A patient with nonsyndromic Kleeblattschädel, who underwent a craniotomy involving a constricting calvarial ring and frontal calvarial remodeling, developed a superior sagittal sinus thrombosis. The superior sagittal sinus venous outflow was obstructed as a consequence of the rapid brain expansion, along with a conflict of a remaining posterior bone crest. A successful second operation was performed to remove the posterior bone crest and facilitate the venous outflow. Meticulous preoperative planning should be carried out before addressing this complex craniofacial deformity. Copyright © 2013 Mutaz B. Habal, MD.24620302033Preuss, M., Stein, M., Neubauer, B.A., About the operative management and postoperative neural development of patients with cloverleaf skull deformity (2010) Childs Nerv Syst, 26, pp. 1211-1218Cohen Jr., M.M., Cloverleaf skulls: Etiologic heterogeneity and pathogenetic variability (2009) J Craniofac Surg, 20 (SUPPL. 1), pp. 652-656Foo, R., Whitaker, L.A., Bartlett, S.P., Normocephalic pancraniosynostosis resulting in late presentation of elevated intracranial pressures (2010) Plast Reconstr Surg, 125, pp. 1493-1502Jarrahy, R., Kawamoto, H.K., Keagle, J., Three tenets for staged correction of Kleeblättschadel or cloverleaf skull deformity (2009) Plast Reconstr Surg, 123, pp. 310-318Machado, G., Di Rocco, F., Sainte-Rose, C., Cloverleaf skull deformity and hydrocephalus (2011) Childs Nerv Syst, 27, pp. 1683-1691Manjila, S., Chim, H., Eisele, S., History of the Kleeblättschadel deformity: Origin of concepts and evolution of management in the past 50 years (2010) Neurosurg Focus, 29, pp. E7Thompson, D.N., Hayward, R.D., Harkness, W.J., Lessons from a case of Kleeblättschadel. Case report (1995) J Neurosurg, 82, pp. 1071-1074Tuncbilek, G., Kaykcoglu, A., Bozkurt, G., Spring-mediated cranioplasty in patients with multiple-suture synostosis and cloverleaf skull deformity (2012) J Craniofac Surg, 23, pp. 374-377Noetzel, M.J., Marsh, J.L., Palkes, H., Hydrocephalus and mental retardation in craniosynostosis (1985) J Pediatr, 107, pp. 885-892McCarthy, J.G., Warren, S.M., Bernstein, J., Parameters of care for craniosynostosis (2012) Cleft Palate Craniofac J, 49, pp. 1S-24SWarren, S.M., Proctor, M.R., Bartlett, S.P., Parameters of care for craniosynostosis: Craniofacial and neurologic surgery perspectives (2012) Plast Reconstr Surg, 129, pp. 731-737Fearon, J.A., Ruotolo, R.A., Kolar, J.C., Single sutural craniosynostoses: Surgical outcomes and long-Term growth (2009) Plast Reconstr Surg, 123, pp. 635-642Tubbs, R.S., Sharma, A., Griessenauer, C., Kleeblättschadel skull: A review of its history, diagnosis, associations, and treatment (2013) Childs Nerv Syst, 29, pp. 745-748Cinalli, G., Chumas, P., Arnaud, E., Occipital remodeling and suboccipital decompression in severe craniosynostosis associated with tonsillar herniation (1998) Neurosurgery, 42, pp. 66-71Sargent, L.A., Griner, D., Use of osteogenesis distractors in cloverleaf skull reconstruction (2013) Ann Plast Surg, 70, pp. 546-548Rivero-Garvia, M., Marquez-Rivas, J., Rueda-Torres, A.B., Early endoscopy-assisted treatment of multiple-suture craniosynostosis (2011) Childs Nerv Syst, 28, pp. 427-431Resnick, D.K., Pollack, I.F., Albright, A.L., Surgical management of the cloverleaf skull deformity (1995) Pediatr Neurosurg, 22, pp. 29-37