Associated (Parallel) Tomographic Findings in Patients With Single-Sutural Synostosis
Abstract
INTRODUCTION: Craniosynostosis is the premature fusion of 1 or more of the cranial sutures, which causes an abnormal skull shape. The treatment is complex and requires surgical intervention for correction, between 3 and 12 months of age. The current standard for diagnosing craniosynostosis is to obtain a computed tomographic (CT) scan. However, recent studies have emphasized potential problems associated with ionizing radiation. The aim of this study was to evaluate the use of the preoperative CT scan, and its findings, and to define the value of these data. MATERIALS AND METHODS: This study is a retrospective analysis of 89 patients with craniosynostosis during the period between 1998 and 2007, who had CT using the Yale-New Haven Hospital computer system. Clinical findings such as age, sex, and diagnosis were recorded. All intraoperative abnormalities were noted. Preoperative CT scans were reevaluated for accuracy and completeness of diagnosis, cerebral anomalies, and other head and neck pathologic conditions. RESULTS: Initially, 131 cases of nonsyndromic craniosynostosis were identified. Of these, we had access to CT evaluations in 89 patients. The mean age at the time of the surgery was 13 months, varying from 2 months to 18 years old. Most patients were males. The most common diagnoses were sagittal synostosis in 47 cases; unilateral coronal, 16; and metopic, 15. In most patients, the CT scan demonstrated the same diagnosis as the clinical examination-derived diagnosis. However, 6 patients had an incomplete diagnosis or misdiagnosis. In addition, 3 cases of prominence of the subarachnoid space, 2 cases of cerebral atrophy, 1 case of subarachnoid tumor, and 1 deformational dysplasia of encephalon were identified. Other minor additional diagnoses were 5 cases of fluid in the middle ear and antrum of mastoid, 2 cases of cysts in the maxilla, and 1 case of an associated cervical lymphatic tumor. CONCLUSIONS: The advantage of CT use is greater accuracy in diagnosis, less potential for inappropriate surgery, and, as an ancillary effect, a more complete and timely assessment of congenital anomalies so that more appropriate referrals can be made. Low-dose (pediatric) radiation CT still seems to have a place in the examination of a patient with skull deformity and potential craniosynostosis.
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CT helps detect additional suture involvement, such as combined sagittal and metopic synostosis, which may go unnoticed without imaging.
“While sagittal synostosis is often identified clinically, CT helps detect additional suture involvement, such as combined sagittal and metopic synostosis, which may go unnoticed without 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 [69]
da Silva Freitas et al. emphasized the value of preoperative CT scans in improving diagnostic accuracy for sagittal craniosynostosis and associated conditions.
“In 2010 da Silva Freitas et al. emphasises the value of preoperative CT scans in improving diagnostic accuracy for sagittal craniosynostosis and associated conditions.”
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 [69]
Low-dose paediatric CT remains valuable for accurate diagnosis and comprehensive presurgical planning.
“Overall, low-dose paediatric CT persists valuable for accurate diagnosis and comprehensive presurgical planning [69].”
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 [69]
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“Da Silva Freitas study on sagittal synostosis reported a change in pre-operative planning in 7% of patients from CT imaging.(18) We also have had cases that initially presented with classical features of sagittal synostosis on clinical examination, but further imaging confirmed otherwise with minor suture fusion invol…”
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“The treatment of craniosynostosis can be complex as it normally requires surgical intervention for correction, however milder cases may be treated with a specially molded helmet or observation (da Silva Freitas et al., 2010).”
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“Overall, low-dose paediatric CT persists valuable for accurate diagnosis and comprehensive presurgical planning [69].”
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- Authors
- da Silva Freitas, R., de Freitas Azzolini, T., Shin, J. H., & Persing, J. A.
- Affiliations
- Yale University (US)
- Corresponding author
- Persing, John A.
- ORCID
- Persing, John A.
- Venue
- Journal of Craniofacial Surgery
- Published
- 2010-03
- Volume
- 21
- Issue
- 2
- Pages
- 411-413
- ISSN
- 1049-2275 (ISSN-L)
- OpenAlex
- W2021117987
- Cited by
- 17
- References
- 17
- Citations by year
- 2025: 2 · 2024: 1 · 2021: 3 · 2019: 2 · 2017: 2 · 2016: 1 · 2015: 2 · 2014: 1 · 2013: 1 · 2012: 1
- FWCI
- 0.54
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Craniofacial Surgery (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
- Social Sciences › Arts and Humanities › Archeology › Forensic Anthropology and Bioarchaeology Studies
- Keywords
- craniosynostosis, single-suture craniosynostosis, preoperative CT, sagittal synostosis, coronal synostosis, metopic synostosis, diagnostic accuracy, pediatric radiation exposure, brain abnormalities, brain atrophy, cranial deformity, pediatric radiology, misdiagnosis, associated congenital anomalies, maxillary cysts
- MeSH terms
- Adolescent, Age Factors, Atrophy, Brain, Child, Child, Preschool, Cranial Sutures, Craniosynostoses, Female, Follow-Up Studies, Frontal Bone, Humans, Infant, Intraoperative Care, Jaw Cysts, Male, Maxillary Diseases, Otitis Media, Parietal Bone, Retrospective Studies, Sex Factors, Subarachnoid Space, Tomography, X-Ray Computed
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