Reasons for the late 1980s apparent epidemic of craniosynostosis and neurosurgical intervention in Colorado, including reports of clusters in selected high-altitude communities, were investigated in the Colorado Department of Health and the University of Colorado School of Medicine, Denver. Of 605 children in the craniosynostosis registry, Colorado Dept of Health, 1986-1989, 307 (51%) had definite radiographic evidence of synostosis. Case reports fell from 347 in the first year to 103 in the third year, following dissemination of information on the controversial nature of the diagnosis and treatment of craniosynostosis. There was also a close surveillance of local diagnostic practices which contributed to the decreased prevalence. Dramatic media coverage of the still unexplained cluster of severe cases in late 1979 preceeded the apparent epidemic. Diagnostic criteria, and the inclusion of radiographically questionable cases, had influenced the rate of synostosis. Evidence for an epidemic of craniosynostosis was not confirmed. 
COMMENT. CT is more useful than plain radiographs in the diagnosis of coronal and other synostoses. The expert opinion of radiologists is important in diagnostic confirmation prior to surgical intervention.
Diagnosis and management of posterior plagiocephaly is assessed at the Children’s Hospital of Pittsburgh, PA. Deformational plagiocephaly was diagnosed in 69 of 71 infants, and only two had true lambdoidal synostosis, associated with posterior sagittal synostosis, and successfully treated surgically. Positional therapy or helmet was generally sufficient.