Diagnosis of isolated sagittal synostosis: are radiographic studies necessary?
Abstract
Aims and objectives Isolated sagittal synostosis can be diagnosed easily on clinical grounds. This study was designed to determine if children could be operated on based solely on a clinical diagnosis or whether such an approach would result in any potentially unnecessary surgeries.Materials and methods Records of 114 consecutive children operated on for isolated nonsyndromic sagittal synostosis over a 14-year period (1987-2000) were reviewed to see whether the clinical findings were in concordance with the intraoperative findings and histopathology of the sagittal suture.Results The age at surgery ranged from 1.9 to 81.3 months (median 4.3 months). Preoperative skull radiographs were done in 78 children and computer tomography (CT) scans of the head in 12 children. One hundred percent of the skull radiographs and 83.3% of the CT scans were completed prior to referring the children to a pediatric neurosurgeon. CT scans confirmed the diagnosis in all patients in whom it was available. For the rest, pathology reports and/or operative records were available for 108 (94.7%) children and were confirmatory for sagittal craniosynostosis in all.Conclusions Accurate diagnosis of isolated sagittal synostosis can be made clinically, and operative correction can proceed without a need for radiological investigations, unless the clinical features are not completely typical. This approach could result in significantly reduced radiation exposure for the developing brain and could provide economic benefits to health care providers.
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Agrawal et al. concluded that surgery could proceed based on clinical diagnosis when symptoms are typical, making radiological investigations often unnecessary.
“The study concluded that surgery could proceed based on clinical diagnosis when symptoms are typical [27].”
From Developments in diagnostic and surgical techniques in children with sagittal suture craniosynostosis: a systematic review spanning the last 30 years (2025) · cites this paper as [27]
In Agrawal et al.'s study, pathological examination in 104 of 114 children confirmed the diagnosis of sagittal craniosynostosis.
“Pathological examinations were performed in 104 of 114 children, all of which confirmed the diagnosis of sagittal craniosynostosis.”
From Developments in diagnostic and surgical techniques in children with sagittal suture craniosynostosis: a systematic review spanning the last 30 years (2025) · cites this paper as [27]
Agrawal et al. (2006) found that in most of 114 children with isolated sagittal synostosis, clinical findings were consistent with surgical and histopathological outcomes.
“In most cases, the clinical findings were consistent with surgical and histopathological outcomes.”
From Developments in diagnostic and surgical techniques in children with sagittal suture craniosynostosis: a systematic review spanning the last 30 years (2025) · cites this paper as [27]
Clinical evaluation alone can accurately identify craniosynostosis, eliminating the need for imaging and reducing associated risks.
“Both Agrawal et al. and Schmidt et al. highlighted that clinical evaluation alone can accurately identify the condition, eliminating the need for imaging and reducing associated risks.”
From Developments in diagnostic and surgical techniques in children with sagittal suture craniosynostosis: a systematic review spanning the last 30 years (2025) · cites this paper as [27]
Early diagnosis through detailed physical examination enables timely surgical intervention and helps minimise healthcare costs.
“Early diagnosis through a detailed physical examination not only enables timely surgical intervention but also helps minimise healthcare costs, underscoring the value of clinical expertise in managing this condition [2, 27].”
