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Bilateral coronal craniosynostosis refers to the premature fusion of both coronal sutures in the skull. This condition is a significant form of early cranial suture closure and warrants specific attention due to its unique characteristics.
While unilateral coronal craniosynostosis is discussed elsewhere as the second most common type, bilateral cases stand out for several reasons. They often involve associated syndromes, present distinct physical features, and require specialized treatment approaches that differ from other forms of craniosynostosis. Unlike some other suture fusions that might be managed with neurosurgery alone, bilateral coronal cases typically necessitate combined pediatric craniofacial surgery and neurosurgery for optimal outcomes.
Bilateral coronal craniosynostosis can be broadly categorized into two types:
This discussion focuses on the abnormal head shape rather than midface retrusion treatments, with processing steps explained in related sections on multiple suture closures.
The hallmark of bilateral coronal craniosynostosis is a tall, flat skull with a shortened anteroposterior diameter. The head appears elevated and flat, reminiscent of a "Simpson's family" character, with an increasingly pronounced forehead. The forehead is notably flat, and from the side, the brow bones sit behind the eyes. The skull widens laterally, creating a noticeable shape that is hard to overlook.
As with multiple suture closures, there's a 47% chance of increased intracranial pressure, making surgery essential. Early intervention yields better results for skull shape and pressure management, while delayed treatment may address pressure but offer poorer cosmetic outcomes.
Surgical management for bilateral coronal craniosynostosis differs from single suture cases due to the resulting tall, flat head shape (turribrachycephaly). Untreated, this shape is challenging to correct.
Traditional methods involve full skull reshaping at 10-12 months, but results are often suboptimal, especially for the flat posterior skull, with higher risks.
Modern trends favor initial distraction to expand the skull at six months, followed by forehead reshaping around one year old. This approach fully corrects the shape, leaving no signs of the condition.
Forehead reshaping is crucial, as in unilateral cases, to address brow bone positioning relative to the eyes.
Endoscopic-assisted minimal incision craniotomies are ineffective for bilateral coronal craniosynostosis and are not recommended for this condition.