Suture pathology in craniosynostosis

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Abstract
✓ Gross and histological pathology of skull sutures affected by craniosynostosis was evaluated. Nineteen sutures were examined: 14 sagittal, three coronal, and two metopic. Sutures were removed en bloc, examined grossly, then sectioned perpendicular to the axis of the suture and examined microscopically. Foci of dural invagination into the sutures occurred in only four of the 19 specimens. In areas of maximum clinical abnormality, there was no microscopic evidence of the suture. The suture adjacent to the fused portion was narrowed by encroaching calvaria, and suture farther away was normal. Suture ossification was never multifocal. In infants less than 1 year old, the extent of suture fusion did not correlate with age. It is concluded that craniosynostosis is characterized by the progressive obliteration of cranial sutures by fusion of adjacent cranial bones, and that changes in the skull base angles are secondary to suture obliteration.