Comparison of Head Shape Outcomes in Metopic Synostosis Using Limited Strip Craniectomy and Open Vault Reconstruction Techniques

Abstract

Aim: Metopic craniosynostosis (MCS), with its trigonocephalic head shape, is often treated with either limited incision strip craniectomy (LISC) followed by helmet orthotic treatment, or open cranial vault reconstruction techniques (OCVR). There is controversy regarding resultant shape outcomes among craniofacial surgeons. Those adverse to LISC claim normal head shape is never attained, while proponents believe there is gradual correction to an equivalent outcome. This study aims to quantitate, over time, the three-dimensional (3D) head shapes in patients who have undergone LISC or OCVR intervention for MCS. Methods: Sixty-three 3D images of 26 patients with MCS were analyzed retrospectively. Head shape analyses were performed at: (1) preoperative, (2) 1-month postoperative, (3) 10 to 14 months postoperative (1 year), and (4) 2 years postoperative. Composite 3D head shapes of patients were compared at each time point. Two-dimensional (2D) standardized cross sections of the forehead were also compared. Results: Composite head shapes for both groups were nested, to allow visual comparison as the child’s forehead grows and expands. The difference between LISC and OCVR 2D cross sections was calculated; 108.26 mm preoperatively, 127.18 mm after 1-month postoperative, 51.05 mm after 10 to 14 months postoperative, and 27.03 mm after 2 years postoperative. Conclusions: This study found excellent head shape outcomes for both the LISC and OCVR techniques at 2 years of age. It also corroborates the slow and progressive improvement in head shape with the LISC technique. This study highlights the advantages of 3D photography for measurement of contour outcomes, utilizing both 2D vector and 3D whole head analytical techniques.

Superior Long-term Appearance of Strip Craniectomy Compared with Cranial Vault Reconstruction in Metopic Craniosynostosis

“…Though anthropometric measurements have been used to objectively characterize skull morphology, they remain insufficient to comprehensively assess aesthetic outcomes. 16,17,19,22 No described measurement captures adverse aesthetic outcomes that are commonly observed following craniosynostosis repair, such as irregularities of the forehead contour. Since aesthetic and social concerns are among the primary indications for surgery, this represents a meaningful deficiency in the literature.…”

Correction of Metopic Craniosynostosis Using Limited Incision Strip Craniectomy Versus Open Fronto-Orbital Reconstruction: An Assessment of Aesthetic Outcomes

“…A recent study used three-dimensional head shape contour analysis to compare the outcomes of open cranial vault to limited incision strip techniques for metopic craniosynostosis repair, finding equivalent shape outcomes at 2 years postop. 16 Third, the aesthetic ratings provided by craniofacial surgeons were based on subjective rather than objective criteria. 17,18 However, some have argued that such results are fundamentally subjective and should not be held to objective standards.…”

Correction of trigonocephaly after endoscopic strip craniectomy with postoperative helmet orthosis therapy: a 3D stereophotogrammetric study

“…15 Unlike in sagittal synostosis, where the cranial/cephalic index (CI) is widely accepted as a useful (if imperfect) method for recording deformity, there is an absence of universally accepted parameters in trigonocephaly, despite many suggested measurements. 10,11,15,16,19,25,26 One restriction has been the need for CT scans to measure 3D morphology in this group of children. The use of CT in children has obvious disadvantages, such as the exposure of the developing brain to ionizing radiation and the need for sedation/anesthesia in many children, as well as being expensive and inconvenient.…”

“…For the control group, we used 3D soft-tissue images driven from CT scans which have been reported to be interchangeable with 3DSPG. [29][30][31] The existing literature on morphometrics of trigonocephaly surgery focuses almost entirely on the forehead shape, [16][17][18][19] presumably as the standard operation (FOAR) corrects the fronto-orbital region only. To our knowledge, FIG.…”

“…[9][10][11][12][13] Imaging for these studies was performed with CT scans, which produce accurate, high-quality images, but the CT scanning procedure exposes children to ionizing radiation and may require anesthesia. 3D stereophotogrammetry (3DSPG), in which 2D images captured by multiple cameras are merged to produce a 3D image, 14 is an attractive alternative to CT, [15][16][17][18][19] as it is free of ionizing radiation and can be performed on awake children.…”