Intracranial volume (ICV) in isolated sagittal craniosynostosis: a retrospective case-matched-control study

  • James Holland
  • Desideiro Rodrigues
  • Shyam Mohan
  • Nicholas WhiteEmail author
Original Paper



Children with sagittal craniosynostosis (SC) are at risk of developing raised intracranial pressure (ICP). This is thought to result from cephalocranial disproportion—the restriction of normal cerebral development by a small cranial vault. It remains unclear whether intracranial volume (ICV) is altered in SC. This study offers a novel volumetric analysis of the scaphocephalic skull, comparing supratentorial (ST) volume, infratentorial (IT) volume, and total ICV of patients with sagittal synostosis to normal controls.


ICVs of 32 consecutive patients undergoing total calvarial vault remodelling (TCVR) for isolated SC were compared to 32 age- and sex-matched normal controls. ICV was measured with manual techniques on head computerised tomographic (CT) scans using OsiriX software. A paired t test was used to compare data between cases and controls.


Mean total ICV, ST volume and IT volume were larger in SC than in controls, except in females > 6 months of age. There was no statistical significance. Regression analysis demonstrated larger ICVs in diseased children than in controls younger than 10 months, at which age trend lines intersected and the reverse became true for older children. This likely represents an evolving risk of cephalocranial disproportion beyond 10 months of age. The IT/ST volume ratio was conserved in scaphocephaly, and very closely approximated that of controls.


Sagittal craniosynostosis appears to be associated with a larger cranial vault at less than 10 months and a smaller vault at greater than 10 months, although statistical significance was not achieved.


Sagittal craniosynostosis Scaphocephaly Intracranial volume (ICV) Intracranial pressure (ICP) 


Funding information

This work was part funded by the University of Birmingham Medical School Intercalated BSc Clinical Anatomy Programme.

Compliance with ethical standards

Conflicts of interest statement

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Supplementary material

381_2018_4018_MOESM1_ESM.docx (34 kb)
ESM 1 (DOCX 33 kb)


