Secondary Bicoronal Craniosynostosis Following Sagittal Strip Craniectomy: Identification and Treatment

Craniosynostosis is defined as the premature fusion of one or more cranial sutures. Secondary craniosynostosis refers to the subsequent fusion of initially patent sutures following surgical correction of primary nonsyndromic craniosynostosis. This complication is rarely reported, and limited data exist regarding its detection and operative management. The authors present a unique case of a pediatric patient with nonsyndromic sagittal craniosynostosis treated with minimal access strip craniectomy and postoperative helmet therapy who later developed bicoronal craniosynostosis that was not present preoperatively. The secondary fusion was identified through deviations in head circumference growth and cephalic ratio measurements. For correction of the bicoronal craniosynostosis, the patient underwent posterior cranial vault distraction osteogenesis, resulting in satisfactory cranial contour restoration and a normal ophthalmologic examination at 1-year follow-up. This case underscores the importance of structured, multidisciplinary postoperative surveillance to enable early recognition of secondary craniosynostosis and demonstrates the effectiveness of posterior cranial vault distraction as a definitive corrective strategy with favorable long-term outcomes.