Craniosynostosis in Growing Children : Pathophysiological Changes and Neurosurgical Problems

caused by craniosynostosis would restrict growth of the brain by limiting the amount of space within the cranial vault 1,15,20) .Therefore, it was widely accepted that most cases of cranaiosynostosis would result in reduced ICV.However, this concept is changed with the development of advanced image-manipulation techniques.Many studies using accurate measurement of ICV by either computerized tomography or magnetic resonance images conclude that ICV in majority of children with craniosynostosis is within normal limits and even that children with Apert syndrome tend to have larger ICV than normal 24,26,42,43,51) .Other studies demonstrate that patients with craniosynostosis are born with a significantly smaller ICV, but at around the age of 6 months they achieve normal volume 51) .According to these studies, in craniosynostosis, the skull struggles to maintain normal ICV during growth, despite the obstacles caused by fused sutures, probably due to compensatory growth through unaffected suture sites.Only patients with the rare forms of pansynostosis may have a true restriction of skull growth, resulting in microcephaly and a small ICV 51) .However, exception is still found in Apert syndrome, which is characterized by greater than normal ICV despite multiple suture involvement 26) .