Positional skull deformities in children: skull deformation without synostosis

Area of Science:

• Pediatric Neurosurgery
• Developmental Pediatrics
• Neuroradiology

Background:

• Craniosynostosis is diagnosed clinically and via neuroimaging; surgical intervention prevents neurological deficits and corrects deformities.
• Nonsynostotic skull deformities, particularly positional plagiocephaly, are increasingly common, prompting neurosurgical consultation.
• Abnormalities in cerebrospinal fluid (CSF) spaces have been noted in children with craniosynostosis.

Purpose of the Study:

• To investigate the association between cerebrospinal fluid (CSF) space alterations and the development of positional skull deformities in children.
• To compare CSF space findings in infants with nonsynostotic skull deformities versus those with benign extracerebral fluid collections.

Main Methods:

• Retrospective review of demographic, clinical, and neuroimaging data from 23 infants with nonsynostotic skull deformities (Group A).
• Comparison with 9 infants diagnosed with benign extracerebral fluid collections (Group B).
• Analysis included head circumference (HC) measurements and clinical presentation details.

Main Results:

• Sixteen of 23 infants (69.5%) with nonsynostotic deformities had enlarged subarachnoid CSF spaces.
• Infants with positional deformities presented later (mean 12.7 months) than those with fluid collections (mean 7.17 months).
• Enlarged CSF spaces in nonsynostotic cases were age-related and tended to resolve over time.

Conclusions:

• Positional head deformities are primarily attributed to infant sleeping positions, not macrocephaly.
• Brain pulsations transmitted to CSF accumulations may contribute to the development of infant skull deformities.
• Abnormalities in CSF spaces in positional deformities differ from those in benign extracerebral collections and are age-dependent.