Craniosynostosis

Craniosynostosis is the early closure of one or more of the seams (sutures) between the bony plates of a baby's skull. The skull cannot expand evenly at the fused seam, so it grows in other directions and the head takes on a characteristic shape.

It affects roughly one in every 2,000 babies. It is different from positional flattening of the back of the head caused by lying position, which is far more common, does not involve a fused suture and does not need surgery.

Symptoms

• A long narrow head (sagittal suture), the most common form
• A triangular forehead with a midline ridge (metopic suture)
• A flattened forehead and raised eyebrow on one side (one coronal suture)
• A short, wide, tall head (both coronal sutures)
• A firm ridge along a suture and an early-closing soft spot
• Signs of raised pressure in some children: irritability, vomiting, bulging fontanelle, developmental slowing

Causes and risk factors

In most children a single suture is fused and no cause is found. About one in five cases is part of a genetic syndrome such as Apert, Crouzon, Pfeiffer or Muenke, usually involving FGFR or TWIST1 genes and often affecting several sutures, the face and the limbs. Risk may be slightly raised with certain medicines in pregnancy, such as valproate, and with restricted space in the womb. Parents did not cause it by how they held or positioned their baby.

How it is diagnosed

• Examination by a craniofacial specialist: Head shape from above is often enough to tell true synostosis from positional flattening.
• Low-dose 3D CT or ultrasound of the sutures: Confirms which suture is fused. Imaging is kept to the minimum needed.
• Eye examination: Swelling of the optic disc is a sign of raised pressure inside the skull.
• Genetic testing: Offered when more than one suture is involved or other features are present.

Treatment options

• Endoscopic strip craniectomy: A small operation before about four to six months of age, followed by a custom moulding helmet worn for several months.
• Open cranial vault remodelling: The skull bones are reshaped, generally between 6 and 12 months. It often needs a blood transfusion and a short stay in intensive care.
• Spring-assisted or distraction surgery: Used in some centres for particular suture patterns.
• Syndromic care: Children with syndromes may need staged operations for the skull, midface, airway and hands over many years.
• Monitoring only: Very mild metopic ridging without a triangular forehead usually needs no treatment.

When it is urgent

A baby who is unusually drowsy, vomits repeatedly, has a tense bulging soft spot, or has pauses in breathing needs to be seen urgently by local paediatric services. After surgery, fever, wound leakage or increasing swelling need same-day review.

Travelling to Türkiye for treatment

Think carefully before travelling with an infant for this surgery. It should be performed only by a paediatric craniofacial team (neurosurgeon, plastic surgeon, paediatric anaesthetist and intensive care), and children need follow-up of head growth, vision and development for years. If no such team is reachable at home, a trip is possible: allow two to three weeks for open surgery. A helmet programme requires repeated fittings, which is hard to manage from a distance. A remote review of photographs and scans is a sensible first step.

Send your reports, scans and a short history and a Clinic-Y coordinator replies within 24 hours with suitable teams and written, all-inclusive proposals side by side. Reviewing your case is free.

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