Objective: Thirty patients early diagnosed within the first six months of age as primary craniosynostosis. Were operated by early suture release surgery endoscopic assisted suturectomy in neurosurgery department in Shebin Elkom Teaching hospital (2011- 2016). The studied group 16 females 14 males all have primary craniosynostosis. 9 Brachycephaly, 7 scaphocephally, 4 anterior plagiocephaly, 4 trigonocephaly, 2 posterior plagiocephaly and 4 oxycephaly. 63.3% of patients presented with deformity alone. Other clinical presentations as manifestations of increased intracranial pressure (vomiting, irritable crying, and fits) and delayed milestones plus deformity was 30%, 6.7% respectively. The 3D CT volume rendering technique of all of them retrospectively studied, and Ectocranial skull suture closure grading system of Meindl and Lovejoy applied to 3D skull of the studied group as it simulate real time one. Of all patients 38 sutures was affected. After application of proposed grading 10 sutures G1, 16 sutures G2 and 12 sutures G3. Of coronal sutures 6 G1, 13G2, and 4G3. Of lambdoid sutures 2G1 and 1G3. Of metopic sutures 5 are G3. And of sagittal sutures 2G1, 3G2, and 2G3.

Conclusion: Application of ectocranial skull suture closure grading system to 3D skull in early cases of primary craniosynostosis will help in precise diagnosis and surgical decision, as it demonstrate the degree of affected suture from single bony bridge that restrict or arrest suture growth in mild cases to completely obliterated one.