Child's Nervous System

, 23:1467

Significance of beaten copper appearance on skull radiographs in children with isolated sagittal synostosis

  • Deepak Agrawal
  • Paul Steinbok
  • D. Douglas Cochrane
Original Paper

DOI: 10.1007/s00381-007-0430-6

Cite this article as:
Agrawal, D., Steinbok, P. & Cochrane, D.D. Childs Nerv Syst (2007) 23: 1467. doi:10.1007/s00381-007-0430-6


Aims and Objectives

The significance of beaten copper appearance (BCA) on skull radiographs in children following surgery for isolated sagittal craniosynostosis has not been studied. This study was designed to look for any correlation between BCA and symptoms suggestive of intracranial hypertension in this group of patients.

Materials and Methods

Forty-eight consecutive children, who were operated for isolated sagittal synostosis from1987 to 2000 and had postoperative skull radiographs, were included. Patients were divided into: (a) BCA group (n = 20), consisting of children who had beaten copper appearance on skull radiographs at last follow up, and (b) Non-BCA group (n = 28), consisting of children who did not have this finding. Records were reviewed to look for symptoms suggestive of intracranial hypertension, such as headache, head banging, and irritability.


Median age at surgery was 4.8 months for BCA group and 4 months for the non-BCA group. Follow up ranged from 4 to 156 months with a mean of 36.2 months. Total of 28.6% (n = 6) of the children with follow up radiographs done at ≤18 months of age had BCA. The incidence of BCA increased to 83.3% in children with skull radiographs performed after 48 months of age. In 18 (90%) children, the BCA was ‘diffuse’ with 5 (25%) children having the maximum possible score of 8. In the BCA group, 45% (n = 9) had symptoms compared to 10.7% (n = 3) in the control group (p = 0.0068).


This study suggests a significant number of children with BCA on radiographs develop symptoms suggestive of raised ICP following surgical treatment in infancy and prolonged follow up may be warranted in this group of patients.


Sagittal synostosisCraniosynostosisSymptomsHeadacheRadiologyCopper-beaten appearanceIncreased convolution markingsIntracranial pressureIntracranial hypertensionSkull radiographPediatricPostoperative

Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • Deepak Agrawal
    • 1
  • Paul Steinbok
    • 2
    • 3
  • D. Douglas Cochrane
    • 2
    • 3
  1. 1.Department of Neurosurgery, Neurosciences & Gamma-Knife CentreAll India Institute of Medical SciencesNew Delhi-110029India
  2. 2.Division of Pediatric Neurosurgery, Department of Pediatric Surgery, British Columbia’s Children’s HospitalChildren’s and Women’s Health CentreVancouverCanada
  3. 3.Division of Neurosurgery, Department of SurgeryUniversity of British ColumbiaVancouverCanada