What is Sagittal Craniosynostosis?

November 30, 2017 By Sarah Frommer MD

What is Sagittal Craniosynostosis?

In our previous post, we explained the difference between craniosynostosis and deformational plagiocephaly. There are four major sutures of the human skull – sagittal, metopic, coronal (paired), and lambdoid (paired). The sagittal suture runs down the middle of the skull dividing it into the right and left sides. This suture normally fuses in a person’s 20’s.

Infant skull bird's eye view

When this suture fuses early, it restricts growth of the skull out to the sides causing a characteristic long narrow head shape with frontal bossing.

CT scan of sagittal craniosynostosis

Bird's eye clinical view of sagittal craniosynostosis

Why does Sagittal Craniosynostosis need to be treated?

In the first year of life, a baby’s brain grows very rapidly and the skull bones are very thin and moldable. When the sagittal suture fuses too early, there is a restriction of growth of the skull out to the sides however the brain continues to grow in the front and back resulting in a long narrow head shape.

Head circumference growth chart. Note the rapid growth in the first 12 months of life.

As the child gets older, the skull bones become harder and less moldable; however the brain still continues to grow until around 8 years old. If the skull bones can not accommodate the growing brain, then this causes abnormal pressure on the brain. This can manifest as developmental delays, headaches, behavioral problems, and visual problems. A brain MRI on a patient with sagittal craniosynostosis demonstrates sulcal effacement and narrowing of the ventricles, which means the space inside the skull is too tight for the brain.

MRI of patient with sagittal craniosynostosis — MRI T2 weighted (CSF is white) of 6 month old patient with sagittal craniosynostosis. Note the narrowed ventricles and sulcal effacement (loss of fluid space between gyri).

An MRI of the same patient after cranial vault remodeling shows improvement of ventricular narrowing and sulcal effacement.

MRI of patient with sagittal craniosynostosis after surgery — MRI T2 weighted (CSF in white) of sagittal craniosynostosis patient after cranial vault remodeling surgery. Note the improvement of ventricle space and evidence of fluid between gyri.

The goal of early (before 12 months of age) surgical treatment of sagittal craniosynostosis is to allow the brain to grow without restriction in order to avoid problems with development, behavior, and vision in the future.

Does an abnormal head shape mean my baby has craniosynostosis?

November 13, 2017 By Sarah Frommer MD

What is craniosynostosis?

Craniosynostosis translates directly to “the skull has fused bones”; it is the premature fusion of one or more cranial sutures. The human skull is primarily composed of five bones – the paired frontal and parietal bones, and the occipital bone. Between the bones are sutures, which aid in the passage of the head through the birth canal and are centers for skull growth. When the cranial sutures fuse prematurely, it causes restriction of skull growth perpendicular to the suture leading to an abnormal head shape and underlying restriction on brain growth. Craniosynostosis occurs in 1:2000-2500 live births worldwide.

Are there different types of craniosynostosis?

Yes. There are four major sutures of the skull – Metopic, sagittal, coronal, and lambdoid. One of more of these sutures can fuse prematurely to cause abnormal head shape. The type of craniosynostosis is typically named by the suture that is abnormally fused (metopic, sagittal, coronal, lambdoid) or the resultant head shape (scaphocephaly, brachycephaly, trigonocephaly, plagiocephaly, turricephaly).

Does an abnormal head shape mean my baby has craniosynostosis?

No. Babies' heads are meant to be moldable to allow for passage through the birth canal and also accommodate rapid brain growth in the first two years of life. The head shape can appear abnormal depending on in utero positioning, method of delivery, head positioning while sleeping, etc. This is called deformational plagiocephaly and is not pathologic. However, babies should be assessed for torticollis to make sure this is not contributing to the head shape.

It is important to rule out craniosynostosis as a cause for abnormal head shape in babies because missing this diagnosis could affect their development in the future.

How do I learn more about craniosynostosis?

Visit our webpage https://www.craniofacialteamtexas.com/craniofacial-conditions-we-treat/craniosynostosis-diagnosis-and-treatment/ to read about this subject in more detail.

Call to schedule an appointment 512-377-1142 if you are concerned about your baby's head shape. We do NOT require a CT scan before evaluating your child.

#choosekind

November 6, 2017 By Sarah Frommer MD

#choosekind

Wonder is a movie with Jacob Tremblay, Julia Roberts, and Owen Wilson based on the book with the same name by R.J. Palacio. #Wonder is about a 10 year old boy named Auggie born with #craniofacial differences attending mainstream school for the first time.

"As his family, his new classmates, and the larger community all struggle to find their compassion and acceptance, Auggie’s extraordinary journey will unite them all and prove you can’t blend in when you were born to stand out."

Children with craniofacial differences and their families are incredibily strong and have to go through so much during childhood. For example, a child with cleft lip and palate will undergo nasoalveolar molding in the first few months of life, then their first surgery to repair the lip around age 3-4 months, then the next surgery to repair the palate around 12 months. After that, there is more possible surgical preparation and surgery – speech surgery, alveolar bone grafting, braces, palatal expansion, cleft lip/nose revision, jaw surgery, and rhinoplasty. It is a long journey and without the support of their community and friends it can be an emotionally draining and difficult one.

At the Craniofacial Team of Texas we strongly believe that every child deserves to have the chance to just be a kid. We take pride in working with the community and families to educate about craniofacial differences and support them through this long journey!

#choosekind — Wonder is out November 17th!

Dell Children’s Craniofacial and Pediatric Plastic Surgery Program