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This study tested whether quantitative, continuous assessment of calvarial suture patency can help explain endocranial shape variability when categorical suture descriptions fail. We retrospectively analyzed preoperative cranial CT scans from children with FGFR2\u2010related bicoronal craniosynostosis and age\u2010matched controls (birth to 4\u2009years). Endocasts were reconstructed using a semiautomated pipeline and analyzed with three\u2010dimensional geometric morphometrics. Suture patency of major calvarial sutures was quantified as a continuous measure and converted into age\u2010adjusted residuals, allowing deviations from control closure dynamics to be assessed independently of age. Intracranial volume increased with age at comparable rates in both groups, indicating preserved global endocranial growth. However, endocranial shape and its allometric relationship to growth differed between groups. While age\u2010adjusted suture patency showed only weak associations with shape in controls, suture residuals covaried strongly with coherent, system\u2010level endocast shape changes in Crouzon patients, including alterations in anteroposterior proportions and cranial fossa configuration. Morphological clusters did not map one\u2010to\u2010one onto suture closure patterns, indicating nonlocal and context\u2010dependent effects. These findings suggest that suture\u2010based\n                    <jats:italic>models<\/jats:italic>\n                    such as Virchow's law fail to predict cranial shape in syndromic craniosynostosis. By treating suture patency as a continuous, age\u2010adjusted variable embedded within a coupled brain\u2013skull growth system, this study suggests that Crouzon syndrome could act as a test case for quantitative, system\u2010level models of craniofacial development.\n                  <\/jats:p>","DOI":"10.1111\/joa.70237","type":"journal-article","created":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T05:33:36Z","timestamp":1789450416000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["When Virchow's law fails: Crouzon syndrome as a test case for quantitative suture closure\u2013endocranial shape relationships"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4574-2919","authenticated-orcid":false,"given":"F. W. 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S.","family":"Van De Lande","sequence":"additional","affiliation":[{"name":"Department of Oral and Maxillofacial Surgery Erasmus University Medical Center  Rotterdam The Netherlands"},{"name":"Craniofacial Growth and Form Lab Imagine Institute, UMR 1163  Paris France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3355-6200","authenticated-orcid":false,"given":"M.","family":"Taverne","sequence":"additional","affiliation":[{"name":"Craniofacial Growth and Form Lab Imagine Institute, UMR 1163  Paris France"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,14]]},"reference":[{"key":"e_1_2_10_2_1","unstructured":"3D Slicer Community. (2020)Fill or extract cavities in segmentations using the new \u201cWrap Solidify\u201d effect. 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