Development of secondary unilateral coronal suture synostosis with a sagittal suture synostosis in a nonsyndromic patient

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Multiple-suture synostosis is typically associated with syndromic craniosynostosis but has been occasionally reported in large series of nonsyndromic children. The diagnosis of multiple fused sutures usually occurs at the same time, but rarely has the chronological development of a secondary suture synostosis been noted. The development of secondary bicoronal suture synostosis requiring surgical intervention has only been reported, to date, after surgical intervention and is hypothesized to arise from a disruption of inhibitory factors from the dura. The disinhibition of these factors permits the sutures to then fuse at an early stage. The authors report on a patient who developed secondary unilateral coronal synostosis after the diagnosis of an isolated sagittal synostosis. The secondary synostosis was identified at the time of the initial surgical intervention and ultimately required a second procedure of a frontoorbital advancement.

The clinical appearance of this phenomenon may be subtle, and surgeons should monitor for the presence of secondary synostosis during surgery as it may require intervention. Failure to identify the secondary synostosis may necessitate another surgery or result in a poor cosmetic outcome. The authors recommend close clinical follow-up for the short term in patients with isolated sagittal synostosis.

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Contributor Notes

Address correspondence to: Leonardo Rangel-Castilla, M.D., Department of Neurosurgery, The Methodist Neurological Institute, 6560 Fannin, Houston, Texas 77030. email: LRCastilla@tmhs.org.Please include this information when citing this paper: DOI: 10.3171/2011.11.PEDS11320.
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  • 1

    Antúnez SArnaud ECruz AMarchac DRenier D: Scaphocephaly: Part I: indices for scaphocephalic frontal and occipital morphology evaluation: long-term results. J Craniofac Surg 20:Suppl 2183718422009

    • Search Google Scholar
    • Export Citation
  • 2

    Arnaud ECapon-Degardin NMichienzi JDi Rocco FRenier D: Scaphocephaly: Part II: secondary coronal synostosis after scaphocephalic surgical correction. J Craniofac Surg 20:Suppl 2184318502009

    • Search Google Scholar
    • Export Citation
  • 3

    Chumas PDCinalli GArnaud EMarchac DRenier D: Classification of previously unclassified cases of craniosynostosis. J Neurosurg 86:1771811997

    • Search Google Scholar
    • Export Citation
  • 4

    Connolly JPGruss JSeto MLWhelan MFEllenbogen RWeiss A: Progressive postnatal craniosynostosis and increased intracranial pressure. Plast Reconstr Surg 113:131313232004

    • Search Google Scholar
    • Export Citation
  • 5

    Greene AKMulliken JBProctor MRMeara JGRogers GF: Phenotypically unusual combined craniosynostoses: presentation and management. Plast Reconstr Surg 122:8538622008

    • Search Google Scholar
    • Export Citation
  • 6

    Jimenez DFBarone CM: Multiple-suture nonsyndromic craniosynostosis: early and effective management using endoscopic techniques. Clinical article. J Neurosurg Pediatr 5:2232312010

    • Search Google Scholar
    • Export Citation
  • 7

    Kolar JC: An epidemiological study of nonsyndromal craniosynostoses. J Craniofac Surg 22:47492011

  • 8

    Sloan GMWells KCRaffel CMcComb JG: Surgical treatment of craniosynostosis: outcome analysis of 250 consecutive patients. Pediatrics 100:E21997

    • Search Google Scholar
    • Export Citation
  • 9

    Stein SCSchut L: Management of scaphocephaly. Surg Neurol 7:1531551977

  • 10

    Tuite GFChong WKEvanson JNarita ATaylor DHarkness WF: The effectiveness of papilledema as an indicator of raised intracranial pressure in children with craniosynostosis. Neurosurgery 38:2722781996

    • Search Google Scholar
    • Export Citation
  • 11

    Tuite GFEvanson JChong WKThompson DNHarkness WFJones BM: The beaten copper cranium: a correlation between intracranial pressure, cranial radiographs, and computed tomographic scans in children with craniosynostosis. Neurosurgery 39:6916991996

    • Search Google Scholar
    • Export Citation
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