Kleeblattschädel

Newborn with

an unusual head shape. AP (above left) and lateral (above right) radiographs of the skull and anterior (below left) and lateral (below right) 3D CT reconstructions of the skull show fusion of the bilateral coronal sutures, bilateral lambdoid sutures, metopic suture and anterior and posterior aspects of the sagittal suture. There is compensatory widening of the bilateral squamosal sutures. Hypotelorism is present and there are quizzical eye deformities present bilaterally. The diagnosis was cloverleaf skull.

pediatricimaging.org • CC-by-nc-sa 4.0

Prenatal

diagnosis of pfeiffer syndrome type II using ultralow dose CT. Anterior−posterior view of the head shows a cloverleaf skull.

www.eurorad.org • CC by-nc-sa-4.0

Prenatal

diagnosis of pfeiffer syndrome type II using ultralow dose CT. Magnetic resonance imaging (half-Fourier acquisition single-shot turbo spin-echo) of the fetal head at 31 3/7 weeks of gestation. Coronal image shows a cloverleaf skull with temporal protrusion (arrows) and mild ventriculomegaly (asterisk).

www.eurorad.org • CC by-nc-sa-4.0

Prenatal

diagnosis of pfeiffer syndrome type II using ultralow dose CT. Sagittal image shows proptosis (arrowhead) and mild ventriculomegaly (asterisk).

www.eurorad.org • CC by-nc-sa-4.0

Prenatal

diagnosis of pfeiffer syndrome type II using ultralow dose CT. Three-dimensional computed tomography of the fetus at 32 3/7 weeks of gestation. Volume rendering of full skeletal image shows craniosynostosis, the large distal phalanx (arrowhead) of the left great toe, and bilateral radio-ulnar-humeral synostoses (arrows).

www.eurorad.org • CC by-nc-sa-4.0

Kleeblattschädel

skull presenting in concert with Pfeiffer syndrome. a Patient with tri-lobar skull. b A side angle of the tri-lobar skull

EJNS.springeropen.com • CC-by-4.0

Kleeblattschädel

skull presenting in concert with Pfeiffer syndrome. CAT showing gross biventricular hydrocephalus with disproportionate ballooning of the temporal horns

EJNS.springeropen.com • CC-by-4.0

Kleeblattschädel

skull presenting in concert with Pfeiffer syndrome. 3D reconstruction imaging of the skull

EJNS.springeropen.com • CC-by-4.0

Cloverleaf

skull (craniosynostosis) • Cloverleaf skull - Ganzer Fall bei Radiopaedia

Radswiki T, Cloverleaf skull. Case study, Radiopaedia.org (Accessed on 25 Nov 2022) https://doi.org/10.53347/rID-12007 • CC by-nc-sa 3.0 (modified)

Cloverleaf

skull (craniosynostosis) • Cloverleaf shaped skull in the absence of craniosynostosis - Ganzer Fall bei Radiopaedia

Hosn S, Cloverleaf shaped skull in the absence of craniosynostosis. Case study, Radiopaedia.org (Accessed on 25 Nov 2022) https://doi.org/10.53347/rID-21296 • CC by-nc-sa 3.0 (modified)

Cloverleaf

skull (craniosynostosis) • Pfeiffer syndrome - Ganzer Fall bei Radiopaedia

Bickle I, Pfeiffer syndrome. Case study, Radiopaedia.org (Accessed on 25 Nov 2022) https://doi.org/10.53347/rID-35578 • CC by-nc-sa 3.0 (modified)

Cloverleaf

skull (craniosynostosis) • Cloverleaf skull deformity - Ganzer Fall bei Radiopaedia

Hamidi H, Cloverleaf skull deformity. Case study, Radiopaedia.org (Accessed on 25 Nov 2022) https://doi.org/10.53347/rID-70373 • CC by-nc-sa 3.0 (modified)

Craniosynostosis

• Cloverleaf skull - Ganzer Fall bei Radiopaedia

Ibrahim, D. Cloverleaf skull. Case study, Radiopaedia.org. (accessed on 24 Oct 2022) https://doi.org/10.53347/rID-91901 • CC by-nc-sa 3.0 (modified)

Cloverleaf

skull (craniosynostosis) • Cloverleaf skull (craniosynostosis) - Ganzer Fall bei Radiopaedia

Hamdi A, Cloverleaf skull (craniosynostosis). Case study, Radiopaedia.org (Accessed on 25 Nov 2022) https://doi.org/10.53347/rID-150495 • CC by-nc-sa 3.0 (modified)

Radiopaedia • CC-by-nc-sa 3.0 • de

Cloverleaf skull, also known as kleeblattschädel syndrome or deformity, refers to a type of severe craniosynostosis which gives the skull a cloverleaf shape. It is very rare, with less than 130 case reports globally. It typically results from intrauterine premature closure of the sagittal, coronal and lambdoid sutures, through which the cranial contents bulge, giving rise to the characteristic trilobate shape (hence the name).

It is usually seen in the context of the following conditions:

thanatophoric dysplasia: classically type II only
severe Apert syndrome
severe Crouzon syndrome
Boston-type craniosynostosis
Carpenter syndrome
Pfeiffer-Syndrom

The vast majority of patients with kleeblattschädel have intellectual impairment and hydrocephalus.

History and etymology

Holtermüller and Wiedemann gave the name "Kleeblattschädel syndrome" in their paper published in the journal Medicinische Bild in 1958 describing severe cranial deformity. Then, the name was included in the second edition of the dictionary of clinical syndromes by Leiber in 1959.