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Cited by 3Craniofacial Disorders and TreatmentsFetal and Pediatric Neurological DisordersCleft Lip and Palate Research

Prenatal Ultrasound Parameters of Twins With Sagittal Suture Craniosynostosis Question Mechanical Constraint as the Leading Cause

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Cinca, Kevin P., de Planque, Catherine A., Peters, Nina C.J., Versnel, Sarah L., Mathijssen, Irene M.J.·2022·Journal of Craniofacial Surgery
DOI 10.1097/scs.0000000000008809
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Abstract

Background: Multiple pregnancy is a known predisposing factor for sagittal suture synostosis, and intrauterine constraint has been suggested as a potential cause. This study evaluates prenatal images of single and multiple pregnancies of children with sagittal suture synostosis to assess the possible pathogenesis. Materials and Methods: Prenatal ultrasound data of scaphocephaly twins treated at Erasmus MC was retrieved retrospectively. The head circumference, cephalic index (CI), and biparietal diameter (BPD) were analyzed. Data were compared with the nonaffected sibling, singletons with scaphocephaly, and to general fetal growth reference values. Results: Data of 8 twin pregnancies with 10 cases of scaphocephaly was gathered. For the head circumference no difference was found between affected fetuses and reference values throughout pregnancy. For the BPD a reduced growth was found, compared with control values. The growth curve for the CI of the affected twins is lower from the start and declines over time. When comparing affected fetuses to nonaffected fetuses, the same differences for the BPD and CI were found as compared with controls. No differences in growth parameters were found between the nonaffected siblings and reference values, nor between the affected scaphocephaly twins and singletons with scaphocephaly. Conclusions: Scaphocephaly in twin pregnancy develops early on in pregnancy, similar to singleton pregnancy, making the theory of constraint as a cause less likely. The development of scaphocephaly in twins is likely to be attributed to the same disturbed developmental processes in suture development as in singletons, and not to mechanical constraint.

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Crossref · 10.1097/scs.0000000000008809

Cites

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  • Cinca et al. (2022) proposed that mechanical factors such as crowding or abnormal positioning of twins may be a significant factor in the development of sagittal suture craniosynostosis alongside genetic causes.

    “The authors propose that mechanical factors, such as crowding or abnormal positioning of the twins, may be a significant factor in the development of SSC, alongside genetic causes [38].”

    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 [38]

    The Discussion concludes that scaphocephaly in twins is likely due to the same disturbed suture-development processes seen in singletons, “and not to mechanical constraint.” Although the Abstract notes that constraint had previously been suggested as a possible cause, the authors' findings argue against it rather than propose it as a significant factor alongside genetic causes. (LLM, conf=0.91)

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  • Cinca et al. proposed that mechanical constraints in twin pregnancies may contribute to sagittal suture fusion.

    “More recently Cinca et al. proposed that mechanical constraints in twin pregnancies may contribute to sagittal suture fusion, highlighting the multifactorial nature of this condition [38].”

    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 [38]

    The Abstract describes mechanical constraint as an existing suggestion that Cinca et al. set out to test, not a proposal they make. Its conclusion says scaphocephaly in twins is likely due to disturbed suture-development processes, not mechanical constraint; the Discussion likewise calls reduced womb space an improbable influence at the apparent onset of synostosis. Page numbers are unavailable in our copy. (LLM, conf=0.88)

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  • Cornelissen et al. and other authors highlighted the potential of prenatal ultrasound, with BPD deviations suggesting improved accuracy using 3D imaging.

    “Cornelissen et al. and other authors highlighted the potential of prenatal ultrasound, with BPD deviations suggesting improved accuracy using 3D imaging.”

    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 [38]

    The Biometrics results (page unavailable) report that affected twins had slower BPD growth and a smaller BPD later in pregnancy, supporting the point that prenatal ultrasound can reveal deviations. The paper does not report that 3D imaging improves accuracy, and it is not a study by Cornelissen et al. (LLM, conf=0.87)

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  • Ultrasound is non-invasive and widely available, but CI alone is unreliable, and the feasibility of advanced imaging in routine screening requires further study.

    “While ultrasound is non-invasive and widely available, CI alone is unreliable, and the feasibility of advanced imaging in routine screening requires further study [36, 38].”

    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 [38]

    The Analysis section (page unavailable) says pregnancy ultrasound measurements are used in daily practice, and the Discussion notes that measurements are user-dependent. The paper does not establish that CI alone is unreliable or discuss the feasibility of advanced imaging in routine screening; it also does not address ultrasound's non-invasiveness. (LLM, conf=0.76)

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Cites

Flagged first, then by citations

1 of the 24 references couldn’t be matched to a known paper.

Research works printed but not linked: 1

  1. Di Rocco F, Arnaud E, Renier D. Evolution in the frequency of nonsyndromic craniosynostosis. J Neurosurg Pediatr 2009;4:21-25

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Authors
Cinca, K. P., de Planque, C. A., Peters, N. C. J., Versnel, S. L., & Mathijssen, I. M. J.
Affiliations
  • Erasmus MC (NL)
  • Department of Plastic and Reconstructive Surgery and Hand Surgery, Erasmus MC
Corresponding author
  • Cinca, Kevin P.
  • Versnel, Sarah L.
  • Mathijssen, Irene M.J.
ORCID
Venue
Journal of Craniofacial Surgery
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2022-07-22
Volume
33
Issue
8
Pages
2350-2353
ISSN
1049-2275 (ISSN-L)
DOI
10.1097/scs.0000000000008809
OpenAlex
W4286433110
Cited by
3
References
24
Citations by year
2025: 1 · 2023: 2
FWCI
0.45
Type
journal article
Language
en
Open access
Licence
other-oa
Locations
  • Journal of Craniofacial Surgery (publishedVersion)
  • PubMed (publishedVersion)
  • EUR Research Repository (Erasmus University Rotterdam) (submittedVersion, other-oa)
  • EUR Research Repository (Erasmus University Rotterdam) (submittedVersion)
Topics
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Craniofacial Disorders and Treatments
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Fetal and Pediatric Neurological Disorders
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Cleft Lip and Palate Research
Keywords
sagittal craniosynostosis, scaphocephaly, twins, prenatal ultrasound, cephalic index, biparietal diameter, head circumference, fetal growth, pathogenesis
MeSH terms
Child, Craniosynostoses, Female, Gestational Age, Humans, Jaw Abnormalities, Pregnancy, Retrospective Studies, Sutures, Twins, Ultrasonography, Prenatal

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