Craniosynostosis is a congenital condition in which one or more of the skull sutures close prematurely, restricting normal skull and brain growth. As the brain continues to grow, the skull compensates by expanding in other directions, leading to abnormal head shape and sometimes increased intracranial pressure. Early diagnosis and timely surgery allow the skull and brain to develop normally, preventing long-term neurological or cosmetic issues.
Symptoms
The symptoms depend on which sutures are fused and how early the closure occurs. Typical signs include:
- Abnormal head shape noticed after birth or within the first months of life
- Raised, hard ridge along the affected suture
- Asymmetry of the forehead, eyes, or skull
- Slow head growth despite normal brain growth
- In severe cases: irritability, vomiting, bulging fontanelle, developmental delay, or vision problems due to raised intracranial pressure
Common patterns include:
- Sagittal synostosis (scaphocephaly) – long, narrow head
- Coronal synostosis (plagiocephaly) – flattened forehead on one side
- Metopic synostosis (trigonocephaly) – triangular forehead
- Lambdoid synostosis – asymmetric flattening at the back of the head
Diagnosis
Diagnosis begins with physical examination and head shape assessment by a pediatric neurosurgeon. Cranial ultrasound can confirm early suture closure in infants. 3D CT scan provides detailed visualization of fused sutures and skull deformity, helping plan surgery. In syndromic cases (Apert, Crouzon, Pfeiffer syndromes), genetic testing is recommended to guide management.
Treatment Options
- Observation: In mild deformities without pressure symptoms, regular head circumference monitoring and follow-up imaging may be sufficient.
- Endoscopic-Assisted Suture Release (Minimally Invasive): Ideal for infants under 6 months of age, this minimally invasive technique removes the fused suture through a small incision using an endoscope. After surgery, the child wears a custom cranial molding helmet for several months to guide skull growth naturally. This approach offers shorter recovery time, minimal blood loss, and excellent cosmetic results.
- Open Cranial Vault Remodeling: For older infants or more complex cases, open cranial vault remodeling is performed between 6–12 months of age. The skull bones are carefully reshaped and repositioned to create a normal head contour and allow the brain to grow freely. This technique provides immediate correction and long-term stability.
- Multidisciplinary Care: Children with syndromic craniosynostosis may require combined care from neurosurgery, plastic surgery, genetics, and ophthalmology, ensuring both functional and aesthetic outcomes.
Recovery & Follow-Up
Most infants stay in the hospital for 3–5 days after surgery. Regular follow-up visits assess head shape, growth, and neurological development. 3D photography or CT imaging may be used to monitor skull symmetry over time. Helmet therapy, if used, continues for several months under specialist supervision. Most children achieve excellent cosmetic and developmental outcomes.
When to See a Pediatric Neurosurgeon
If you notice abnormal head shape, asymmetry, or a raised ridge on your baby’s skull, early evaluation is essential. Timely surgery before one year of age provides the best functional and cosmetic results.