Abstract
Background
Midline cranial defects can be divided into lesions with intracranial tissue herniation (cranium bifidum cysticum) and lesions mainly with ossification failure (cranium bifidum occultum). Herniated cephaloceles mostly require surgical resection, while persisted parietal foramina might become smaller with age.
Clinical case
Here, we report a neonate with large symmetric midline skull defect at high parietal area. A mild bulging mass was noticed. Interestingly, unlike sac herniation, it was surrounded by bony ridges extended from the rim of the calvarial defect, which suggests aberrant ossification. Persistent falcine sinus was also detected. At the corrected age of 11 months, the size of the skull defect had decreased spontaneously, favoring the diagnosis of parietal bone ossification defect. Potential mechanisms resulting in the special appearance of skull bone were discussed.
Conclusion
Incomplete closing of the parietal foramina might be expected due to the aberrant ridge formation. We suggest protective measures for the calvarial defect.
Similar content being viewed by others
References
Okumoto T, Iijima Y, Yoshimura Y (2012) Treatment of cranium bifidum occultum of the frontonasal region with a pericranial flap. J Plast Reconstr Aesthet Surg 65:e64–66
Padmanabhan R (2006) Etiology, pathogenesis and prevention of neural tube defects. Congenit Anom (Kyoto) 46:55–67
Moron FE, Morriss MC, Jones JJ, Hunter JV (2004) Lumps and bumps on the head in children: use of CT and MR imaging in solving the clinical diagnostic dilemma. Radiographics 24:1655–1674
Mupparapu M, Binder RE, Duarte F (2006) Hereditary cranium bifidum persisting as enlarged parietal foramina (Catlin marks) on cephalometric radiographs. Am J Orthod Dentofacial Orthop 129:825–828
Murphy J, Gooding CA (1970) Evolution of persistently enlarged parietal foramina. Radiology 97:391–392
Patterson RJ, Egelhoff JC, Crone KR, Ball WS Jr (1998) Atretic parietal cephaloceles revisited: an enlarging clinical and imaging spectrum? AJNR Am J Neuroradiol 19:791–795
Thompson DN (2009) Postnatal management and outcome for neural tube defects including spina bifida and encephalocoeles. Prenat Diagn 29:412–419
Fink AM, Maixner W (2006) Enlarged parietal foramina: MR imaging features in the fetus and neonate. AJNR Am J Neuroradiol 27:1379–1381
Mavrogiannis LA, Taylor IB, Davies SJ, Ramos FJ, Olivares JL, Wilkie AO (2006) Enlarged parietal foramina caused by mutations in the homeobox genes ALX4 and MSX2: from genotype to phenotype. Eur J Hum Genet 14:151–158
Reddy AT, Hedlund GL, Percy AK (2000) Enlarged parietal foramina: association with cerebral venous and cortical anomalies. Neurology 54:1175–1178
Sener RN (2000) Association of persistent falcine sinus with different clinicoradiologic conditions: MR imaging and MR angiography. Comput Med Imag Graph 24:343–348
Wu YQ, Badano JL, McCaskill C, Vogel H, Potocki L, Shaffer LG (2000) Haploinsufficiency of ALX4 as a potential cause of parietal foramina in the 11p11.2 contiguous gene-deletion syndrome. Am J Hum Genet 67:1327–1332
Otsubo Y, Sato H, Sato N, Ito H (1999) Cephaloceles and abnormal venous drainage. Childs Nerv Syst 15:329–332
Bartels RH, Merx JL, van Overbeeke JJ (1998) Falcine sinus and occipital encephalocele: a magnetic resonance venography study. J Neurosurg 89:738–741
Antonopoulou I, Mavrogiannis LA, Wilkie AO, Morriss-Kay GM (2004) Alx4 and Msx2 play phenotypically similar and additive roles in skull vault differentiation. J Anat 204:487–499
Nishimura R, Hata K, Matsubara T, Wakabayashi M, Yoneda T (2012) Regulation of bone and cartilage development by network between BMP signalling and transcription factors. J Biochem 151:247–254
Lakhwani S, Garcia-Sanz P, Vallejo M (2010) Alx3-deficient mice exhibit folic acid-resistant craniofacial midline and neural tube closure defects. Dev Biol 344:869–880
Yoon WJ, Cho YD, Cho KH, Woo KM, Baek JH, Cho JY et al (2008) The Boston-type craniosynostosis mutation MSX2 (P148H) results in enhanced susceptibility of MSX2 to ubiquitin-dependent degradation. J Biol Chem 283:32751–32761
Shiihara T, Kato M, Kimura T, Hayasaka K, Yamamori S, Ogata T (2004) Craniosynostosis with extra copy of MSX2 in a patient with partial 5q-trisomy. Am J Med Genet A 128A:214–216
Kortesis B, Richards T, David L, Glazier S, Argenta L (2003) Surgical management of foramina parietalia permagna. J Craniofac Surg 14:538–544
Conflict of interest
The authors report no financial or other conflict of interest relevant to the subject of this article.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Yang, CA., Peng, S.SF., Hsieh, WS. et al. Large parietal midline defect with unusual ridge-like structure at the rim and persistent falcine sinus. Childs Nerv Syst 29, 1069–1072 (2013). https://doi.org/10.1007/s00381-013-2096-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00381-013-2096-6