Cerebral perfusion defects secondary to simple craniosynostosis

Premature fusion of multiple cranial sutures has been associated with increased intracranial pressure and the potential for mental impairment. Isolated craniosynostosis, however, has been thought to be a benign condition primarily reconstructed for aesthetic purposes. On the basis of subjective developmental improvement postoperatively, an objective radiographic analysis (single positron emission computed tomography [SPECT]) was used to assess differences in cerebral perfusion in the areas compressed secondary to the fused cranial suture both before and after cranial reconstructive surgery in patients with simple craniosynostosis. Seven children with craniosynostosis, six boys and one girl (age range, 3-28 months), were enrolled in this prospective study. Six of the seven had cranial asymmetry on preoperative cranial computed tomographic scans, and one had a symmetric defect and was used as a control. Each subject had a preoperative SPECT scan approximately 3 to 5 days before the cranial reconstruction procedure and a follow-up scan 6 to 10 weeks postoperatively. Preoperative asymmetries in cerebral perfusion ranged from 0 to 30% (mean, 13%) in the areas compressed secondary to the premature suture fusion. In five patients cerebral blood flow, which was asymmetric before surgery, became symmetric after craniofacial reconstruction, and no new perfusion defects were documented. The control patient and one other patient had symmetric perfusion both pre- and postoperatively. Craniosynostosis may be associated with decreased cerebral blood flow as a result of the constriction of the brain from the prematurely fused suture. The correction of asymmetric cranial single-suture synostosis is more than a cosmetic procedure in that it allows for normalization of cerebral blood flow. This difference in blood flow supports early surgical intervention to prevent any potential central nervous system compromise secondary to abnormal blood flow.