Solution to Unknown Case # 8 – Luckenschadel Skull versus Copper Beaten Skull

History: Infant with a congenital anomaly. 

Luckenschadel (or lacunar) Skull: Lateral radiograph of the skull reveals multiple areas of thinning of the inner table of the skull (yellow arrows) that make the skull appear fenestrated.

This is the appearance of a Luckenschadel (or lacunar) skull. Luckenschadel skull is a congenital defect in the skull that results from abnormal membranous ossification. It is associated with Chiari II malformations, which includes the following features:

1. Cerebellar tonsil herniation through foramen magnum due to a small posterior fossa

2. Luckenschadel skull (seen above)

3. Myelomeningocele (which this patient had)

4. Hydrocephalus

5. Dural abnormalities

6. Beaked tectum

Luckenschadel skull must be distinguished from what is known as a copper beaten skull, which is seen frequently with craniosynostosis. Copper beaten skull is from prominent gyral impressions on the inner table due to increased intracranial pressure. Luckenschadel skull is not due to increased intracranial pressure, but is the result of abnormal ossification.