A New Measure of Posterior Morphology in Sagittal Craniosynostosis: The Occipital Bullet Index

Bins, Griffin  P.; Cull, Deborah; Layton, Ryan G.; Kogan, Samuel; Zhou, Larry; Dunson, Blake; David, Lisa R.; Runyan, Christopher M.

doi:10.1159/000533168

Cited by 3 publications

(4 citation statements)

References 27 publications

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“…Sellion projection is relatively unaffected in SC 22,23 and has been used in outside studies as an internal control for head size. 24,25 These findings were confirmed in our previous study, 11 and the sellion was again used here as an internal control. The ratio of head width to sellion projection was calculated for all points of intersection on the axial-coronal Cartesian grid for all individuals.…”

Section: Population Analysissupporting

confidence: 88%

“…The method for obtaining preoperative and control population scans was previously described in detail 10,11 and is summarized below.…”

Section: Methodsmentioning

confidence: 99%

“…The Cartesian grid formed by the axial and coronal plane systems is used for analysis of biparietal width, as it has the highest number of intersections on the lateral head and the lateral displacement or width exists as a continuous rather than discrete variable. In the previous anterior 10 and posterior 11 measures, the combination of axial and sagittal planes was used for analogous reasons in the anterior and posterior cranium.…”

Section: Population Analysismentioning

confidence: 99%

“…2, below, left ) allow for objective quantification of regional anterior and posterior elongation in these patients. 10,11 These indices were designed using surface imaging modalities, including three-dimensional photography and the surface anatomy from computed tomography (CT) scans, and have great potential for both diagnostic screening and as a tool to guide surgical approach and to quantify outcomes objectively.…”

mentioning

confidence: 99%

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“Creation of the Scaphocephalic Index: Measurement of Global and Regional Severity in Scaphocephaly”

Bins

Zhou

Cull

et al. 2023

Plastic &Amp; Reconstructive Surgery

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remature fusion of the sagittal suture results in inhibited perpendicular biparietal expansion and parallel anterior and posterior compensatory elongation. 1 The resulting head shape is described by a classic dysmorphology: scaphocephaly. 2 Attempts to measure this abnormality globally have led to the widespread adoption of the cephalic index and its derivatives. 3,4 The cephalic index is limited by its 2-dimensionality and an inability to regionalize dysmorphology. [4][5][6][7][8][9] For example, 2 patients with sagittal craniosynostosis (SC) and identical cephalic indices, as depicted in Figure 1, may have vastly different shape abnormalities (eg, either predominance of frontal bossing or an occipital bullet), each potentially necessitating different surgical approaches. The recently described frontal bossing index (FBI; Fig. 2, above) and occipital Background: The recently described frontal bossing index (FBI) and occipital bullet index (OBI) allow for quantification of scaphocephaly. A similar index examining biparietal narrowing has not been described. Addition of such an index measuring width would allow for direct evaluation of the primary growth restriction in sagittal craniosynostosis and the formation of an optimized global width/length measure. Methods: Computed tomography scans and three-dimensional photographs were used to recreate scalp surface anatomy. Equidistant axial, sagittal, and coronal planes were overlaid, creating a Cartesian grid. Points of intersection were analyzed for population trends in biparietal width. Using the most descriptive point coupled with the sellion protrusion to control for head size, the vertex narrowing index is formed. By combining this index with the FBI and OBI, the scaphocephalic index (SCI) is created as a tailored width/length measure. Results: Using 221 controls and 360 individuals with sagittal craniosynostosis, the greatest difference occurred superiorly and posteriorly at a point 70% of the head's height and 60% of the head's length. This point had an area under the curve of 0.97 and sensitivity and specificity of 91.2% and 92.2%, respectively. The SCI has an area under the curve of 0.9997, sensitivity and specificity greater than 99%, and interrater reliability of 0.995. The correlation coefficient between computed tomography imaging and three-dimensional photography was 0.96. Conclusions: The vertex narrowing index, FBI, and OBI evaluate regional severity, while the SCI is able to describe global morphology in patients with sagittal craniosynostosis. These measures allow for superior diagnosis, surgical planning, and outcome assessment, independent of radiation. (Plast.

