ORIGINAL PAPER The path of the superior sagittal sinus in unicoronal synostosis Aaron J. Russell & Kamlesh B. Patel & Gary Skolnick & Albert S. Woo & Matthew D. Smyth Received: 5 December 2013 /Accepted: 6 February 2014 /Published online: 28 February 2014 # Springer-Verlag Berlin Heidelberg 2014 Abstract Purpose This study investigates the anatomic relationship between the superior sagittal sinus (SSS) and the sagittal suture in infants with uncorrected unicoronal synostosis. The morphology of the SSS is also evaluated postoperatively to assess whether normalization of intracranial structures occurs following reconstruction. Methods The study sample consisted of 20 computed tomog- raphy scans (10 preoperative, 6 postoperative, and 4 unaffect- ed controls) obtained between 2001 and 2013. The SSS and the sagittal suture were outlined using Analyze imaging soft- ware. These data were used to measure the maximum lateral discrepancy between the SSS and the sagittal suture preoper- atively and to assess for postoperative changes in the mor- phology of the SSS. Results In children with uncorrected unicoronal synostosis, the SSS deviates to the side of the patent coronal suture posteriorly and tends to follow the path of the sagittal and metopic sutures. The lateral discrepancy between the SSS and the sagittal suture ranged from 5.0 to 11.8 mm, with a 99.9 % upper prediction bound of 14.4 mm. Postoperatively, the curvature of the SSS was statistically decreased following surgical intervention, though it remained significantly greater than in unaffected controls. Conclusions The SSS follows a predictable course relative to surface landmarks in children with unicoronal synostosis. When creating burr holes for craniotomies, the SSS can be avoided in 99.9 % of cases by remaining at least 14.4 mm from the lateral edge of the sagittal suture. Postoperative changes in the path of the SSS provide indirect evidence for normalization of regional brain morphology following fronto- orbital advancement. Keywords Unicoronal synostosis . Superior sagittal sinus . Fronto-orbital advancement Introduction Craniosynostosis is a congenital deformity of the skull caused by the abnormal fusion of one or more calvarial sutures. It has an estimated prevalence of 1:2,000 to 1:2,500 live births [3, 9, 13] and produces a characteristic set of cranial abnormalities based on the specific suture involved. Unicoronal synostosis (UCS), defined by the premature fusion of a single coronal suture, is the third most common form of craniosynostosis [8, 14]. It occurs more frequently in females and predominantly affects the right coronal suture [8, 9, 14]. Individuals with UCS present with anterior plagiocephaly, an abnormal cranial morphology characterized by flattening of the ipsilateral fore- head, protrusion of the contralateral forehead, and elevation of the eyebrow and superior orbital rim on the ipsilateral side [2, 11]. Fronto-orbital advancement is the primary surgical inter- vention for the treatment of anterior plagiocephaly. It is an open procedure that involves unilateral or bilateral advance- ment of the fronto-orbital bandeau, a horizontal strip of bone encompassing the superior rim of both orbits [5, 11, 12]. In order to obtain surgical access for this procedure, a frontal craniotomy is performed. Following the initial dissection of soft tissue from the calvaria, burr holes are drilled on either side of the anterior fontanelle to allow epidural access for A. J. Russell (*) School of Medicine, Washington University, St. Louis, MO, USA e-mail: russella@wusm.wustl.edu K. B. Patel : G. Skolnick : A. S. Woo Department of Plastic and Reconstructive Surgery, Washington University School of Medicine, St. Louis, MO, USA M. D. Smyth Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO, USA Childs Nerv Syst (2014) 30:1701–1709 DOI 10.1007/s00381-014-2384-9