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Neuroradiology Case of the Week

Case 429

July 2009

Sara Ann Majewski, MD

Clinical Presentation: Patient is an 10-year-old female with vomiting and headache. She has a history of Chiari I/II malformation and ventriculoperitoneal shunt placement.

Imaging Findings: Oval or round thinning, pits or fenestra in the frontal, parietal and occipital bones.

Diagnosis: Lückenschãdel skull

Discussion: Lückenschãdel or lacunar skull is a common finding with Chiari II malformation. It is associated with myelomeningocele, encephalocele and hydrocephalus.
     It can be seen as areas of thinning, pits or fenestra in the membranous frontal, parietal and occipital bones. Theses findings can be more pronounced in the upper half of the calvarium. Both the inner and outer tables of the skull can be affected. The brain parenchyma can be seen to fill these pits.
     These findings demonstrated as early as the late third trimester on x-rays. In most cases, the lacunae are no longer present by six months of age.

References:

1. Naidich TP, Pudlowski RM, Naidich JB, Gornish M, Rodriguez FJ. Computed tomographic signs of the Chiari II malformation. Part I: Skull and dural partitions. Radiology. 1980 Jan;134(1):65-71. PMID: 7350637 [PubMed]