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Background:  The shape of the head in the front view usually has a near half circle shape. While the original sagittal suture line may be the highest point of the skull it should gradually go to the sides (parasagittal region) into the temporal region with a very gradual slope. For women this head shape may be fine while for men they may desire a less round and more square shape. (higher temporal lines)

When the midline sagittal ridge is the distinct high point of the head with the parasagittal region sharply fading away from it, this creates the inverted V head shape. When this undesired head shape is significant it could be due to an isolated high sagittal ridge, an abnormally low parasagittal/temporal lines or, most commonly, a combination of both. The fundamental correction of this head shape requires augmentation of the parasagittal/temporal region which often includes the upper upper parietal region (crown) as well. Think of this as a horseshoe-shaped skull deformity. Whether the sagittal ridge needs some reduction or not requires preoperative computer imaging to determine. That would also be important information in making the custom skull implant design as well. 

Case Study: This male was bothered by his peaked or inverted V head shape (from the frontal view) which he camouflaged by keeping his hair longer. His 3D CT scan showed an inverted V shape which was due to a parasagittal deficiency and not a true high sagittal crest. (pseudo sagittal crest) The parasagittal deficiency, as it frequently does, wraps around the back of the head creating a crown deficiency as well…which isolates the sagittal ridge making it look more prominent.

A custom skull implant was designed to fill in the parasagittal and crown deficiencies, crossing the midline sagittal region to ensure a smooth and flat contour. How high the parasagittal region is designed will determine if the head shape will be round or more square. That is a personal preference. The higher the parasagittal regions are the crown areas must be similarly augmented. It is essentially a horseshoe-shaped implant design that only crosses the sagittal ridge region with a very thin layer of material. 

Under general anesthesia a small crown of the skull incision was made through which the custom skull implant was introduced and placed into position.

His three month postoperative result showed his attainment of an improved and much more desired head shape.

When adding to the parasagittal region of the skull it is important to make sure that it extends far enough past the bony temporal line to to have an unnatural shape. As a parasagittal deficiency also means an upper temporal deficiency as well. 

Case Highlights:

1) The high peaked skull shape often consists of a sagittal ridge which appears too high in the midline (apparent sagittal crest) with a more prominent bilateral parasagittal deficiency.

2) The peaked skull shape is often associated with a crown of the head skull deficiency as well.

3) A custom skull implant can take a peaked head shape to a rounder or even a square shape if the patient desires.

Dr. Barry Eppley

Indianapolis, Indiana

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