To identify skull-base growth patterns in Crouzon syndrome, we hypothesized premature minor suture fusion restricts occipital bone development, secondarily limiting foramen magnum expansion.
Design
Skull-base suture closure degree and cephalometric measurements were retrospectively studied using preoperative computed tomography (CT) scans and multiple linear regression analysis.
Setting
Evaluation of multi-institutional CT images and 3D reconstructions from Wake Forest’s Craniofacial Imaging Database (WFCID).
Patients
Sixty preoperative patients with Crouzon syndrome under 12 years-old were selected from WFCID. The control group included 60 age- and sex-matched patients without craniosynostosis or prior craniofacial surgery.
Interventions
None
Main Outcomes Measure(s)
2D and 3D cephalometric measurements.
Results
3D volumetric evaluation of the basioccipital, exo-occipital, and supraoccipital bones revealed decreased growth in Crouzon syndrome, attributed solely to premature minor suture fusion. Spheno-occipital (β = −398.75; P < .05) and petrous-occipital (β = −727.5; P < .001) suture fusion reduced growth of the basioccipital bone; lambdoid suture (β = −14 723.1; P < .001) and occipitomastoid synchondrosis (β = −16 419.3; P < .001) fusion reduced growth of the supraoccipital bone; and petrous-occipital suture (β = −673.3; P < .001), anterior intraoccipital synchondrosis (β = −368.47; P < .05), and posterior intraoccipital synchondrosis (β = −6261.42; P < .01) fusion reduced growth of the exo-occipital bone. Foramen magnum morphology is restricted in Crouzon syndrome but not directly caused by early suture fusion.
Conclusions
Premature minor suture fusion restricts the volume of developing occipital bones providing a plausible mechanism for observed foramen magnum anomalies.
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