What is the management approach for Bathrocephaly?

Management of Bathrocephaly

Bathrocephaly, a posterior cranial deformity characterized by bulging of the midportion of the occipital bone, typically requires no intervention as it is often associated with a benign persistent mendosal suture. 1

Understanding Bathrocephaly

Bathrocephaly is characterized by:

• Prominent bulging of the midportion of the occipital bone
• Often associated with a persistent mendosal suture (where endochondral and membranous portions of the occipital bone converge)
• The mendosal suture normally closes during fetal life or early infancy, but when it persists, it creates this characteristic head shape 1, 2

Diagnostic Approach

Clinical evaluation should include:

• Complete examination of head shape with particular attention to the posterior skull
• Assessment for any associated developmental concerns or neurological symptoms
• Differentiation from other cranial deformities:
  • Absence of ridges (unlike craniosynostosis)
  • Pattern of occipital bulging rather than flattening (unlike positional plagiocephaly)
  • Symmetry assessment (bathrocephaly is typically midline) 2

Management Recommendations

1. Observation and Reassurance

   • Most cases require no intervention as this is considered a benign anatomical variant 1
   • Regular monitoring of head growth and development is sufficient

2. When to Consider Further Evaluation

   • If associated with developmental delays
   • If there is progressive worsening of head shape
   • If neurological symptoms are present
   • If there is significant cosmetic concern 3

Special Considerations

While surgical correction has been described in rare cases with significant deformity using techniques such as:

• Reverse pi procedure (though with inconsistent results)
• Absorbable microplate-reinforced bone strut frameworks
• Turned biparietal flap transposition 4, 5

These interventions are rarely indicated for typical bathrocephaly, which is generally considered a benign variant that does not require treatment.

Differential Diagnosis

When evaluating bathrocephaly, consider other conditions that may affect posterior skull shape:

• Positional plagiocephaly (flattening rather than bulging)
• Craniosynostosis involving other sutures
• Hydrocephalus
• Dandy Walker or Arnold Chiari malformations
• Microencephaly 5, 6

Parent Counseling

Parents should be reassured that:

• Bathrocephaly is typically a benign finding
• No intervention is usually necessary
• Regular follow-up with the primary care provider is sufficient to monitor development
• The condition is not associated with developmental or neurological problems in most cases 1, 2