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Vertex

he vertex refers to the highest point of the skull, forming the superior-most aspect of the cranial vault. It is not a discrete anatomical structure but a topographic region defined primarily by the parietal bones near the midline. The vertex is an important landmark in neuroanatomy, radiology, neurosurgery, and cranial surface anatomy.

It is commonly referenced in imaging orientation, EEG electrode placement, scalp and calvarial evaluation, and assessment of parasagittal brain structures.

Synonyms

  • Cranial vertex

  • Skull vertex

Location

  • Situated at the superior-most aspect of the skull

  • Formed mainly by the paired parietal bones

  • Centered around the sagittal suture

  • Posterior to the frontal bone

  • Anterior to the occipital bone

  • Superficial to the superior sagittal sinus and parasagittal cerebral cortex

Anatomical components

  • Parietal bones

  • Sagittal suture

  • Adjacent sutures (variable proximity):

    • Coronal suture (anterior)

    • Lambdoid suture (posterior, near but not part of the vertex proper)

  • Scalp layers:

    • Skin

    • Dense connective tissue

    • Galea aponeurotica

    • Loose areolar tissue

    • Pericranium

Relations

Superiorly:

  • Scalp and subcutaneous tissues

Inferiorly:

  • Parasagittal cerebral cortex

  • Superior sagittal sinus

Medially:

  • Sagittal suture

  • Falx cerebri (deep)

Laterally:

  • Parietal convexities

Anteriorly:

  • Frontal bone and coronal suture region

Posteriorly:

  • Parietal–occipital transition

Structures related to the vertex

  • Superior sagittal sinus

  • Bridging cortical veins

  • Parasagittal motor and sensory cortex

  • Falx cerebri

X-ray appearance 

Skull radiographs (AP / lateral / vertex views):

  • Parietal bones: Symmetric calvarial outlines

  • Sagittal suture: Thin radiolucent midline line (age dependent)

  • Calvarial thickness: Uniform cortical density

  • Diploë: Mildly radiolucent trabecular pattern between inner and outer tables

  • Soft tissues: Scalp soft-tissue outline visible

CT appearance

Non-contrast CT:

  • Outer and inner tables: Hyperdense cortical bone

  • Diploic space: Lower density marrow between tables

  • Scalp: Soft-tissue density

  • Superior sagittal sinus: May be faintly appreciated as a midline structure

Post-contrast CT:

  • Superior sagittal sinus: Linear midline enhancement

  • Scalp vessels: Mild enhancement

  • Calvarium: No enhancement

3D CT VRT appearance 

Volume-rendered technique (VRT):

  • Vertex contour: Smooth, convex superior skull outline

  • Parietal bones: Symmetric morphology

  • Sagittal suture: Visible as a fine midline seam (may be fused in adults)

  • Calvarial integrity: Continuous outer table without defects

  • Clinical utility: Excellent for assessing skull shape, symmetry, and surface anatomy

MRI appearance 

T1-weighted images:

  • Calvarial cortex: Low signal intensity

  • Diploic marrow: Intermediate to high signal (age dependent)

  • Scalp fat: High signal

  • Underlying brain: Normal parasagittal cortex

T2-weighted images:

  • Bone cortex: Low signal

  • Diploë: Intermediate signal

  • CSF in parasagittal sulci: High signal

X ray image

Vertex X RAY ANATOMY IMAGE

CT VRT 3D image

Vertex 3D IMAGE