Posterior Cranial Vault Manifestations in Nonsyndromic Sagittal Craniosynostosis

Sagittal synostosis is the most common type of craniosynostosis. Sagittal suture fusion causes restriction of biparietal cranial vault growth, with expansion of the growing brain causing frontal bossing, an occipital bullet, and an elongated head shape. Due to the absence of studies focusing on the posterior cranial vault pattern in isolated sagittal craniosynostosis, we organized this study to characterize the posterior part of the cranial vault and its association with sagittal craniosynostosis. A retrospective study was conducted of isolated sagittal craniosynostosis patients who had undergone total cranial vault remodeling at the Cleft and Craniofacial South Australia (formerly known as the Australian Craniofacial Unit) between January 2018 and February 2020. Preoperative three-dimensional computed tomography (3D-CT) images were reviewed. The following parameters were evaluated: the cephalic index, lambdoid suture shape, lambdoid suture line pattern, presence of wormian bones along the lambdoid sutures and occipital fontanelle, presence of the mendosal suture, and angle at the tip of the join between the 2 lambdoid sutures. Thirty-nine 3D-CT scans of 32 males and 7 females were evaluated. The mean age when the patients underwent the 3D-CT imaging was 6.72 ± 7.9 months. A high prevalence of mendosal sutures (74.4%) was significantly found in sagittal craniosynostosis. Adult-like types of lambdoid suture interdigitating patterns were also significantly associated with young patients with sagittal craniosynostosis. No associations between the remaining parameters and particular synostoses were revealed.