La diagnosi di craniostenosi: alcune riflessioni per il pediatra

Abstract

Microcephaly is a medical condition involving a smaller-than-normal head. Microcephaly may present at birth or it may develop in the first few years of life. Patients with this disorder often have an intellectual disability, poor motor function, poor speech, abnormal facial features and seizures. Microcephaly does not have to suggest exclusively a craniosynostosis. Over the last decade, cranial suture ultrasound has played an increasingly important role in diagnosing craniosynostosis; ultrasound allows a differential diagnosis between craniosynostosis and a positional malformation to be made. A cranial suture is considered normal if a hypoechoic space has been identified between two hyperechoic bony plates. The anterior fontanelle is the largest fontanelle and is placed at the junction of the sagittal suture, coronal suture and frontal suture. The fontanelle allows the skull to deform during birth to ease its passage through the birth canal and for expansion of the brain after birth. The anterior fontanelle can remain open until 18 months. The early closure of the bregmatic fontanelle is never the expression of a craniostenosis, unlike what happens for the fusion of the cranial sutures that are always an indication of craniostenosis.