Multiple Suture Synostosis and Increased Intracranial Pressure following Repair of Single Suture, Nonsyndromal Craniosynostosis

Abstract

Objective Increased intracranial pressure, frequently associated with closure of multiple cranial sutures, has been reported to occur in 36% of cases following correction of syndromal craniosynostosis. Although much less common, multiple suture closure may occur following repair of single suture, non-syndromal craniosynostosis and we present cases that concern two such children. Results Two children with nonsyndromal craniosynostosis, one metopic and one left-coronal, underwent fronto-orbital advancement at age 3 months. At age 19 months and at age 5 years, respectively, both patients re-presented with headaches, decrease in head circumference percentile, and acceptable cosmetic outcome. Both had computerized tomographic evidence of multiple closed cranial sutures and increased intracranial pressure (ICP) (determined by monitoring). Both patients improved following a cranial expansion procedure. Conclusion Delayed closure of multiple sutures and resultant increased ICP may occur following correction of nonsyndromal, single suture craniosynos-tosis. This may be more likely when the initial suture is contiguous with the facial sutures. Children should be followed for many years following cranio-synostosis repair with cranial, neurologic, and possibly funduscopic examinations as well as head circumference measurements to detect delayed closure of cranial sutures.