My 14 year old step daughter was born with a large posterior fontanelle. By age three it had fused in the center leaving two quarter sized fontanelle about the size of a quarter. At that time there were no recommended procedures from the neurosurgeon and no clear diagnosis explaining the disorder. She is now 14 and a recent CT shows the holes in the skull remain quarter sized and symmetrical. These fontanelles are quite tender to the touch, but no signs of rash or infection. Her BP runs @ 115/55, her long bone growth is above average, hands/fingers are long and slender, rickets ruled out in infancy, She is somewhat tall 5 7 with an athletic 130 build. When she gets headaches (not very frequently), they are only in the area of the fontanelles, never anywhere else. Recently, she s developed headaches upon standing, and she s always had issues if her head is lower than the rest of her body. She has historically been very active in sports and we ve become concerned about these soft spots being a risk from contact during basketball and softball as the competitiveness increases in the kids she s playing against. My logic tells me to seek surgery to close the fontanelles and hope to regulate the innercranial pressure so that pressures are perhaps diffused over the larger interior surface area and not focused on the openings in the skull. In my mind this also would serve to protect her brain from trauma in the area of the fontanelles. What I d like to know is, what are the most effective fixes, (patches, plates, grafts) and do the surgical risks typically outweigh the benefits. The resident neurologist in the ER described surgery as typically cosmetic, but that seemed a little strange to me and the ER attending looked a bit befuddled by her description/need for a potential closure. Also, Has anyone seen a similar case or perhaps refer me to an area for additional research information. From my brief Internet search, her symptoms are quite rare, and the typical conditions associated with this type of disorder usually include some form of retarded bone growth, which she exhibits no signs of. Thank You, E