Quantitative and qualitative comparison of morphometric outcomes after endoscopic and conventional correction of sagittal and metopic craniosynostosis versus control groups

Abstract

OBJECTIVE Surgical correction for sagittal and metopic craniosynostosis (SCS and MCS) aims to alter the abnormal cranial shape to resemble that of the normal population. The achieved correction can be assessed by morphometric parameters. The purpose of the presented study was to compare craniometric parameters of control groups to those same parameters after endoscopic and conventional (open) correction. METHODS The authors identified 4 groups of children undergoing surgical treatment for either SCS or MCS, with either endoscopic (SCS, n = 17; MCS, n = 16) or conventional (SCS, n = 29; MCS, n = 18) correction. In addition, normal control groups of nonaffected children who were 6 (n = 30) and 24 (n = 18) months old were evaluated. For all groups, several craniometric indices calculated from 3D photographs were compared for quantitative analysis. For qualitative comparison, averages of all 3D photographs were generated for all groups and superimposed to visualize relative changes. RESULTS For children with SCS, the cephalic index and coronal circumference index significantly differed preoperatively from those of the 6-month normal controls. The respective postoperative values were similar to those of the 24-month normal controls after both endoscopic and conventional correction. Similarly, for children with MCS, indices for circumference and diagonal dimension that were significantly different preoperatively became nonsignificantly different from those of 24-month normal controls after both endoscopic and conventional correction. The qualitative evaluation of superimposed average 3D head shapes confirmed changes toward normal controls after both treatment modalities for SCS and MCS. However, in SCS, the volume gain, especially in the biparietal area, was more noticeable after endoscopic correction, while in MCS, relative volume gain of the bilateral forehead was more pronounced after conventional correction. The average 3D head shapes matched more homogeneously with the average of normal controls after endoscopic correction for SCS and after conventional correction for MCS. CONCLUSIONS This quantitative analysis confirms that the performed surgical techniques of endoscopic and conventional correction of SCS and MCS alter the head shape toward those of normal controls. However, in a qualitative evaluation, the average head shape after endoscopic technique for SCS and conventional correction for MCS appears to be closer to that of normal controls than after the alternative technique. This study reports on morphometric outcomes after craniosynostosis correction. Only an assessment of the whole multiplicity of outcome parameters based on multicenter data acquisition will allow conclusions of superiority of one surgical technique.

Endoscopic treatment of sagittal suture synostosis — a critical analysis of current management strategies

“… Iyer, 2017 [ 24 ] 7 15.2 ± 7.7* 12.3* 6 ♂ 1 ♀ Iyer, 2018 [ 25 ] 31 2.7 r (1.6–3.2) 27 ♂ 4 ♀ Isaac, 2018 [ 22 ] 187 (207 in total; 187 endoscopic vs. 20 undergone CVR; data separated in article) 3.0 IQR [2.5–4.0] r (1.5–7.0) 137 ♂ 50 ♀ Jimenez, 2012 [ 28 ] 256 3.9 187 ♂ 69 ♀ Lepard, 2021 [ 33 ] 19 (50 patients in total; 19 endoscopic vs. 31 undergone open surgical correction; data separated in article) 2.6 r (2.4–2.9) 16 ♂ 3 ♀ Magge, 2019 [ 34 ] 30 (51 in total, 30 endoscopic vs. 21 undergone pi-procedure; data separated in article) 3.11 (± 3.18) n.g. Martin, 2018 [ 35 ] 5 2.8 r (1.5–4.5) 3 ♂ 2 ♀ Nguyen, 2017 [ 37 ] 100 3.3 (± 1.1) 70 ♂ 30 ♀ Ridgway, 2011 [ 39 ] 56 3.24 (± 1.48) 47 ♂ 9 ♀ Schulz, 2021 [ 42 ] 17 (128 in total: sagittal CS ( n = 17) with endoscopic treatment vs. conventional/open surgery ( n = 29); metopic CS with endoscopic treatment ( n = 16) vs. conventional/open surgery ( n = 18); non-affected control groups at 6 ( n = 30) and 24 ( n = 18) months of age) 3.0 r ...…”

“…The majority of the groups indicated carrying out a clinical examination [ 6 , 8 , 22 , 25 , 28 , 39 , 42 , 48 ]. If not performed routinely, the reasons for ophthalmologic investigation mainly were not only to further evaluate the intracranial pressure by screening for papilledema but also to keep track of possible deviations in line of sight [ 22 ].…”

“…Among them, four indicated to do so in all patients [ 28 , 34 , 37 , 44 ], whereby only one [ 22 ] preserved the confirming method for cases of observed papilledema or macrocephaly [ 22 ]. Other teams elaborated their anthropometric measurements by caliper [ 25 , 39 , 44 ], either using existing 3D reconstructed CT scans [ 34 , 37 , 44 ], laser scans evaluated by the orthotist [ 2 , 11 , 25 , 33 , 35 , 42 , 48 ], or their results on 3D images taken photographically [ 39 ]. The most common anthropometric measurement tool used in our included data was the CI (cranial index, defined by BP/AP diameter × 100).…”

“…The majority of surgeons performed two transverse skin incisions. In contrast, Iyer et al [ 24 ] developed a technique with a single, transverse 3-cm incision about 1 cm posterior to the anterior fontanelle — later also realized by Schulz et al [ 42 ], following which they left the pericranium intact to mark the bone using electrocautery. Burr holes were performed using a high-speed drill [ 2 , 24 , 35 , 39 , 48 ] and hereafter locally enlarged with Kerrison rongeurs [ 2 , 22 , 35 , 39 ].…”

“… Nguyen, 2017 [ 37 ] 2 transverse midline incisions A 4–5 cm in width B ; performed in conjunction with bilateral wedge osteotomies 77.1 ± 22.2 34.0 ± 34.8 9 - 1 conversion to open technique required due to presence of a large emissary vein difficult to control endoscopically; - 1 readmission due to emesis while a small SAH occurred - Postoperative period: hyperglycemia, respiratory distress requiring CPAP, respiratory syncytial virus infection Ridgway, 2011 [ 39 ] 2 incisions, 1.5–2.5 cm in length A 1 cm strip craniectomy B 45.32 ± 11.23 n.g. 3.6 None Schulz, 2021 [ 42 ] “1 small skin incision” 2–3 cm strip craniectomy B n.g. n.g.…”