  1. 1.
    Anderson P, Netherway D, McGlaughlin K, David D (2007) Intracranial volume measurement of sagittal craniosynostosis. J Clin Neurosci 14(5):455–458CrossRefGoogle Scholar
  2. 2.
    Breakey W, Knoops P, Borghi A, Rodriguez-Florez N, Dunaway D, Schievano S et al (2017) Intracranial Volume Measurement. J Craniofac Surg 28(7):1746–1751CrossRefGoogle Scholar
  3. 3.
    Cloonan Y, Collett B, Speltz M, Anderka M, Werler M (2013) Psychosocial outcomes in children with and without non-syndromic craniosynostosis: findings from two studies. Cleft Palate Craniofac J 50(4):406–413CrossRefGoogle Scholar
  4. 4.
    Fischer S, Maltese G, Tarnow P, Wikberg E, Bernhardt P, Tovetjärn R, Kölby L (2014) Intracranial volume is normal in infants with sagittal synostosis. J Plast Surg Hand Surg 49(1):62–64CrossRefGoogle Scholar
  5. 5.
    Garza R, Khosla R (2012) Nonsyndromic craniosynostosis. Semin Plast Surg 26(02):053–063CrossRefGoogle Scholar
  6. 6.
    Gault D, Renier D, Marchac D, Ackland F, Jones B (1990) Intracranial volume in children with Craniosynostosis. J Craniofac Surg 1(1):1–3CrossRefGoogle Scholar
  7. 7.
    Heliövaara A, Leikola J, Koljonen V, Vuola P, Koivikko M (2017) Length of synostosis and segmented intracranial volume correlate with age in patients with non-syndromic sagittal synostosis. Childs Nerv Syst 34(3):511–515CrossRefGoogle Scholar
  8. 8.
    Heller J, Heller M, Knoll B, Gabbay J, Duncan C, Persing J (2008) Intracranial volume and cephalic index outcomes for Total Calvarial reconstruction among Nonsyndromic sagittal Synostosis patients. Plast Reconstr Surg 121(1):187–195CrossRefGoogle Scholar
  9. 9.
    Kapp-Simon K, Speltz M, Cunningham M, Patel P, Tomita T (2006) Neurodevelopment of children with single suture craniosynostosis: a review. Childs Nerv Syst 23(3):269–281CrossRefGoogle Scholar
  10. 10.
    Kimiwada T, Hayashi T, Sanada T, Shirane R, Tominaga T (2013) Surgical treatment of scaphocephaly with sinus pericranii. Neurol Med Chir 53(2):121–125CrossRefGoogle Scholar
  11. 11.
    Lavigne J, Faier-Routman J (1992) Psychological adjustment to pediatric physical disorders: a meta-analytic review. J Pediatr Psychol 17(2):133–157CrossRefGoogle Scholar
  12. 12.
    Lee S, Duncan C, Knoll B, Persing J (2010) Intracranial compartment volume changes in sagittal craniosynostosis patients: influence of comprehensive cranioplasty. Plast Reconstr Surg 126(1):187–196CrossRefGoogle Scholar
  13. 13.
    Mursch K, Enk T, Christen H, Markakis E, Behnke-Mursch J. Venous intracranial haemodynamics in children undergoing operative treatment for the repair of craniosynostosis. Childs Nerv Syst 15(2-3):110–116Google Scholar
  14. 14.
    Netherway D, Abbott A, Anderson P, David D (2005) Intracranial volume in patients with nonsyndromal craniosynostosis. J Neurosurg Pediatr 103(2):137–141CrossRefGoogle Scholar
  15. 15.
    Park S, Kim S, Cho B, Kim H, Kim J, Phi J, Kim IO, Wang KC (2009) Sinus pericranii in children: report of 16 patients and preoperative evaluation of surgical risk. J Neurosurg Pediatr 4(6):536–542CrossRefGoogle Scholar
  16. 16.
    Posnick J, Armstrong D, Bite U (1995) Metopic and sagittal Synostosis. Plast Reconstr Surg 96(2):310–315CrossRefGoogle Scholar
  17. 17.
    Rifkinson-Mann S, Goraj B, Leslie D, Visintainer P, Padua H (1995) Transcranial Doppler analysis of cerebral hemodynamics in primary craniosynostosis: study in progress. Surg Neurol 44(4):334–337CrossRefGoogle Scholar
  18. 18.
    Seeberger R, Hoffmann J, Freudlsperger C, Berger M, Bodem J, Horn D, Engel M (2016) Intracranial volume (ICV) in isolated sagittal craniosynostosis measured by 3D photocephalometry: a new perspective on a controversial issue. J Cranio-Maxillofac Surg 44(5):626–631CrossRefGoogle Scholar
  19. 19.
    Snyder H, Pope A (2010) Psychosocial adjustment in children and adolescents with a craniofacial anomaly: diagnosis-specific patterns. Cleft Palate Craniofac J 47(3):264–272CrossRefGoogle Scholar
  20. 20.
    Speltz M (2004) Single-suture craniosynostosis: a review of neurobehavioral research and theory. J Pediatr Psychol 29(8):651–668CrossRefGoogle Scholar
  21. 21.
    Taylor W, Hayward R, Lasjaunias P, Britto J, Thompson D, Jones B, Evans RD (2001) Enigma of raised intracranial pressure in patients with complex craniosynostosis: the role of abnormal intracranial venous drainage. J Neurosurg 94(3):377–385CrossRefGoogle Scholar
  22. 22.
    Toma R, Greensmith A, Meara J, Da Costa A, Ellis L, Willams S et al (2010) Quantitative morphometric outcomes following the Melbourne method of total vault remodelling for scaphocephaly. J Craniofac Surg 21(3):637–643CrossRefGoogle Scholar
  23. 23.
    Wall S, Thomas G, Johnson D, Byren J, Jayamohan J, Magdum S, McAuley D, Richards PG (2014) The preoperative incidence of raised intracranial pressure in nonsyndromic sagittal craniosynostosis is underestimated in the literature. J Neurosurg Pediatr 14(6):674–681CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Craniofacial Unit, Birmingham Children’s HospitalBirminghamUK
  2. 2.College of Medical and Dental Sciences, University of Birmingham BirminghamUK
  3. 3.Department of NeurosurgeryBirmingham Children’s HospitalBirminghamUK
  4. 4.Department of RadiologyBirmingham Children’s HospitalBirminghamUK
  5. 5.Department of Craniofacial SurgeryBirmingham Children’s HospitalBirminghamUK

Personalised recommendations