The processes of craniosynostosis (premature fusion of one or more of the calvarial sutures) and artificial cranial deformation are similar since both can alter the shape of the craniofacial complex. Most research exploring these processes has focused on the ectocranium, although it is obvious that these processes also modify the endocranium. Endocranial changes due to either craniosynostosis or artificial cranial deformation have not been as thoroughly examined. Silicone rubber endocasts were made from 11 craniosynostotic archaeologically derived specimens from North and South America. For comparative purposes, endocasts were made from 22 normal and 17 occipitally deformed crania that were archaeologically derived from North and South America. With all samples, middle meningeal vessel patterns and venous sinus impressions were qualitatively and quantitatively analyzed. Depth, width, and convolution of the middle meningeal vessels were recorded, and the direction of vessel branches was noted. Both artificial cranial deformation and craniosynostosis altered the endocranial vasculature. Middle meningeal vessel and venous sinus impressions of the craniosynostotic group differed when compared to both the undeformed and artificially cranially deformed samples. Sinuses traversing under synostosed sutures became wider and deeper. In contrast, sinuses directly underneath the greatest artificial deformational stress were shallower, while there was compensatory enlargement of sinuses further away from the greatest deformational effects. Such compensatory enlargement also was shown by the high incidence of enlarged occipital/marginal sinuses in artificially deformed skulls. Increased intracranial pressure is hypothesized to be the cause of the venous sinus changes found in craniosynostotic individuals. Middle meningeal vessel patterns from craniosynostotic and artificially deformed specimens were similar in that their direction paralleled the direction of altered cranial growth. These findings demonstrate that the endocranial vasculature is developmentally plastic and responds to deformation in a predictable pattern.