Neurocranial Growth in Craniosynostosis

In this chapter, we focus on the growth patterns of the infant brain and skull and their implications for the treatment of craniosynostosis. Neurocranial growth is genetically predefined up to the point that calvarial growth at the sutures is becoming the result of intracranial driving forces, regulated by a complex interplay of different genes that control the proliferation-differentiation balance of cells in the mid-sutural mesenchyme. The skull growth shows a very fast expansion in the first year of life, with a peculiar fast rate during the first 6 months of life accommodating the exceptional volumetric increase of the developing brain. In general, skull growth is more evenly distributed in the first 5−6 months of life. Thereafter, there is an alternating growth pattern resulting in an elongation of the head. If this normal growth is limited by the premature closure of a suture, it is paramount to remove this restriction as soon as possible to restore normal growth potential and avoid progressive deformation of the skull. Treatment before the age of 6 months should therefore be the goal.