The Infant Skull: A Vault of Information

Abstract

The art of interpreting skull radiographs is slowly being lost as trainees in radiology see fewer plain radiographs and depend more heavily on computed tomography and magnetic resonance imaging. Nevertheless, skull radiographs still provide significant information that is helpful in finding pathologic conditions and appreciating their extents. Abnormalities in the skull may be reflected as variations in the density, size, and shape of the skull, as well as skull defects. Skeletal dysplasias may manifest as a generalized decrease in calvarial density (hypophosphatasia, osteogenesis imperfecta), a generalized increase in calvarial density (osteopetrosis), or a focal increase in density (frontometaphyseal dysplasia). Diffusely decreased or increased calvarial density is usually associated with a process that affects the entire skeleton. Therefore, correct differentiation among these dysplasias depends on other concurrent features. Decreased size of the cranial vault at birth generally implies an underlying insult to the brain, including fetal alcohol syndrome and the so-called TORCH infections (toxoplasmosis, rubella, cytomegalovirus infection, herpes simplex). Macrocephaly may result from skeletal dysplasia or an increase in the intracranial volume (eg, due to underlying anomalies of the brain such as hydrocephalus).

Anatomoradiological identification of intrasutural bones for importance of cranial fracture

“…Thus, it is implied that preinterparietal centers with different locations could To be able to distinguish a fracture from a suture, one should be aware of the appearance and position of the normal sutures and the variants (5,15). MRI does not show sutures clearly and CT may also fail to distinguish a suture from a fracture if there is only the axial image (5,6,8,12,21). It was advised that, in case occipital bone injuries the treating clinician should plan a meticulous differential diagnosis and should go for a 3D-CT scan especially in patients with low Glasgow coma score.…”

Three-dimensional CT imaging in pediatric calvarial pathologies

“…The posterior fontanelle is in the conjunction of the sag-ittal and lambdoid sutures and closes by about three months of age (1)(2)(3). The closure of the sutures and fontanelles are outlined in Table.…”

“…The well-defined lucent areas in the calvarium represent nonossified fibrous bones, which are bound by normally ossified bones (2). They are usually present at birth and occur most prominently in the parietal and occipital bones.…”

“…The lacunae resolves spontaneously by the age of six months and is not related to the degree of hydrocephalus. Lacunar skull is usually associated with Chiari II malformation and less commonly with encephalocele (2).…”

Geometric morphometric analysis of shape outlines of the normal and abnormal fetal skull using three-dimensional sonographic multiplanar display

“…Craniofacial manifestations are among the few features common to most individuals with trisomy 21, and the characteristic face of these individuals is a result primarily of maldevelopment of the craniofacial skeleton 4 . An abnormal skull shape may frequently reflect underlying brain insult or maldevelopment 5 . Geometric morphometric analysis has been used to quantify differences in biologic shapes 6 -11 .…”