Bicoronal and Multisuture Craniosynostosis

Abstract Bicoronal and multisuture craniosynostosis represent complex craniofacial conditions frequently associated with syndromic diagnoses, including Apert, Crouzon, Pfeiffer, Muenke, and Saethre–Chotzen syndromes, although any combination of synostosis can occur and the mere presence of more than one involved suture does not guarantee a syndromic diagnosis. These conditions carry significant risk for elevated intracranial pressure, hydrocephalus, Chiari malformation, and neurodevelopmental impairment. These patients benefit from thorough multidisciplinary evaluation and comprehensive long-term follow-up. Surgical management has evolved from single-stage open remodeling at older ages toward staged, expansion-based procedures beginning earlier in life. Frequently, these procedures are tailored to patient age, suture involvement, syndromic status, and age at presentation. Posterior vault distraction osteogenesis is commonly favored over fronto-orbital advancement as the initial treatment for many bicoronal and multisuture patients, though fronto-orbital advancement, spring-assisted cranioplasty, endoscopic strip craniectomy, and eventual midface distraction all remain part of the treatment algorithm. Perioperative morbidity, reoperation rates, and long-term ophthalmologic, respiratory, and neurodevelopmental outcomes remain key considerations in guiding treatment decisions. This review synthesizes current evidence on bicoronal and multisuture craniosynostosis, emphasizing a coordinated, staged, patient-centered approach to care.