Childs Nerv Syst. 2025 Nov 19;41(1):362. doi: 10.1007/s00381-025-07009-7.
ABSTRACT
PURPOSE: Classical teaching suggests that major cranial sutures normally close during the third decade of life. This study investigates the prevalence of incidentally discovered cranial suture closure in healthy pediatric patients and its effects on cranial morphology.
METHODS: A retrospective review was performed of 1,119 patients (aged 0-18 years) who underwent head CT imaging at our pediatric emergency department from 2014 to 2024. Patients with craniofacial disorders, genetic syndromes, skull fractures, prior skull surgery, or intracranial pathologies were excluded. Three neuroradiologists evaluated the metopic, sagittal, coronal, and lambdoid sutures for patency. Cephalic index was calculated for morphological analysis.
RESULTS: Complete or partial sagittal suture closure was observed in 11.1% of patients, with coronal and lambdoid closure in 2.8% and 1.6%, respectively. Most patients under age three had open sagittal sutures (99.3%), decreasing to 83% by age nine. Metopic suture closure followed established patterns, with over 75% closure rates by 21 months. Multivariable regression revealed sagittal suture closure was associated with decreased cephalic index (β = -0.8, p = 0.026), though 83.1% of these patients remained normocephalic. However, among patients with cephalic index < 70, 86.4% had partial or complete sagittal closure.
CONCLUSION: Up to 17% of pediatric patients may experience either partial or complete asymptomatic calvarial suture closure before adulthood. While sagittal suture closure is associated with decreased cephalic index, most patients maintain normocephaly.
PMID:41254355 | DOI:10.1007/s00381-025-07009-7