From Developments in diagnostic and surgical techniques in children with sagittal suture craniosynostosis: a systematic review spanning the last 30 years (2025) · cites this paper as [27]
Cites
Estimated Risks of Radiation-Induced Fatal Cancer from Pediatric CT
Brenner, D. J., Elliston, C. D., Hall, E. J., & Berdon, W. E. (2001) · American Journal of Roentgenology · doi:10.2214/ajr.176.2.1760289 · Cited by 3,222 · see citing works
Estimating cancer risks from pediatric CT: going from the qualitative to the quantitative
Brenner, D. J. (2002) · Pediatric Radiology · doi:10.1007/s00247-002-0671-1 · Cited by 555 · see citing works
Hall, P. N., Adami, H., Trichopoulos, D., Pedersen, N. L., Lagiou, P., Ekbom, A., Ingvar, M., Lundell, M., & Granath, F. (2004) · BMJ · doi:10.1136/bmj.328.7430.19 · Cited by 350 · see citing works
Brenner, D. J., Elliston, C. D., Hall, E. J., & Berdon, W. E. (2001) · Medical Physics · doi:10.1118/1.1415074 · Cited by 134 · see citing works
(2004) · PubMed · Cited by 132 · see citing works
Computerized tomography of cranial sutures
Furuya, Y., Edwards, M. S. B., Alpers, C. E., Tress, B. M., Ousterhout, D. K., & Norman, D. M. (1984) · Journal of neurosurgery · doi:10.3171/jns.1984.61.1.0053 · Cited by 112 · see citing works
Computerized tomography of cranial sutures
Furuya, Y., Edwards, M. S. B., Alpers, C. E., Tress, B. M., Norman, D. M., & Ousterhout, D. K. (1984) · Journal of neurosurgery · doi:10.3171/jns.1984.61.1.0059 · Cited by 67 · see citing works
Medina, L. S. (2001) · PubMed · Cited by 50 · see citing works
Bendheim, P. E., & Bolton, D. C. (1991) · Reviews in Medical Virology · doi:10.1002/rmv.1980010303 · Cited by 34 · see citing works
Nonsynostotic scaphocephaly: the so-called sticky sagittal suture
Baumgartner, J. E., Seymour-Dempsey, K., Teichgraeber, J. F., Xia, J. J., Waller, A. L., & Gateño, J. (2004) · Journal of Neurosurgery Pediatrics · doi:10.3171/ped.2004.101.2.0016 · Cited by 20 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Neurodevelopment of children with single suture craniosynostosis: a review
Kapp‐Simon, K. A., Speltz, M. L., Cunningham, M. L., Patel, P. K., & Tomita, T. (2006) · Child s Nervous System · doi:10.1007/s00381-006-0251-z · Cited by 290 · see citing works
Genetic advances in craniosynostosis
Lattanzi, W., Barba, M., Di Pietro, L., & Boyadjiev, S. A. (2017) · American Journal of Medical Genetics Part A · doi:10.1002/ajmg.a.38159 · Cited by 129 · see citing works
Evaluation and management of nonsyndromic craniosynostosis
Ursitti, F., Fadda, T., Papetti, L., Pagnoni, M., Nicita, F., Iannetti, G., & Spalice, A. (2011) · Acta Paediatrica · doi:10.1111/j.1651-2227.2011.02299.x · Cited by 79 · see citing works
Isolated sagittal craniosynostosis: definition, classification, and surgical indications
Massimi, L., Caldarelli, M., Tamburrini, G., Paternoster, G., & Di Rocco, C. (2012) · Child s Nervous System · doi:10.1007/s00381-012-1834-5 · Cited by 76 · see citing works
Classification System for Sagittal Craniosynostosis
David, L. R., Glazier, S. S., Pyle, J. W., Thompson, J. T., & Argenta, L. C. (2009) · Journal of Craniofacial Surgery · doi:10.1097/scs.0b013e3181945ab0 · Cited by 56 · see citing works
Increasing Concern Regarding Computed Tomography Irradiation in Craniofacial Surgery
Domeshek, L. F., Mukundan, S., Yoshizumi, T. T., & Marcus, J. R. (2009) · Plastic & Reconstructive Surgery · doi:10.1097/prs.0b013e31819e26d5 · Cited by 50 · see citing works
