Pediatric Craniosynostosis Follow-up

  • Author: Raj D Sheth, MD; Chief Editor: Amy Kao, MD   more...
 
Updated: Jul 23, 2010
 

Further Outpatient Care

Following surgery, carefully monitor patients to ensure that the suture does not re-fuse. Continue head circumference measurements. Watch for signs of raised intracranial pressure in infants at risk.

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Complications

In the immediate postoperative period, complications include hemorrhage.

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Prognosis

  • Patients with primary craniosynostosis must be monitored after surgery. The vast majority of patients with primary, single suture synostosis have little or no morbidity following surgery.
  • In secondary craniosynostosis, prognosis is dependent upon underlying etiology.
  • Patients with syndromic craniosynostosis can have a much more complicated clinical course due to the increased severity of the craniosynostosis and associated problems (eg, hydrocephalus and airway obstruction). A multidisciplinary approach is important in the management of the complex problems of these patients.
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Patient Education

If a patient has a mild head shape deformity, inform parents that the deformity will become less prominent with the appearance of abundant hair and physiological molding.

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Contributor Information and Disclosures
Author

Raj D Sheth, MD  Professor, Mayo College of Medicine; Chief, Division of Pediatric Neurology, Nemours Children's Clinic

Raj D Sheth, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Pediatrics, American Epilepsy Society, American Neurological Association, and Child Neurology Society

Disclosure: Nothing to disclose.

Coauthor(s)

Bermans J Iskandar, MD  Director, Associate Professor, Departments of Neurological Surgery, Pediatrics, Children's Hospital, University of Wisconsin Hospital and Clinics

Bermans J Iskandar, MD is a member of the following medical societies: Alpha Omega Alpha and American College of Surgeons

Disclosure: Nothing to disclose.

Ian M Heger, MD  Assistant Professor, Department of Neurosurgery, University of Florida College of Medicine Jacksonville; Assistant Director of Clinical Services, Pediatric Neurosurgery Center, Wolfson Children's Hospital

Ian M Heger, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Neurological Surgeons, American College of Surgeons, American Epilepsy Society, American Society of Pediatric Neurosurgeons, Children's Oncology Group, and Congress of Neurological Surgeons

Disclosure: Nothing to disclose.

Saswata Roy, MD  Pediatric Otolaryngologist, Director, Facial Anomalies and Cranial Base Program, Division of Pediatric Otolaryngology, Nemours Children's Clinic

Saswata Roy, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American Academy of Pediatrics, and American Cleft Palate/Craniofacial Association

Disclosure: Nothing to disclose.

Specialty Editor Board

James J Riviello Jr, MD  George Peterkin Endowed Chair in Pediatrics, Professor of Pediatrics, Section of Neurology and Developmental Neuroscience, Professor of Neurology, Peter Kellaway Section of Neurophysiology, Baylor College of Medicine; Chief of Neurophysiology, Director of the Epilepsy and Neurophysiology Program, Texas Children's Hospital

James J Riviello Jr, MD is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

Kenneth J Mack, MD, PhD  Senior Associate Consultant, Department of Child and Adolescent Neurology, Mayo Clinic

Kenneth J Mack, MD, PhD is a member of the following medical societies: American Academy of Neurology, Child Neurology Society, Phi Beta Kappa, and Society for Neuroscience

Disclosure: Nothing to disclose.

Selim R Benbadis, MD  Professor, Director of Comprehensive Epilepsy Program, Departments of Neurology and Neurosurgery, University of South Florida School of Medicine, Tampa General Hospital

Selim R Benbadis, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Sleep Medicine, American Clinical Neurophysiology Society, American Epilepsy Society, and American Medical Association

Disclosure: UCB Pharma Honoraria Speaking, consulting; Lundbeck Honoraria Speaking, consulting; Cyberonics Honoraria Speaking, consulting; Glaxo Smith Kline Honoraria Speaking, consulting; Pfizer Honoraria Speaking, consulting; Sleepmed/DigiTrace Honoraria Speaking, consulting

Chief Editor

Amy Kao, MD  Attending Neurologist, Children's National Medical Center, Washington DC

Amy Kao, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Pediatrics, American Epilepsy Society, and Child Neurology Society

Disclosure: Nothing to disclose.

References

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  9. Keshavarzi S, Hayden MG, Ben-Haim S, Meltzer HS, Cohen SR, Levy ML. Variations of endoscopic and open repair of metopic craniosynostosis. J Craniofac Surg. Sep 2009;20(5):1439-44. [Medline].

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  13. Elmslie FV, Reardon W. Craniofacial developmental abnormalities. Curr Opin Neurol. Apr 1998;11(2):103-8. [Medline].

  14. Fernbach SK. Craniosynostosis 1998: concepts and controversies. Pediatr Radiol. Sep 1998;28(9):722-8. [Medline].

  15. Keshavarzi S, Hayden MG, Ben-Haim S, Meltzer HS, Cohen SR, Levy ML. Variations of endoscopic and open repair of metopic craniosynostosis. J Craniofac Surg. Sep 2009;20(5):1439-44. [Medline].

  16. Liptak GS, Serletti JM. Pediatric approach to craniosynostosis. Pediatr Rev. Oct 1998;19(10):352; quiz 359. [Medline].

  17. Miraoui H, Ringe J, Haupl T, Marie PJ. Increased EFG- and PDGF{alpha}-receptor signaling by mutant FGF-receptor 2 contributes to osteoblast dysfunction in Apert craniosynostosis. Hum Mol Genet. Feb 13 2010;[Medline].

  18. Sheth RD, Mullett MD, Bodensteiner JB, Hobbs GR. Longitudinal head growth in developmentally normal preterm infants. Arch Pediatr Adolesc Med. Dec 1995;149(12):1358-61. [Medline].

  19. Stelnicki E, Heger I, Brooks CJ, Ghersi MM, Stubbs CB, Bahuleyan B. Endoscopic release of unicoronal craniosynostosis. J Craniofac Surg. Jan 2009;20(1):93-7. [Medline].

 
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Diagram of a neonate's skull demonstrating the location of the sutures.
Frontal view showing a fused and ridged metopic suture on 3-dimensional CT.
CT image demonstrating features of secondary craniosynostosis with cerebral atrophy. Cerebral atrophy is not present in primary craniosynostosis.
Positional molding. Note the anterior displacement of the right occiput and of the right frontal region on the same side, which differentiate positional molding from posterior plagiocephaly craniosynostosis.
Posterior view of 3-dimensional cranial CT demonstrating early fusion of the lambdoid suture.
Isolated fusion of the metopic suture. Note that the remaining sutures are open.
Trigonocephaly. Note the triangular shape of the head.
Infant with primary craniosynostosis. The specific deformity of the skull is Kleeblattschadel or cloverleaf skull.
Skull deformities associated with single suture synostosis.
Positional plagiocephaly. Note anterior position of the ear on the side with occipital flattening.
Sagittal synostosis and the associated scaphocephaly seen on skull radiograph and 3-dimensional craniofacial CT scan.
Sagittal synostosis before and after cranial vault surgery and the associate improvement of scaphocephaly.
Unilateral coronal deformity with retrusion of the orbit and harlequin eye deformity. Note the ipsilateral deviation of the nasal radix and the contralateral deviation of the nasal tip.
Fusion of coronal sutures bilaterally. Note the increase transverse dimension and retrusion of the orbital rim.
Intraoperative view of bilateral coronal synostosis. Note the decreased anterior-posterior dimension, increased transverse width and retruded orbital rim.
Pre- and postoperative photos of metopic synostosis. Note the prominent forehead keel corrected after surgical repair.
 
 
 
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