MULTIPLE SUTURE SYNOSTOSIS AND INCREASED INTRACRANIAL-PRESSURE FOLLOWING REPAIR OF SINGLE SUTURE, NONSYNDROMAL CRANIOSYNOSTOSIS

Objective: Increased intracranial pressure, frequently associated with closure of multiple cranial sutures, has been reported to occur in 36 % of cases following correction of syndromal craniosynostosis. Althoug h much less common, multiple suture closure may occur following repair of single suture, nonsyndromal craniosynostosis and we present cases that concern two such children. Results: Two children with nonsyndroma l craniosynostosis, one metopic and one left-coronal, underwent fronto -orbital advancement at age 3 months. At age 19 months and at age 5 ye ars, respectively, both patients re-presented with headaches, decrease in head circumference percentile, and acceptable cosmetic outcome. Bo th had computerized tomographic evidence of multiple closed cranial su tures and increased intracranial pressure (ICP) (determined by monitor ing). Both patients improved following a cranial expansion procedure. Conclusion: Delayed closure of multiple sutures and resultant increase d ICP may occur following correction of nonsyndromal, single suture cr aniosynostosis. This may be more likely when the initial suture is con tiguous with the facial sutures. Children should be followed for many years following craniosynostosis repair with cranial, neurologic, and possibly funduscopic examinations as well as head circumference measur ements to detect delayed closure of cranial sutures.