craniofacial

Sagittal Craniosynostosis

What is Sagittal Craniosynostosis?

Sagittal craniosynostosis is the most common form of craniosynostosis, a condition where one or more sutures in a baby’s skull close too early. In this type, the sagittal suture, which runs from the front to the back of the skull, fuses prematurely. As a result, the skull cannot expand sideways and compensates by growing longer and narrower. This results in a head shape known as scaphocephaly, where the head appears elongated from front to back and narrow from side to side. In more severe cases, the forehead and back of the head may protrude.

The Procedure

Diagnosis

Sagittal craniosynostosis is often diagnosed during infancy, either at birth or within the first few months of life. Diagnosis is primarily clinical, based on the characteristic head shape. A pediatrician or specialist may notice the elongated skull and feel the ridged suture. To confirm the diagnosis and plan treatment, imaging studies such as X-rays, CT scans, or 3D imaging are typically performed. These provide detailed views of the skull structure and confirm premature suture fusion.

What Are the Causes?

The exact cause of sagittal craniosynostosis is often unknown and is considered sporadic in most cases. It usually occurs in isolation and is not associated with other health issues. However, in some cases, it can be linked to genetic syndromes which involve mutations affecting bone development. Environmental factors, maternal health conditions, or medications taken during pregnancy are also being studied as possible contributing factors, but no definitive cause has been identified for the majority of cases.

What Are the Implications?

The main implication of sagittal craniosynostosis is the abnormal head shape, which can cause both cosmetic and functional concerns. If left untreated, the restricted skull growth may lead to increased intracranial pressure, which can affect brain development and cause symptoms like headaches, vomiting, and developmental delays. Most children with this condition have normal intelligence, but untreated cases with significant pressure buildup may face neurological complications.

In addition to physical implications, children may experience psychological effects due to the noticeable difference in appearance. Social challenges and self-esteem issues can emerge, especially as the child grows older.

What Are the Treatment Options?

Treatment typically involves surgery to correct the skull shape and prevent any pressure on the brain. Not all children with sagittal craniosynostosis need surgery. The main surgical options include:

Cranial Vault Remodeling (CVR): Involves removing and reshaping parts of the skull. This surgery is usually performed between 9-12 months of age.
Endoscopic-Assisted Surgery: A less invasive procedure done before 6 months of age. It removes the fused suture and relies on helmet therapy afterward to guide skull growth.
Spring-Assisted Cranioplasty: Performed in infants under 6 months, this involves placing metal springs after suture removal to gradually expand the skull. A second surgery is required to remove the springs after a few months.

What Are the Possible Complications?

Surgical treatment is generally safe and effective, but there are risks. These include:

Infection and bleeding
There is a small risk of causing damage to the brain
Scarring and anaesthesia complications
Recurrence of deformity, requiring additional surgery
Increased intracranial pressure in rare cases
Implant-related issues with spring-assisted methods

With timely diagnosis and appropriate treatment, most children with sagittal craniosynostosis lead healthy, typical lives with good cosmetic and developmental outcomes.