At a glance
What it is
Premature fusion of one or more cranial sutures — the fibrous joints between the flat bones of the skull — before brain growth is complete. The fused suture cannot expand, so the skull compensates by growing in other directions, producing a characteristic deformity whose pattern depends on which suture(s) are involved. Raised intracranial pressure, facial asymmetry, and neurodevelopmental problems may result.
Symptoms
An abnormal or asymmetric skull shape — the specific deformity depends on which suture fused early (e.g., sagittal: elongated narrow skull; coronal: flattened forehead; metopic: triangular forehead). A hard bony ridge over the fused suture. Slow head growth compared to peers. In severe cases: raised intracranial pressure producing headache, visual problems, irritability, or developmental delay.
Approach
Surgery is the primary treatment. The goals are to relieve intracranial pressure, allow normal brain growth, and correct skull shape. The optimal age is before 12 months, when bones are still malleable. Procedures include open cranial vault remodelling (calvarial remodelling) and, for single-suture cases, minimally invasive endoscopic strip craniectomy followed by helmet therapy. Multidisciplinary follow-up monitors neurological development.
What craniosynostosis is
The skull of a newborn is formed by several flat bone plates separated by fibrous joints called sutures. These sutures normally remain open throughout childhood, allowing the skull to expand as the brain grows rapidly in the first years of life. Craniosynostosis occurs when one or more sutures close prematurely — before the brain has finished growing — restricting skull expansion and redirecting growth in abnormal directions.
**Types and skull deformities**
The pattern of skull deformity depends on which suture(s) fuse early:
- *Sagittal synostosis* (most common — ~50%): premature fusion of the sagittal suture (running front-to-back along the top of the skull) produces scaphocephaly — a long, narrow skull with frontal and occipital bossing ('boat shape') - *Coronal synostosis*: affects one (unilateral) or both (bilateral) coronal sutures. Unilateral: asymmetric flattening of one side of the forehead with orbital asymmetry (plagiocephaly). Bilateral: a short, wide skull with a flattened, recessed forehead (brachycephaly) - *Metopic synostosis*: premature fusion of the metopic suture (forehead midline) produces trigonocephaly — a triangular forehead with prominent midline ridge and hypotelorism (eyes closer together) - *Lambdoid synostosis* (rare): posterior skull flattening; must be distinguished from positional plagiocephaly (non-synostotic) - *Multi-suture synostosis*: multiple sutures involved — may occur in the context of a syndromic craniosynostosis (Apert, Crouzon, Muenke, Pfeiffer syndromes)
**Causes**
Most cases (~85%) are non-syndromic and isolated (sporadic mutations, no identifiable genetic syndrome). A minority occur as part of genetic syndromes — typically autosomal dominant mutations in FGFR1, FGFR2, or TWIST1 genes. A family history warrants genetic evaluation.
**Complications if untreated**
- Elevated intracranial pressure — progressive, may cause headache, papilloedema, and visual loss - Cognitive and neurodevelopmental impairment — particularly with multi-suture or syndromic disease - Facial and orbital asymmetry — may cause strabismus and amblyopia in coronal synostosis - Psychosocial impact of visible deformity
**Surgical treatment**
Surgery is recommended for the majority of patients. The specific procedure and timing depend on which suture(s) are affected, patient age, and whether raised intracranial pressure is present:
- *Open calvarial remodelling:* the neurosurgeon and craniofacial surgeon remove and reshape the affected bone plates to expand the skull and release the fused suture. Provides the most control over skull shape. Usually performed between 6 and 12 months - *Endoscopic strip craniectomy:* a minimally invasive technique — the fused suture is removed endoscopically through a small incision. Post-operative helmet orthosis reshapes the skull over months. Best results when performed before 3–4 months of age - *Distraction osteogenesis:* used for more complex or older presentations — gradual bone lengthening with an implanted device
**Multidisciplinary follow-up**
Children with craniosynostosis require long-term follow-up by a multidisciplinary team including neurosurgery, craniofacial surgery, ophthalmology (for raised ICP and orbital asymmetry), and developmental paediatrics to monitor neurological progress and identify any complications early.
Treatment options at Alimran Medical Center
Neuromodulation
Injection therapies
- Botox® injections
- Ozone injection
- Trigger point injections
Advanced therapies
Physiotherapy & rehabilitation
- Electrical stimulation
- Short and long wave therapy
- Laser therapy
- Ultrasound therapy
- Neurodevelopmental rehabilitation and physiotherapy
- SpineMED® system
- Sigma
Book a consultation
The secretary schedules first appointments during clinic hours; please have prior imaging, operative notes and a current medication list available at the time of the call.
This page provides general information about craniosynostosis and is not a substitute for individual medical assessment. If your symptoms are severe or worsening, contact a clinician promptly.