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Updated: Aug 19, 2026
State of the Art Cranial Ultrasound Imaging in Neonates
Published on: February 2, 2015
The developing anterior skull base: CT appearance from birth to 2 years of age
C J Belden1, A A Mancuso, I M Kotzur
1Department of Radiology, University of Florida, Gainesville, USA.
Insights
The anterior skull base ossifies predictably in infants up to 24 months. This study details the normal CT appearance and ossification patterns of the developing skull base in young children.
Area of Science:
- Pediatric Radiology
- Craniofacial Development
- Anatomy
Background:
- The anterior skull base undergoes significant development and ossification during infancy.
- Understanding normal developmental patterns is crucial for accurate interpretation of pediatric imaging.
Purpose of the Study:
- To characterize the typical computed tomography (CT) findings of the developing anterior skull base in children up to 24 months of age.
- To establish normative data for anterior skull base ossification in early childhood.
Main Methods:
- Retrospective review of CT scans from 61 healthy infants (newborn to 24 months).
- Independent assessment of skull base length, ossification patterns, and development of key structures (crista galli, ethmoid bone, fovea ethmoidalis) by two investigators.
Main Results:
- At birth, the anterior skull base is primarily cartilaginous.
- Ossification progresses from the ethmoidal labyrinth towards the midline, with 84% ossification by 24 months.
- Ossification of the crista galli and perpendicular plate begins around 2 months, while the fovea ethmoidalis starts developing by 6 months.
Conclusions:
- Observed ossification timing and patterns differ slightly from previous studies.
- Early bony bridging between the ethmoidal complex and crista galli can be seen as early as 2 months.
- The predictable development of the anterior skull base aids in accurate CT interpretation and error avoidance.
Purpose:
To describe the normal CT appearance of the developing anterior skull base in children 24 months of age and younger.
Methods:
A retrospective review of the CT examinations of a healthy population of 61 subjects newborn through 24 months of age was performed. Two investigators independently reviewed the examinations, making measurements and observations regarding the length of the skull base, ossification pattern, and development of the crista galli, perpendicular plate of the ethmoid bone, and fovea ethmoidalis.
Results:
At birth, the anterior skull base is largely cartilaginous. Ossification begins in the roof of the ethmoidal labyrinth laterally and spreads toward the midline. By 6 months of age, 50% of the anterior skull base has completely ossified. This percentage steadily increases over the first 2 years of life, and by 24 months, 84% of the anterior skull base is completely ossified, with a cartilaginous gap anteriorly in the region of the foramen cecum, the residual unossified portion. Ossification of the crista galli and perpendicular plate of the ethmoid bone begins around 2 months of age, shows a steady increase in ossification to 14 months of age, then increases little to 24 months of age. The fovea ethmoidalis begins development by 6 months of age, with the anterior portion the most developed in 82% of the population.
Conclusion:
The timing and pattern of ossification we observed differ somewhat from that reported in prior radiologic and anatomic studies, with the earliest bony bridging of the ethmoidal complex to the crista galli seen as early as 2 months of age. Development of the anterior skull base follows a predictable and orderly pattern that is important for understanding how to avoid errors in interpreting CT examinations through this region.
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