Accuracy of Craniofacial Measurements
Fruehwald‐Pallamar, J., Schicho, K., Figl, M., Benesch, T., Watzinger, F., & Kainberger, F. M. (2008) · Journal of Craniofacial Surgery · doi:10.1097/scs.0b013e318052ff1a · Cited by 44 · see citing works
Simanovsky, N., Hiller, N., Koplewitz, B. Z., & Rozovsky, K. (2008) · European Radiology · doi:10.1007/s00330-008-1193-5 · Cited by 42 · see citing works
Cranial ultrasound is a reliable first step imaging in children with suspected craniosynostosis
Pogliani, L., Zuccotti, G. V., Furlanetto, M., Giudici, V., Erbetta, A., Chiapparini, L., & Valentini, L. (2017) · Child's Nervous System · doi:10.1007/s00381-017-3449-3 · Cited by 39 · see citing works
Engel, M., Castrillon‐Oberndorfer, G., Hoffmann, J., & Freudlsperger, C. (2012) · Journal of Plastic Reconstructive & Aesthetic Surgery · doi:10.1016/j.bjps.2012.03.038 · Cited by 36 · see citing works
Metopic “ridge” vs. “craniosynostosis”: Quantifying severity with 3D curvature analysis
Cho, M., Kane, A. A., Seaward, J. R., & Hallac, R. R. (2016) · Journal of Cranio-Maxillofacial Surgery · doi:10.1016/j.jcms.2016.06.019 · Cited by 34 · see citing works
Ultrasonography for the diagnosis of craniosynostosis
Proisy, M., Riffaud, L., Chouklati, K., Tréguier, C., & Bruneau, B. (2017) · European Journal of Radiology · doi:10.1016/j.ejrad.2017.03.006 · Cited by 34 · see citing works
Surgical Correction of Nonsyndromic Sagittal Craniosynostosis
Simpson, A. M., Wong, A. L., & Bezuhly, M. (2016) · Annals of Plastic Surgery · doi:10.1097/sap.0000000000000713 · Cited by 33 · see citing works
Analysis of Morbidity, Readmission, and Reoperation After Craniosynostosis Repair in Children
Jubbal, K. T., Agrawal, N., & Hollier, L. H. (2016) · Journal of Craniofacial Surgery · doi:10.1097/scs.0000000000003316 · Cited by 30 · see citing works
Seeberger, R., Hoffmann, J., Freudlsperger, C., Berger, M., Bodem, J., Horn, D., & Engel, M. (2016) · Journal of Cranio-Maxillofacial Surgery · doi:10.1016/j.jcms.2016.01.023 · Cited by 25 · see citing works
Multicentre approach to epidemiological aspects of craniosynostosis in Germany
Neusel, C., Class, D., Eckert, A. W., Firsching, R. P., Göbel, P., Götz, D., Haase, R., Jorch, G., Köhn, A., Kropf, S., et al. (2018) · British Journal of Oral and Maxillofacial Surgery · doi:10.1016/j.bjoms.2018.10.003 · Cited by 24 · see citing works
How ultrasonography can contribute to diagnosis of craniosynostosis
Proisy, M., Bruneau, B., & Riffaud, L. (2019) · Neurochirurgie · doi:10.1016/j.neuchi.2019.09.019 · Cited by 24 · see citing works
Mertens, C., Wessel, E., Berger, M., Ristow, O., Hoffmann, J., Kansy, K., Freudlsperger, C., Bächli, H., & Engel, M. (2017) · Journal of Cranio-Maxillofacial Surgery · doi:10.1016/j.jcms.2017.09.019 · Cited by 22 · see citing works
Atypical scaphocephaly: a review
Vinchon, M., Pellerin, P., Guerreschi, P., Baroncini, M., & Dhellemmes, P. (2012) · Child s Nervous System · doi:10.1007/s00381-012-1807-8 · Cited by 22 · see citing works
Associated (Parallel) Tomographic Findings in Patients With Single-Sutural Synostosis
da Silva Freitas, R., de Freitas Azzolini, T., Shin, J. H., & Persing, J. A. (2010) · Journal of Craniofacial Surgery · doi:10.1097/scs.0b013e3181cfa7ad · Cited by 17 · see citing works
Linz, C., Meyer‐Marcotty, P., Böhm, H., Müller-Richter, U. D. A., Jager, B., Hartmann, S., Reichert, C., Kochel, J., & Schweitzer, T. (2013) · Child s Nervous System · doi:10.1007/s00381-013-2253-y · Cited by 17 · see citing works
