Surgical Treatment of Unilateral Coronal Craniostenosis (Plagiocephaly)
CRANIOSTENOSIS or premature closure of cranial sutures ordinarily presents no diagnostic difficulty to the pediatrician or neurosurgeon. For example, the long boatshaped head (scaphocephaly) caused by early closure of the sagittal suture is easily recognized and is by far the most common type. The wide or brachycephalic skull found in bilateral closure of the coronal sutures, and the pointed or tower skull associated with fusion of all the cranial sutures (oxycephaly) likewise present no problem in identification. Roentgenography, of course, has greatly facilitated diagnosis. A simple classification designating the defect according to which suture or sutures are involved is shown in Table 1.
Some of the rare types of craniostenosis, however, may be difficult to categorize from the clinical and even the roentgen appearance. Unilateral premature stenosis of the coronal suture (plagiocephaly) is one of these unusual varieties, and thus often is not well understood and sometimes is not even recognized. It is the purpose of this paper to report three cases of plagiocephaly treated surgically during the four-year period from 1958 through 1962, and to discuss the clinical and roentgenographic features of the condition. Nathan, Collins, and Collins1 described three cases of premature unilateral synostosis of the coronal suture; however, they did not discuss the results of surgical treatment. In addition, we wish to state our position in regard to the recent controversy in the literature concerning the general principles for surgical treatment of craniostenosis.2–4
Although various theories have been proposed, the cause of craniostenosis remains unknown.5 However, . . .