**) 3D reconstruction of a patient’s skull CT (computerized tomography) showing a synostosis of the atopic suture (the second most prevalent nonsynormic craniosynostosis (CS), see text for details), in frontal (**left**) and superior (**right**) views; black arrows indicate the fused metric solute white arrows indicate the open sagittal suture. The magnifications in the lower panels represent a diagram of the tissue architecture at the fused (**left**) and open (**right**) suture sites. Mesenchymal stromal cells (MSC) are viable within the open suture mesenchyme until the suture is ossified. Informed consent by both the parents of the patients was obtained prior to use the CT scan for assembling the figure. cause increased intracranial pressure and correct the craniofacial deformity. Pediatric cranial vault surgery is inherently invasive and typically requires blood transfusion, which account for most of the public health burden of the disease [24; 25]. Despite the lack of a clear consensus on the optimal timing for CS intervention, this is usually performed within the first year of life. An early surgical treatment allows reducing the invasiveness and complexity of the procedures and the risk of perioperative complications [26], significantly impacting on the risks of prolonged brain growth restraint, and yielding better cosmetic and functional outcomes [27; 28; 29; 30]. Patients with complex and/or syndromic CS, especially in the presence of proven genetic causes, typically require multiple surgeries, with increased burden and consequently worse prognosis [31]. Indeed, a personalized surgical planning driven by the knowledge of the specific genetic background of the patient may dramatically improve the clinical and neurodevelopmental outcome [32]. \begin{table}
\begin{tabular}{l c c c} \hline \hline \multicolumn{1}{c}{\multirow{2}{*}{**Syndrome(s) or Phenotype**}} & **OMIM ID and/or PubMed** & \multirow{2}{*}{**Involved Suture(s)**} & **Gene** \\  & **Reference** & & **Symbol** \\ \hline
**3C SYNDROME-LIKE** & 603527 & Sagittal & _DPH_1 \\
**PHENOTYPE** & & & \\
**3 MC SYNDROME 3** & 248340 & Lambdoid & _COLEC10_ \\ \hline
**3 MC1 SYNDROME 1** & 257920 & Lambdoid, coronal & _MASP1_ \\
**ACROCEPHALOPOLYDACTYLOUS** & 200995 & - & - \\
**DYSPLISA** & 200995 & - & - \\
**ACROCEPHALOPOLYSYNDACTYLY** & 101120 & - & - \\
**TYPE III** & & & \\
**ACROMELIC FRONTONASAL** & 603671 & Coronal, lambdoid & _ZSWIM6_ \\
**DYSOSTOSIS** & & & \\ \hline
**ALAGILLE SYNDROME 1** & 118450 & Coronal & _JAG1_ \\ \hline
**ANTLEY-BIXER SYNDROME** & & & \\
**WITH GENITAL ANOMALIES** & 201750 & Coronal, lambdoid & _POR_ \\
**AND DISORDERED** & & & \\
**STEROIDOGENESIS, ABS1** & & & \\
**ANTLEY-BIXER SYNDROME** & & & \\
**WHITHOUT GENITAL** & & & \\
**ANOMALIES AND DISORDERED** & & & \\
**STEROIDOGENESIS, ABS2** & & & \\ \hline
**APERT SYNDROME** & 101200 & Multisuture & _FGFR2_ \\ \hline
**ARTHROGRYPOSIS, CLEFT** & & & \\
**PALATE, CRANIOSYNOSTOSIS,** & & & \\
**AND IMPAIRED** & 618265 & Coronal & _PPP3 CA_ \\
**INTELLECTUAL** & & & \\
**DEVALOPMENT** & & & \\ \hline
**ATYPICAL MARFANOID** & & & \\
**SYNDROME WITH** & 616914 & Sagittal & _FBN1_ \\
**CRANIOSYNOSTOSIS** & & & \\ \hline
**AU-KLINE SYNDROME** & 616580 & \begin{tabular}{c} Sagittal, metopic, \\ multisuture \\ \end{tabular}