Preoperative imaging patterns and intracranial findings in single-suture craniosynostosis: a study from the Synostosis Research Group
Abstract
OBJECTIVE: The diagnosis of single-suture craniosynostosis can be made by physical examination, but the use of confirmatory imaging is common practice. The authors sought to investigate preoperative imaging use and to describe intracranial findings in children with single-suture synostosis from a large, prospective multicenter cohort. METHODS: In this study from the Synostosis Research Group, the study population included children with clinically diagnosed single-suture synostosis between March 1, 2017, and October 31, 2020, at 5 institutions. The primary analysis correlated the clinical diagnosis and imaging diagnosis; secondary outcomes included intracranial findings by pathological suture type. RESULTS: A total of 403 children (67% male) were identified with single-suture synostosis. Sagittal (n = 267), metopic (n = 77), coronal (n = 52), and lambdoid (n = 7) synostoses were reported; the most common presentation was abnormal head shape (97%), followed by a palpable or visible ridge (37%). Preoperative cranial imaging was performed in 90% of children; findings on 97% of these imaging studies matched the initial clinical diagnosis. Thirty-one additional fused sutures were identified in 18 children (5%) that differed from the clinical diagnosis. The most commonly used imaging modality by far was CT (n = 360), followed by radiography (n = 9) and MRI (n = 7). Most preoperative imaging was ordered as part of a protocolized pathway (67%); some images were obtained as a result of a nondiagnostic clinical examination (5.2%). Of the 360 patients who had CT imaging, 150 underwent total cranial vault surgery and 210 underwent strip craniectomy. The imaging findings influenced the surgical treatment 0.95% of the time. Among the 24% of children with additional (nonsynostosis) abnormal findings on CT, only 3.5% required further monitoring. CONCLUSIONS: The authors found that a clinical diagnosis of single-suture craniosynostosis and the findings on CT were the same with rare exceptions. CT imaging very rarely altered the surgical treatment of children with single-suture synostosis.
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Ravindra et al. suggested that routine preoperative CT imaging may not be essential in cases with a clear clinical diagnosis.
“Consequently, the authors suggest that routine preoperative CT imaging may not be essential in cases with a clear clinical diagnosis, thereby potentially reducing radiation exposure in affected infants [37].”
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 [37]
Ravindra et al. (2021) found that preoperative CT imaging in clinically diagnosed single suture craniosynostosis corroborated the clinical diagnosis and rarely altered the surgical approach.
“Results demonstrated that in most of the cases, CT imaging corroborated the clinical diagnosis and rarely altered the surgical approach.”
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 [37]
Today the most common approach for evaluating suspected craniosynostosis is a detailed clinical examination by skilled professionals, where characteristic skull morphology serves as the primary indicator for provisional diagnosis.
“Today the most common approach for evaluating suspected craniosynostosis is a detailed clinical examination by skilled professionals, where characteristic skull morphology serves as the primary indicator for provisional diagnosis.”
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 [37]
Diagnostic confirmation typically involves measurement of head circumference, ultrasonography and, if required and technically possible, three-dimensional stereophotography.
“Diagnostic confirmation typically involves the use of methods such as measurement of the head circumference, ultrasonography and if required and technically possible three-dimensional stereophotography.”
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 [37]
In more challenging or atypical cases, additional imaging techniques like CT and MRI may be employed.
“In more challenging or atypical cases, additional imaging techniques like CT and MRI may be employed [2, 7, 8, 37].”
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 [37]
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- Authors
- Ravindra, V. M., Awad, A.-W., Baker, C. M., Lee, A., Anderson, R. C. E., Gociman, B., Patel, K. B., Smyth, M. D., Birgfeld, C., Pollack, I. F., Goldstein, J. A., Imahiyerobo, T., Siddiqi, F. A., Kestle, J. R. W., & _, _.
- Affiliations
- Naval Medical Center San Diego (US)
- Department of Neurosurgery, and
- Seattle Children's Hospital (US)
- Morgan Stanley Children's Hospital (US)
- University of Utah (US)
- Division of Plastic and Reconstructive Surgery, Department of Surgery, and
- St. Louis Children's Hospital (US)
- and Departments of Pediatric Neurosurgery and
- Children's Hospital of Pittsburgh (US)
- NewYork–Presbyterian Hospital (US)
- ORCID
- Venue
- Journal of Neurosurgery: Pediatrics
- Published
- 2021-09
- Volume
- 28
- Issue
- 3
- Pages
- 344-350
- ISSN
- 1933-0707 (ISSN-L)
- 1933-0715
- OpenAlex
- W3173245883
- Cited by
- 12
- References
- 34
- Citations by year
- 2026: 1 · 2025: 4 · 2024: 5 · 2023: 1 · 2022: 1
- FWCI
- 0.99
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Neurosurgery Pediatrics (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 › Surgery › Reconstructive Facial Surgery Techniques
- Keywords
- single-suture craniosynostosis, computed tomography, sagittal synostosis, metopic synostosis, coronal synostosis, lambdoid synostosis, strip craniectomy
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