The authors describe the clinical and radiological findings in a case
of non-syndromic craniosynostosis affecting multiple sutures, in which
the intracranial venous drainage was grossly anomalous. Investigation
by magnetic resonance imaging and angiography revealed that almost al
l of the intracranial venous blood was draining from the dural sinuses
transosseoussly via enlarged emissary veins to the external jugular v
eins and the vertebral veins. Although present, both internal jugular
veins were small. This discovery represented a contraindication for th
e vault expansion surgery that had been recommended as treatment for t
he patient's raised intracranial pressure, and it has important implic
ations for the management of all types of craniosynostosis.