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Delayed Presentation and Treatment of Sagittal Synostosis: A Case Report
Amy V Lyons1, Kelechi C Eseonu2, Stefan Kluzek3,4
1Medical Sciences Division, University of Oxford, Oxford, GBR.
Insights
Late diagnosis of sagittal suture synostosis (SSS) can impact brain development and self-esteem. Surgical repair in a 10-year-old successfully improved aesthetics, vision, neurobehavioral issues, and self-esteem.
Area of Science:
- Pediatric Neurosurgery
- Craniofacial Surgery
- Developmental Neuroscience
Background:
- Sagittal suture synostosis (SSS) is premature fusion of the skull's sagittal suture, typically addressed in infancy.
- Delayed diagnosis of SSS can lead to increased intracranial pressure (ICP), impaired neurocognitive development, and psychological distress.
Observation:
- A unique case of non-syndromic SSS presented at age 10 with aesthetic concerns, vision deficits, and neurobehavioral issues.
- The patient's family prioritized aesthetic correction, unaware of potential underlying developmental impacts.
Findings:
- Total cranial vault remodeling was successfully performed at age 10.
- Post-surgery, the patient exhibited a normalized cephalic index, immediate vision improvement, halted neurobehavioral underdevelopment, and enhanced self-esteem.
Implications:
- This case underscores the challenges in diagnosing SSS and the adverse effects of delayed treatment.
- Successful surgical intervention for SSS is possible even in older children, significantly improving quality of life.
Abstract:
Sagittal suture synostosis (SSS), caused by premature closure of the sagittal suture of the skull, is usually diagnosed and treated in the first few months of life; delayed diagnosis can be associated with abnormalities in brain development, including raised intracranial pressure (ICP) and neurocognitive development impairments. It can also affect an individual's self-perception and self-esteem. We present a unique case of late presentation and treatment of non-syndromic sagittal synostosis in a 10-year-old. Whilst the patient and his family's main concerns were aesthetic, he also had neurobehavioural issues and needed glasses for vision. Total cranial vault remodelling was offered and successfully performed at the age of 10; this normalised his cephalic index, immediately improved vision, prevented the progression of neurobehavioural under-development and significantly improved self-esteem. This case highlights the difficulties of sagittal synostosis diagnosis, the potential consequences of delayed presentation and the success of treatment, even in an older age group.
