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Craniolacunia (Lückenschädel)

1941; Radiological Society of North America; Volume: 36; Issue: 2 Linguagem: Inglês

10.1148/36.2.147

1527-1315

E. Vogt, George M. Wyatt,

Pediatric Hepatobiliary Diseases and Treatments

CRANIOLACUNIA, a condition known in the literature as “lacunar skull” and “Lückenschädel,” has attracted the interest of several European authors. In the American literature, attention was called to this condition by Kerr (2) and by Doub and Danzer (1), who summarized and discussed the previous literature in addition to reporting their own observations. Except for these papers, only occasional mention has been made of this finding. The roentgenologic appearance in a typical case of craniolacunia is that of an arborizing pattern of bony ridges which sharply delineate and separate rounded defects one from another (Figs. 1-A and 1-B). In the pathologic specimen, these defects may be completely devoid of bony structure, in which case they are bridged by membranous diaphragms of periosteum and dura. Some of the defects may have an additional covering of bone which corresponds to the outer table of the skull, the inner table being incomplete (Fig. 2). There is considerable variation in the degree of involvement, even among lesions in the same skull. These perforations and depressions are well described by the word “lacunæ.” The term “craniolacunia” is suggested for this condition in preference to the previously used terms “Lückenschädel” and “lacunar skull,” because it represents a form of nomenclature which is not limited to a single modern language.2 Several theories have been advanced regarding the etiology of craniolacunia, including an explanation on the basis of increased intracranial pressure during fetal life. To our knowledge, none of the theories has been proved. This condition apparently falls in the same unsatisfactory category as the majority of congenital anomalies, the causes of which are still obscure. The clinical significance of craniolacunia is of interest, and is almost invariably a subject for discussion whenever an example is encountered. I ts close association with meningocele has aroused considerable speculation. This study was undertaken in an effort to determine the relation of craniolacunia to meningocele and to evaluate its clinical significance. Relation of Craniolacunia to Meningocele During a six-year period, from 1932 to 1938, approximately 6,000 skull examinations were made in the Department of Roentgenology of the Infants' and the Children's Hospitals. One hundred and twenty of these examinations were carried out on patients with meningoceles. Skull films were omitted in only one case of meningocele referred to the Department of Roentgenology during this period. Many of these examinations revealed depressions in the inner table of the skull. These were particularly deep in cases of oxycephaly, scaphocephaly, and brain tumor. In a few skulls, such depressions were pronounced in the absence of any neurologic abnormalities or significant history. Depressions of a different type, however, were found in the group of patients with meningocele.