Skull Development and Abnormalities

Abstract

Prior to computed tomography (CT), plain skull radiographs were often the first study in the patient with suspected central nervous system disease [1]. Subtle clues to the intracranial contents could be discerned by the presence of calcification, skull erosion, and signs of increased intracranial pressure, as with demineralization of the sellae or an increase in the size of mastoid emissary veins, as well as by recognition of diseases primarily affecting the osseous structure of the skull in the form of sclerotic and/or lytic lesions (Fig. 29.1). CT revolutionized the radiologist’s ability to see the intrinsic structure of the skull in cross-section. This has decreased the demand for skull x-rays. Magnetic resonance imaging (MRI) has further decreased the demands for skull films, by showing the intracranial contents even more exquisitely than CT. Today, the skull radiograph plays a relatively limited role in the evaluation of the pediatric patient. Except in the evaluation of trauma, craniosynostosis, and known genetic diseases affecting the cranial structures, the skull x-ray tends to be a procedure that follows the recognition of its need on the basis of another examination, such as CT, MRI, or the radionuclide study.