From the Guidelines
Scalloping of the skull vault in a fetus is a significant finding that warrants comprehensive evaluation, including detailed neurosonography and possibly fetal MRI, to assess brain development and identify underlying causes, as recommended by experts in the field 1. When scalloping of the skull vault is detected, it is essential to consider the possibility of increased intracranial pressure, which can be caused by conditions such as hydrocephalus, intracranial tumors, or genetic syndromes. The use of ultrasonography as the primary imaging modality for diagnosing suspected prenatal skeletal dysplasias, including scalloping of the skull vault, is supported by the American Journal of Obstetrics and Gynecology 1.
Key considerations in the evaluation of scalloping of the skull vault include:
- Comprehensive fetal imaging to assess brain development and identify underlying causes
- Genetic testing, particularly if other anomalies are present
- Management depends on the underlying cause and may range from close monitoring to in-utero interventions in severe cases
- Prognosis varies significantly based on the underlying condition, with some cases resolving spontaneously while others may indicate serious neurological conditions requiring postnatal treatment
According to the study published in the American Journal of Obstetrics and Gynecology 1, increased nuchal translucency at 10-14 weeks of gestation can be a sign of a severe skeletal dysplasia, and prenatal next-generation skeletal panel gene sequencing or whole exome/genome testing should be offered to increase diagnostic yield in suspected skeletal dysplasia. Early detection of scalloping of the skull vault allows for appropriate counseling, delivery planning, and preparation for potential interventions after birth, which is critical for optimizing outcomes in terms of morbidity, mortality, and quality of life 1.
From the Research
Scalloping of the Skull Vault in Fetus
- Scalloping of the skull vault in a fetus can be associated with various cranial vault defects, including exencephaly with acrania/acalvaria, acalvaria, and acrania 2.
- The development and growth of the skull vault is a complex process involving membranous ossification and the interaction of multiple tissues, including the neural tube, surface ectoderm, and dura mater 3.
- Abnormal skull shapes, including scalloping, can occur in infants due to environmental deformation or craniosynostosis, and can be evaluated through a combination of physical examination and molecular genetics 4.
- Positional skull deformities, which can include scalloping, can be prevented and managed through proper positioning and referral to a specialist when necessary 5.
- Fetal magnetic resonance imaging (MRI) can be used to study supratentorial brain malformations, including those that may be associated with scalloping of the skull vault, and requires a understanding of normal prenatal brain development 6.