Neuroradiology typical cases

Craniosynostosis

History: 2-year-old boy with cranial asymmetry

Findings: Axial CT with bone algorithm shows fusion of both coronal sutures. Sagittal and lamdoid sutures are open.
Note the rounded and foreshortened appearance of the head. Three-dimensional CT in the frontal oblique projection demonstrates bony bridging and obliteration of both coronal sutures.

Diagnosis: Bilateral coronal craniosynostosis (brachycephaly)

Discussion: Craniosynostosis is the premature closure of the cranial suture. Cessation of growth at a suture leads to a decrease in the diameter of the skull perpendicular to the plane of the affected suture. Premature closure may be idiopathic (primary craniosynostosis) or secondary to metabolic diseases, bony dysplasias, hematologic disorders, or alterations on intracranial pressure. The sagittal suture is the most common suture involved. The coronal suture is the second most commonly involved suture, and craniosynostosis may be unilateral or bilateral. With bilateral coronal synostosis, the skull is brachycephalic (shape of a skull shorter than typical for its species), demonstrating a wide cranium that is short in the anteroposterior dimension. CT is superior in the detection of suture closure as well as demonstrating the shape of the skull. Three-dimensional CT is highly accurate in the diagnosis and assessment of craniosynostosis and may facilitate surgical planning by precisely localizing the proper site for craniectomy.

Aunt Minnie’s Pearls

  • Three-dimensional CT is accurate in the detection and assessment of craniosynostosis.

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