Lacunar Skull
Luckenschadel Skull

General Considerations

• Bone dysplasia of skull consisting of multiple oval lucencies separated by dense, bony ridges
• Associated with
• Neural tube defects, especially myelomeningocele
• Chiari II malformation
• Encephalocele
• Not related to degree of concomitant hydrocephalus
• Inner table more affected than outer

Clinical Findings

• Present at birth
• Unrelated to increased intracranial pressure

Imaging Findings

• Well-defined lucent areas in calvarium representing nonossified fibrous bone
• Lacunae are bounded by normally ossified bone
• Most prominent in parietal bones
• Small posterior fossa associated with Chiari II malformation

Differential Diagnosis

• Normal convolutional markings seen during a period of rapid brain growth (3 to 7 years).
• Increased convolutional markings associated with synostosis at an older age
• Increased intracranial pressure - beaten-silver appearance; closed sutures; may have abnormal skull size

Treatment

• Appearance resolves spontaneously by age 6 months

Prognosis

• Spontaneously disappears by 4-6 months old

Lacunar Skull. There are multiple focal areas of radiolucency in the skull (white arrows) bounded by more normal, dense bony ridges. The child had a known myelomeningocele.
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The Infant Skull: A Vault of Information.  RB J Glass, S K Fernbach, KI Norton, PS Choi and TP Naidich. March 2004 RadioGraphics, 24, 507-522.