Determining the fate of cranial sutures after surgical correction of non-syndromic craniosynostosis

J Craniomaxillofac Surg. 2017 Nov;45(11):1801-1808. doi: 10.1016/j.jcms.2017.08.009. Epub 2017 Aug 19.


Purpose: "Secondary craniosynostosis" (SCS) refers to a loss of sutures after corrective vault reconstruction. There are no prior studies that comprehensively review SCS in various types of non-syndromic craniosynostosis. We assessed idiopathic and iatrogenic SCS using 3-dimensional computed tomography (3D CT). We also performed a systematic review to estimate the overall incidence of SCS in each craniosynostosis type, and to characterize its clinical features.

Materials and methods: We retrospectively reviewed the CT images of patients who underwent surgical correction of craniosynostosis for all types of craniosynostosis between August 1999 and December 2015. A literature search of the Medline and Ovid databases was conducted in October 2016 using the search term "secondary craniosynostosis."

Results: In our series, iatrogenic SCS was observed in all patients who had manipulated normal patent sutures to variable extents. Three (17.6%) cases of idiopathic SCS developed on sagittal sutures, and were confirmed with a 12-month follow-up CT. In a pooled analysis of 10 articles, overall SCS developed in 123 of 1205 patients (10.2%). Iatrogenic SCS cases made up 87 of 1205 cases (7.2%), whereas 38 (3.1%) were idiopathic. Idiopathic SCS most commonly developed at the bi-coronal suture (n = 32, 84.2%), followed by the sagittal suture (n = 4, 10.5%) and uni-coronal suture (n = 1, 2.6%).

Conclusion: This is the first review not only to describe SCS in all types of non-syndromic craniosynostosis, but also to classify SCS into iatrogenic and idiopathic types based on the underlying pathogenesis.

Keywords: Isolated craniosynostosis; Secondary craniosynostosis; Secondary synostosis.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Child
  • Child, Preschool
  • Cranial Sutures / diagnostic imaging
  • Cranial Sutures / surgery*
  • Craniosynostoses / classification
  • Craniosynostoses / diagnostic imaging
  • Craniosynostoses / surgery*
  • Craniotomy / methods
  • Female
  • Humans
  • Iatrogenic Disease
  • Imaging, Three-Dimensional
  • Infant
  • Male
  • Recurrence
  • Reoperation
  • Retrospective Studies
  • Tomography, X-Ray Computed