The Role of Preoperative Computed Tomography in Nonsyndromic Craniosynostosis
Alnaif, N. M., Zhou, M., Galli, R., Azzi, A. J., Alamri, A., & Gilardino, M. S. (2019) · Journal of Craniofacial Surgery · doi:10.1097/scs.0000000000005088 · Cited by 13 · see citing works
Depicting cranial sutures: a travel into the history
Frassanito, P., & Rocco, C. D. (2010) · Child s Nervous System · doi:10.1007/s00381-010-1352-2 · Cited by 13 · see citing works
Postnatal diagnosis of single-suture craniosynostosis with cranial ultrasound: a systematic review
Whittall, I., Lambert, W. A., Moote, D. J., Bookland, M. J., Martin, J. E., Hughes, C. D., & Hersh, D. S. (2021) · Child s Nervous System · doi:10.1007/s00381-021-05301-w · Cited by 12 · see citing works
Aldana, P. R., & Steinbok, P. (2009) · Journal of Neurosurgery Pediatrics · doi:10.3171/2009.4.peds0945 · Cited by 10 · see citing works
Self-citationCraniosynostosis: current conceptions and misconceptions
Fonteles, C. S. R., Finnell, R. H., George, T. M., & Harshbarger, R. J. (2016) · Global Medical Genetics · doi:10.3934/genet.2016.1.99 · Cited by 9 · see citing works
A new three-dimensional measurement in evaluating the cranial asymmetry caused by craniosynostosis
Yin, H., Dong, X., & Yang, B. (2015) · Surgical and Radiologic Anatomy · doi:10.1007/s00276-015-1430-y · Cited by 8 · see citing works
Congenital Malformations of the Skull and Meninges
Kanev, P. M. (2007) · Otolaryngologic Clinics of North America · doi:10.1016/j.otc.2006.10.005 · Cited by 8 · see citing works
Imaging in the Evaluation of Children with Suspected Craniosynostosis
Vinocur, D. N., & Medina, L. S. (2009) · Springer eBooks · doi:10.1007/978-1-4419-0922-0_4 · Cited by 7 · see citing works
Isolierte, nichtsyndromale Kraniosynostosen
Freudlsperger, C., Castrillon‐Oberndorfer, G., Hoffmann, J., & Engel, M. (2013) · Der MKG-Chirurg · doi:10.1007/s12285-013-0364-9 · Cited by 7 · see citing works
Delattre, M.-H., Hennocq, Q., Stricker, S., D, G. P. M., & Khonsari, R. H. (2022) · Journal of Stomatology Oral and Maxillofacial Surgery · doi:10.1016/j.jormas.2022.01.012 · Cited by 5 · see citing works
Saponaro, G., Bernardo, S., Curzio, P. D., Basile, E., Rastelli, E., Martini, S., Vinci, V., Saldari, M., Manganaro, L., & Cascone, P. (2013) · European Journal of Plastic Surgery · doi:10.1007/s00238-013-0898-0 · Cited by 4 · see citing works
The Sutures of the Skull: A Historical Perspective
Syrmos, N. C., Giannouli, V., & Turgut, M. (2021) · Springer eBooks · doi:10.1007/978-3-030-72338-5_2 · Cited by 3 · see citing works
Khormi, Y. H., Chiu, M., Tyndall, R. G., Mortenson, P., Smith, D. J., & Steinbok, P. (2019) · Child s Nervous System · doi:10.1007/s00381-019-04400-z · Cited by 3 · see citing works
Self-citationSpazzapan, P., Verdenik, M., & Velnar, T. (2023) · Child s Nervous System · doi:10.1007/s00381-023-06115-8 · Cited by 3 · see citing works
Rénier, D., Capon-Degardin, N., Arnaud, É., & Marchac, D. (2006) · Neurochirurgie · doi:10.1016/s0028-3770(06)71218-8 · Cited by 3 · see citing works
Hermann, J., Raak, C. K., Ostermann, T., & Scharbrodt, W. (2025) · Orphanet Journal of Rare Diseases · doi:10.1186/s13023-025-03978-9 · Cited by 2 · see citing works
“Early diagnosis through a detailed physical examination not only enables timely surgical intervention but also helps minimise healthcare costs, underscoring the value of clinical expertise in managing this condition [2, 27].”
