Craniosynostosis in primary metabolic bone disorders: a single-institution experience

Purpose The incidence of metabolic bone diseases in pediatric neurosurgical patients is rare. We examined our institutional experience of metabolic bone diseases along with a review of the literature in an effort to understand management for this rare entity. Methods Retrospective review of the electronic medical record database was performed to identify patients with primary metabolic bone disorders who underwent craniosynostosis surgery between 2011 and 2022 at a quaternary referral pediatric hospital. Literature review was conducted for primary metabolic bone disorders associated with craniosynostosis. Results Ten patients were identified, 6 of whom were male. The most common bone disorders were hypophosphatemic rickets ( n = 2) and pseudohypoparathyroidism ( n = 2). The median age at diagnosis of metabolic bone disorder was 2.02 years (IQR: 0.11–4.26), 2.52 years (IQR: 1.24–3.14) at craniosynostosis diagnosis, and 2.65 years (IQR: 0.91–3.58) at the time of surgery. Sagittal suture was most commonly fused ( n = 4), followed by multi-suture craniosynostosis ( n = 3). Other imaging findings included Chiari ( n = 1), hydrocephalus ( n = 1), and concurrent Chiari and hydrocephalus ( n = 1). All patients underwent surgery for craniosynostosis, with the most common operation being bifronto-orbital advancement ( n = 4). A total of 5 patients underwent reoperation, 3 of which were planned second-stage surgeries and 2 of whom had craniosynostosis recurrence. Conclusions We advocate screening for suture abnormalities in children with primary metabolic bone disorders. While cranial vault remodeling is not associated with a high rate of postoperative complications in this patient cohort, craniosynostosis recurrences may occur, and parental counseling is recommended.