An understanding of the growth of the skull after birth is important for early detection and adequate treatment of cranial abnormalities, such as craniosynostosis (Pagnoni et al., 2014). Although head circumference (HC) and cephalic index (CI) have been commonly used to evaluate the growth and shape of the cranium, these parameters have some limitations, including high variability and low reliability for detecting abnormalities in the cranium (Metzler et al., 2013; Fearon et al., 2017).

Intracranial volume (ICV) is important for determining the optimal timing of surgery and evaluating postoperative outcomes in craniosynostosis (Sgouros et al., 1999). Therefore, initial studies estimated ICV using plain skull radiography (Lichtenberg, 1954; Menichini and Ruiu, 1960). The normal values of ICV, obtained from computed tomography (CT) and magnetic resonance (MR) imaging in the pediatric population, have also been reported (Abbott et al., 2000; Kamdar et al., 2009; Kamochi et al., 2017; Tomita et al., 2022; Brandel et al., 2022).

Since ICV alone cannot represent the overall cranial shape, a more detailed description of the cranium is needed (Ramdat Misier et al., 2022). Waitzman et al. reported the normal values of two-dimensional (2D) measurements of the craniofacial complex using axial CT images in the Western population (Waitzman et al., 1992). Recently, normal cranial growth has been studied using a three-dimensional (3D) approach (Delye et al., 2015; Meyer-Marcotty et al., 2018; Meulstee et al., 2020; Liu et al., 2022). However, most of these studies had limitations regarding sample size, specific age ranges, or slice thickness of CT images (i.e. 5 mm). Furthermore, ethnic differences in skull shape should be considered (Inokuchi et al., 2019).

Few studies have presented a complete quantitative database of cranial growth, from infancy to adulthood, as a normative reference for research and practice. There are several considerations required to overcome the limitations of previous studies, in terms of study design and methodology. First, it is necessary to provide the normal values for ICV and cranial length, width, and height using thin-slice CT images from infancy to adulthood (Hariri F et al., 2021). Second, to provide a more detailed description of the cranium, the cranial length should be measured in the anterior, middle, and posterior compartments with coronal planes passing through the sella and basion. Cranial heights (CHs) should be measured at the sella, basion, and opisthion in relation to the horizontal reference plane. Third, cranial growth patterns should be investigated by establishing growth curves, and further analyzed by plotting the percentage of adult size.

To our knowledge, no clinical studies have been conducted on the 3D analysis of the ICV, length, width, and height of the cranium, and cranial growth patterns using a large sample size from infancy to young adulthood in Korean patients. Therefore, the aim of this study was to characterize cranial growth patterns using craniometric parameters and to establish best-fit growth curves.