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Section: Population Analysissupporting

confidence: 88%

“…The method for obtaining preoperative and control population scans was previously described in detail 10,11 and is summarized below.…”

Section: Methodsmentioning

confidence: 99%

Section: Population Analysismentioning

confidence: 99%

mentioning

confidence: 99%

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“Creation of the Scaphocephalic Index: Measurement of Global and Regional Severity in Scaphocephaly”

Bins

Zhou

Cull

et al. 2023

Plastic &Amp; Reconstructive Surgery

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Quantifying dysmorphologies of the neurocranium using artificial neural networks

Abdel‐Alim,

Tapia Chaca,

Mathijssen

et al. 2024

Journal of Anatomy

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BackgroundCraniosynostosis, a congenital condition characterized by the premature fusion of cranial sutures, necessitates objective methods for evaluating cranial morphology to enhance patient treatment. Current subjective assessments often lead to inconsistent outcomes. This study introduces a novel, quantitative approach to classify craniosynostosis and measure its severity.MethodsAn artificial neural network was trained to classify normocephalic, trigonocephalic, and scaphocephalic head shapes based on a publicly available dataset of synthetic 3D head models. Each 3D model was converted into a low‐dimensional shape representation based on the distribution of normal vectors, which served as the input for the neural network, ensuring complete patient anonymity and invariance to geometric size and orientation. Explainable AI methods were utilized to highlight significant features when making predictions. Additionally, the Feature Prominence (FP) score was introduced, a novel metric that captures the prominence of distinct shape characteristics associated with a given class. Its relationship with clinical severity scores was examined using the Spearman Rank Correlation Coefficient.ResultsThe final model achieved excellent test accuracy in classifying the different cranial shapes from their low‐dimensional representation. Attention maps indicated that the network's attention was predominantly directed toward the parietal and temporal regions, as well as toward the region signifying vertex depression in scaphocephaly. In trigonocephaly, features around the temples were most pronounced. The FP score showed a strong positive monotonic relationship with clinical severity scores in both scaphocephalic (ρ = 0.83, p < 0.001) and trigonocephalic (ρ = 0.64, p < 0.001) models. Visual assessments further confirmed that as FP values rose, phenotypic severity became increasingly evident.ConclusionThis study presents an innovative and accessible AI‐based method for quantifying cranial shape that mitigates the need for adjustments due to age‐specific size variations or differences in the spatial orientation of the 3D images, while ensuring complete patient privacy. The proposed FP score strongly correlates with clinical severity scores and has the potential to aid in clinical decision‐making and facilitate multi‐center collaborations. Future work will focus on validating the model with larger patient datasets and exploring the potential of the FP score for broader applications. The publicly available source code facilitates easy implementation, aiming to advance craniofacial care and research.

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The Effect of Barrel-Stave Osteotomy Length in Sagittal Strip Craniectomy

Harrison,

Prezelski,

Hallac

et al. 2024

The Cleft Palate Craniofacial Journal

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Objective In managing sagittal craniosynostosis, strip craniectomy of the affected suture is commonly paired with barrel-stave osteotomies to allow for additional cranial remodeling. However, the effect of these osteotomies is not well-established. This study aimed to evaluate the effect of the length of barrel-stave osteotomies on outcomes in patients with sagittal craniosynostosis. Design A retrospective review of operative records and pre-operative and one-year post-operative three-dimensional images. Setting Tertiary care pediatric institution. Patients Forty-five patients with sagittal craniosynostosis Interventions Sagittal strip craniectomy and either long, medium, or short barrel-stave osteotomy lengths followed by helmet therapy Main Outcome Measures Operative and three-dimensional craniometric outcomes. Results Operative time, estimated blood loss, and hospital length of stay were significantly decreased in the short group ( P = .003; 0.002; 0.027). The cranial index was normalized in all groups, but the long group was significantly lower ( P = .007; 0.025). Head circumference was similar between groups. All indexes were within the normal percentiles in all groups. The medium group had a significantly decreased scaphocephalic index ( P = .031; .035). The short group had significantly greater occipital bulleting than the medium group ( P = .001). The long group had significantly greater narrowing than the short group ( P = .036). Conclusions Strip craniectomy with the addition of long, medium, or short barrel staves all resulted in clinically successful outcomes. Our findings suggest that increased barrel-stave osteotomy length may not be necessary for a successful outcome while avoiding more extensive dissection, potential risk, increased operative time, and hospital length of stay.

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A New Measure of Posterior Morphology in Sagittal Craniosynostosis: The Occipital Bullet Index

Cited by 3 publications

References 27 publications

“Creation of the Scaphocephalic Index: Measurement of Global and Regional Severity in Scaphocephaly”

“Creation of the Scaphocephalic Index: Measurement of Global and Regional Severity in Scaphocephaly”

Quantifying dysmorphologies of the neurocranium using artificial neural networks

The Effect of Barrel-Stave Osteotomy Length in Sagittal Strip Craniectomy

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