Parasagittal suture after strip craniectomy.

Background: Suture reformation after strip craniectomy for nonsyndromic sagittal synostosis remains an inconsistent and underreported phenomenon. Although several theories have been proposed to account for the fate of the cranial defect, no explanation accurately matches clinical experience with the appearance of reformed sutures, ectopic sutures, and complete defect ossification postoperatively.

Methods And Results: We review the case of a 7-year-old boy who formed a parasagittal suture at the defect margin after strip craniectomy for nonsyndromic sagittal synostosis. We review the literature and the clinical experiences of previous authors.

Conclusions: The pathogenesis of suture reformation and the biomechanical forces shaping suture formation are still poorly understood. Previous reports of postoperative suture reformation offer inconclusive evidence as to whether a pathologic suture, an abnormal cranial base, or a combination of biomechanical forces plays the larger role. It remains an open question as to whether a single underlying mechanism can explain suture reformation or if there are instead multiple causes.