Prevalence of Incidental Normocephalic Craniosynostosis: Findings From a Large Cohort Study

Abstract

Craniosynostosis involves premature fusion of cranial sutures, potentially causing craniofacial deformities and increased intracranial pressure. However, emerging evidence of normocephalic sagittal craniosynostosis challenges traditional surgical management paradigms. In a retrospective cross-sectional study (2012-2022) at Siriraj Hospital, a tertiary referral centre in Thailand, the authors examined cranial computed tomography scans of 1364 patients aged 1 to 20 years. Three-dimensional imaging analyses were used to assess suture fusion, and demographic and clinical data were collected. Statistical methods were used to evaluate the prevalence and ensure reliability of the findings. Complete fusion was rare: coronal (1/1364; 0.007%), sagittal (19/1364; 1.39%), lambdoid (2/1364; 0.15%), and squamosal (24/1364; 1.76%). Partial fusion occurred in the sagittal (39/1364; 2.86%), squamosal (42/1364; 3.08%), coronal (22/1364; 1.61%), and lambdoid (22/1364; 1.61%) sutures. Notably, these patients exhibited normocephalic morphology, suggesting that certain instances of early suture fusion may represent normal anatomical variants rather than pathologic synostosis. Normocephalic craniosynostosis involving coronal, sagittal, lambdoid, and squamosal sutures was detected within this contemporary Thai cohort. These findings underscore the need for meticulous clinical assessments to distinguish benign variants from true pathologic conditions, thereby informing more nuanced, individualised treatment strategies.