Radiological assessment of skull base changes in children with syndromic craniosynostosis: role of minor sutures

Introduction This study aims to identify the premature synostosis of major and minor sutures of the four sutural arches of the skull and to perform a morphometric analysis in children with syndromic craniosynostosis in order to evaluate changes in the skull base linked with premature suture synostosis. Methods We reviewed multiplanar high-resolution CT images, implemented with 3D reconstructions, from 18 patients with complex syndromic craniosynostosis and compared them with 18 age-matched healthy subjects. We assessed the calvarial sutures and their extension to the skull base, and then we correlated specific types of synostosis with the size, shape and symmetry of the cranial fossae. Results We found a marked asymmetry of the skull base growth in all patients. The synostotic involvement around the coronal ring caused a reduction in the growth of the anterior and middle fossae. The size of the posterior cranial fossa was related not only to major but also to minor suture synostosis of the lambdoid and parieto-squamosal arches. Conclusion Changes in the skull base and craniofacial axis symmetry are due to structural and functional relationships between major and minor skull sutures, suggesting a structural and functional relationship between the neurocranium and basicranium. The early recognition of prematurely closed skull base sutures may help clinicians and neurosurgeons to establish correct therapeutic approaches.