he debate regarding the etiology of craniosynostosis has primarily revolved around Moss’s hypothesis of a primary abnormality at the cranial base (Moss 1958; Moss 1959; Moss 1972; Moss 1975), versus Babler’s hypothesis that the abnormality is in the affected calvarial sutures (Babler, Persing et al. 1982). With syndromic craniosynostosis, it has become reasonably clear that the primary abnormality involves the cranial base, and that cranial base alterations affect the dural reflections, which somehow predisposes to premature closure of the sutures. As surgery does not correct the underlying pathology, it is not surprising to have recurrent synostosis in these cases.
In contrast, the etiology of nonsyndromic, single suture synostosis is usually ascribed to compressive intrauterine forces that act on individual sutures and recurrent synostosis is less likely, since the surgery usually removes the pathological suture (Hudgins, Cohen et al. 1998). Support for this hypothesis comes from animal experiments which have shown that when the calvaria is excised and discarded, a new calvaria forms with time and sutures redevelop in their normal anatomic positions (Mabbutt and Kokich 1979; Mabbutt, Kokich et al. 1979)
Reformation of Suture Following Surgery for Isolated Sagittal Craniosynostosis Deepak Agrawal, Paul Steinbok, D Cochrane Division of Pediatric Neurosurgery, UBC and BC Children’s Hospital, Vancouver, BC
Both dura mater and pericranium have osteogenic properties
Dura-source of central new bone
Pericranium- enhances peripheral new bone formation
Gosain AK, Santoro TD, Song LS, et al: Osteogenesis in calvarial defects: contribution of the dura, the pericranium, and the surrounding bone in adult versus infant animals. Plast Reconstr Surg 112: 515-527, 2003