Possible secondary craniosynostosis caused by flat head syndrome: Report of two cases

Abstract Standard treatment for patients with craniosynostosis is cranial remodeling surgery. If diagnosed early, minimally invasive surgery, such as suturectomy, is a good alternative, although it is sometimes difficult to diagnose craniosynostosis early because premature suture closure is not always radiologically obvious. In this study, we present two cases of five-month old infants who were conservatively treated for positional brachycephaly without any obvious premature suture closure on CT, who later developed progressive tower-like skull deformity despite conservative treatment for positional skull deformity. Both their fathers showed similar skull deformities. They underwent suturectomy at the site of the lambda, followed by molding helmet therapy based on a diagnosis of craniosynostosis. Histopathological specimens obtained from the resected sutures showed irregularly narrowed suture structure and ossification and fibrous tissue proliferation within it, supporting the diagnosis. The infants’ postoperative course was uneventful. The cephalic index of both the cases improved postoperatively. Conservative therapy-resistant progressive occipital skull deformity can sometimes lead to secondary craniosynostosis, even if CT does not show premature suture closure.