Diagnostik und Therapie isolierter Kraniosynostosen
Freudlsperger, C., Hoffmann, J., & Engel, M. (2015) · Kinder- und Jugendmedizin · doi:10.1055/s-0038-1629263 · Cited by 2 · see citing works
Guadix, S. W., Valenti, A., Zappi, K. E., Garton, A. L. A., Yuan, M., Buontempo, M., Perera, I., Souweidane, M. M., Imahiyerobo, T., & Hoffman, C. E. (2022) · Journal of Craniofacial Surgery · doi:10.1097/scs.0000000000008534 · Cited by 2 · see citing works
Steinbok, P. (2012) · Child s Nervous System · doi:10.1007/s00381-012-1955-x · Cited by 2 · see citing works
Self-citationChen, H. (2017) · Springer eBooks · doi:10.1007/978-1-4939-2401-1_209 · Cited by 1 · see citing works
(2012) · Springer eBooks · doi:10.1007/978-1-4614-1037-9_209 · Cited by 1 · see citing works
Chen, H. (2016) · Springer eBooks · doi:10.1007/978-1-4614-6430-3_209-2 · Cited by 1 · see citing works
Rückschloß, T., Zittel, S., Hassanein, E., Damaty, A. E., Krieg, S. M., Ristow, O., Hoffmann, J., & Engel, M. (2025) · Neurosurgical FOCUS · doi:10.3171/2024.10.focus24582 · Cited by 1 · see citing works
Methods of Cranial Vault Reconstruction for Craniosynostosis
Hinojosa, J. (2012) · Elsevier eBooks · doi:10.1016/b978-1-4160-6839-6.10065-6 · Cited by 1 · see citing works
Isolierte, nichtsyndromale Kraniosynostosen
Freudlsperger, C., Hoffmann, J., & Engel, M. (2018) · Der MKG-Chirurg · doi:10.1007/s12285-018-0154-5 · Cited by 1 · see citing works
Jalal, H., Enneddam, H., Aniba, K., Laghmari, M., Najib, J., Ali, S. A. B., & Idrissi, G. N. C. (2013) · Feuillets de Radiologie · doi:10.1016/j.frad.2013.07.003
Cumulative diagnostic radiation exposure in children with ventriculoperitoneal shunts
Steinbok, P. (2008) · Child s Nervous System · doi:10.1007/s00381-007-0563-7
Self-citationBrachycephalus und Lambdanahtsynostose
Engel, M. (2018) · Springer eBooks · doi:10.1007/978-3-662-48700-6_30
Imaging in the Evaluation of Children with Suspected Craniosynostosis
Alvarado, E., & Medina, L. S. (2022) · Evidence-based imaging · doi:10.1007/978-3-030-38095-3_4-1
Imaging in the Evaluation of Children with Suspected Craniosynostosis
Alvarado, E., & Medina, L. S. (2024) · Evidence-based imaging · doi:10.1007/978-3-030-89688-1_4
Children with Suspected Craniosynostosis: Evidence-Based Neuroimaging
Vinocur, D. N., & Medina, L. S. (2013) · Springer eBooks · doi:10.1007/978-1-4614-3320-0_22
- Authors
- Agrawal, D., Steinbok, P., & Cochrane, D. D.
- Affiliations
- University of British Columbia (CA)
- Corresponding author
- Steinbok, Paul
- Venue
- Child's Nervous System
- Published
- 2005-09-27
- Volume
- 22
- Issue
- 4
- Pages
- 375-378
- ISSN
- 0256-7040 (ISSN-L)
- 1433-0350
- OpenAlex
- W2043172648
- Cited by
- 53
- References
- 10
- Citations by year
- 2025: 2 · 2024: 1 · 2023: 1 · 2022: 3 · 2021: 2 · 2019: 3 · 2018: 3 · 2017: 5 · 2016: 6 · 2015: 2 · 2014: 1 · 2013: 5 · 2012: 6
- FWCI
- 1.08
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Child s Nervous System (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Craniofacial Disorders and Treatments
- Health Sciences › Medicine › Surgery › Pectus Deformity Diagnosis and Treatment
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Spinal Dysraphism and Malformations
- Keywords
- craniosynostosis, diagnosis, radiographic diagnosis, skull radiographs, head CT, unnecessary surgery, radiation exposure, pediatric neurosurgery, nonsyndromic craniosynostosis
- MeSH terms
- Child, Child, Preschool, Cranial Sutures, Craniosynostoses, Humans, Infant, Retrospective Studies, Tomography, X-Ray Computed, Treatment Outcome
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