Evaluating Surgical Decision-making in Nonsyndromic Sagittal Craniosynostosis Using a Digital 3D Model

Abstract

Background: Surgical correction of craniosynostosis addresses potentially elevated intracranial pressure and the cranial deformity. In nonsyndromic sagittal synostosis, approximately 15% of patients have elevated intracranial pressure. The decision to operate therefore likely reflects a combination of aesthetic goals, prevention of brain growth restriction over time, surgeon training and experience, and parental expectations. This study examines clinical factors that influence surgical decision-making in nonsyndromic sagittal synostosis. Methods: An online survey sent to craniofacial and neurosurgeons presented 5 theoretical patients with varying severities of sagittal synostosis. For each cephalic index, 4 separate clinical scenarios were presented to assess influences of parental concern and developmental delay on the decision to operate. Results: Fifty-six surveys were completed (response rate = 28%). Participants were predominantly from North America (57%), had over 10 years of experience (75%), and performed over 20 craniosynostosis procedures annually (50%). Thirty percent of respondents indicated they would operate regardless of head shape and without clinical and/or parental concern. Head shape was the greatest predictor of decision to operate ( P < 0.001). Parental concern and developmental delay were independently associated with decision to operate ( P < 0.001). Surgeons with more experience were also more likely to operate across all phenotypes (OR: 2.69, P < 0.004). Conclusions: Surgeons responding to this survey were more strongly compelled to operate on children with nonsyndromic sagittal craniosynostosis when head shape was more severe. Additional factors, including parental concern and developmental delay, also influence the decision to operate, especially for moderate phenotypes. Geographic and subspecialty variations were not significant.

CranioRate TM: An Image-Based, Deep-Phenotyping Analysis Toolset and Online Clinician Interface for Metopic Craniosynostosis

“…This is crucial in examining the significant variation in the methods by which craniofacial surgeons decide whether to operate on a particular patient with craniosynostosis. 31,32 A major limitation of implementing standardized protocols is the lack of objective quantification of severity. The Whitaker classification has been the accepted standard for aesthetic outcomes reporting in craniosynostosis research, [33][34][35][36] but has been shown to have low interrater reliability and cannot predict the need for future interventions.…”

“…Many clinical factors are considered, including patient age, comorbidities, type and severity of craniosynostosis, surgeon training and experience, aesthetic goals, future neurologic complications, and patient family preference. 32 Furthermore, there are variations in the type of surgery offered to particular patients—open techniques, which have been the standard of care for several decades, and more recently developed minimally invasive techniques. 38 There is currently no agreed-on objective method that contributes to surgical decision-making in the management of patients with craniosynostosis.…”

Incorporation of a biparietal narrowing metric to improve the ability of machine learning models to detect sagittal craniosynostosis with 2D photographs

“…The clinical impact of having accurate head shape classification tools available to medical providers was highlighted by Hughes et al, who recently demonstrated that the severity of the head shape is the most significant factor in determining whether surgeons recommend surgical treatment for a patient with sagittal craniosynostosis. 23 Historically, CI has been used to quantify the severity of scaphocephalic head shapes, but some groups have noted that the use of CI can lead to underreporting of the severity of sagittal craniosynostosis in some patients due to the anterocaudal displacement of the euryon in these cases. 24,25 The appropriateness of relying on the CI was also studied by Fearon et al, who determined that although the average preoperative CI was below normal among patients with sagittal craniosynostosis, 87.5% of patients had measurements that fell within 2 standard deviations of the mean.…”

An eminent rendezvous with a series of cranial vault remodeling for Craniosynostosis

“…An utmost scrutiny to decide whether or not the patient is a candidate with features of raised intra cranial pressure for emergent surgical intervention is accomplished. 4 CT scan of the head and three dimensional reconstruction using both bone and soft tissue windows is the investigation of choice. An auxiliary CT venogram can be done if a suspicion of abnormal venous drainage is speculated.…”