Sagittal Craniosynostosis: Comparing Surgical Techniques Using 3D Photogrammetry

Abstract

Background: The aim of this study was to compare three surgical interventions for correction of sagittal synostosis—frontobiparietal remodeling (FBR), extended strip craniotomy (ESC), and spring-assisted correction (SAC)—based on three-dimensional (3D) photogrammetry and operation characteristics. Methods: Patients who were born between 1991 and 2019 and diagnosed with nonsyndromic sagittal synostosis who underwent FBR, ESC, or SAC and had at least one postoperative 3D photogrammetry image taken during one of six follow-up appointments until age 6 were considered for this study. Operative characteristics, postoperative complications, reinterventions, and presence of intracranial hypertension were collected. To assess cranial growth, orthogonal cranial slices and 3D photocephalometric measurements were extracted automatically and evaluated from 3D photogrammetry images. Results: A total of 322 postoperative 3D images from 218 patients were included. After correcting for age and sex, no significant differences were observed in 3D photocephalometric measurements. Mean cranial shapes suggested that postoperative growth and shape gradually normalized with higher occipitofrontal head circumference and intracranial volume values compared with normal values, regardless of type of surgery. Flattening of the vertex seems to persist after surgical correction. The authors’ cranial 3D mesh processing tool has been made publicly available as a part of this study. Conclusions: The findings suggest that until age 6, there are no significant differences among the FBR, ESC, and SAC in their ability to correct sagittal synostosis with regard to 3D photocephalometric measurements. Therefore, efforts should be made to ensure early diagnosis so that minimally invasive surgery is a viable treatment option. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

3D Analysis of the Cranial and Facial Shape in Craniosynostosis Patients: A Systematic Review

“…Of those 24 publications, 19 publications were considered as reproducible and are described in Supplemental Digital Content Table 2 (http://links.lww.com/SCS/F940). Fourteen publications defined ICV as the volume above a certain base plane 11–28 . In 1 publication, the cranium above the base plane was divided into 10 proportionally spaced intervals, with level 0 at base plane and level 10 at the vertex 14 .…”

“…All publications used landmarks to create the base plane. Seven publications used both tragus and the nasion/sellion, 11,12,14,20,22,24,27 and 4 publications used both tragus and the subnasale point 19,25,26,29 . Three publications used the tragus and the lateral canthi as landmarks 21,23,28 .…”

“…Of these, 30 publications were considered as reproducible (Supplemental Digital Content Table 3, http://links.lww.com/SCS/F940). To measure width or length, there were 3 methods described, including measurements using a base plane in combination with a measurement plane, 11,14,18,20,22,24,25,29–32 measurements using only a base plane 16,27,33–35, or measurements based on landmarks 13,18,22,36–43 …”

“…The first 2 methods use a base plane. For this base plane, the most commonly used landmarks are the left and right tragus and the nasion/sellion, which is used in 9 publications, 11,14,20,22,24,27,33–35 or the left and right tragus and the subnasale, which is used in 2 publications 25,29 . With the maximum width and length, the cephalic index can be calculated, which has been performed in 23 publications 11,13,14,16,18,22,24,25,27,29–39,41–43 …”

“…Thirteen publications measured the head circumference 11,12,14,16,22,24,25,30–32,40,41,45 . Of these 13 publications, 10 used a measurement plane parallel to the base plane 11,12,14,22,24,25,30–32,45 .…”