Shunt-induced craniosynostosis with craniocerebral disproportion: a new way of thinking about an old problem
Kendall Snyder1, Christopher Troy1, Camille Milton1
11Department of Neurological Surgery, University of Tennessee Health Science Center, Memphis.
Objective:
Shunting during infancy can precipitate premature closure of one or more cranial suture. Shunt-induced craniosynostosis (SIC) may in turn result in craniocerebral disproportion (CCD). The authors present a single-institution series and offer a pragmatic diagnostic and treatment framework.
Methods:
This study was a retrospective case series of patients with SIC-CCD who underwent surgical correction between 2018 and 2025 at a single institution.
Results:
Eighteen patients were identified. The mean (range) age at initial shunt placement was 2 (0-9) months, and the mean age at CCD corrective surgery was 5.6 (1.1-18.4) years. Eleven patients (61%) presented with headaches and 14 (78%) had one or more symptoms attributable to CCD. All patients underwent surgery for CCD: 16 underwent cranial vault expansion (12 with distractors), and 2 underwent suturectomy. Three patients required a delayed secondary salvage expansion. The mean follow-up was 3.47 (0.56-8.28) years. At the last follow-up, more than two-thirds of patients reported symptom improvement and all had significantly less radiographic intracranial crowding. Emergency department visits for shunt concerns and shunt revisions decreased after vault expansion.
Conclusions:
Pediatric neurosurgeons, craniofacial plastic surgeons, and neuroradiologists must maintain a high suspicion for SIC-CCD in every child that was shunted early in life. Once CCD is diagnosed, early surgical expansion is recommended. Contemporary craniofacial techniques, aided by computer-assisted surgical planning (CAS), can safely achieve meaningful intracranial volume expansion with symptomatic improvement for most patients.
