topiramate and Craniosynostoses

The authors report on the case of a 6-week-old boy who presented with infantile spasms. At 2.5 months of age, the patient underwent a right hemispherectomy. Approximately 3 months postoperatively, the patient presented with left coronal craniosynostosis. Subsequent cranial vault remodeling resulted in satisfactory cosmesis. Four years after surgery, the patient remains seizure free without the need for anticonvulsant medications. The authors believe this to be the first reported case of iatrogenic craniosynostosis due to hemispherectomy, and they describe 2 potential mechanisms for its development. This case suggests that, in the surgical treatment of infants with intractable epilepsy, minimization of brain volume loss through disconnection techniques should be considered, among other factors, when determining the best course of action.

Topics: Adrenocorticotropic Hormone; Anticonvulsants; Clonazepam; Craniosynostoses; Craniotomy; Electroencephalography; Epilepsy; Fructose; Hemispherectomy; Humans; Infant; Male; Postoperative Complications; Spasms, Infantile; Tomography, X-Ray Computed; Topiramate