Computed Tomography–Based Morphometric Analysis of Extended Strip Craniectomy for Sagittal Synostosis

Seruya, Mitchel; Tran, Jenny; Kumar, Samintharaj; Forrest, Christopher R.; Chong, David

doi:10.1097/scs.0000000000000478

Cited by 16 publications

(25 citation statements)

References 27 publications

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“…This explains the variability in the severity of bifrontal bossing and occipital protuberance seen in sagittal synostosis (Jane et al, 2000; David et al, 2009). To date, much of the existing literature has focused on how to measure the degree of cranial dysmorphism, but CI remains the most commonly used craniometric measurement (Marcus et al, 2006; Ruiz-Correa et al, 2006; Marcus et al, 2009; Hankinson et al, 2010; Gangopadhyay et al, 2014; Seruya et al, 2014). As seen in our study, it is likely that CI correlates well with severity of sagittal synostosis because it captures the 2 most obvious changes in cranial morphology associated with sagittal synostosis: biparietal narrowing and anterior–posterior elongation.…”

Section: Discussionmentioning

confidence: 99%

“…Most of the research in the area of craniometric analysis has focused on ways to measure and quantify the shape of the skull (Marcus et al, 2006; Ruiz-Correa et al, 2006; Marcus et al, 2009; Hankinson et al, 2010; Mendonca et al, 2013; Gangopadhyay et al, 2014; Seruya et al, 2014). One intriguing study evaluated normalization of cranial contour in infants who have undergone surgical correction of sagittal synostosis through photographic assessment (Panchal et al, 1999).…”

Section: Discussionmentioning

confidence: 99%

“…Although CI has been widely adopted mostly because it is easy to compute and reliable, its use is met with increasing concerns as many argue that a simple width-to-length ratio is insufficient to accurately describe the complex dysmorphism associated with sagittal synostosis (Amm and Denny, 2005; Marcus et al, 2006; Marcus et al, 2009; Mendonca et al, 2013). There are several measurement tools other than CI that exist in the literature (Marcus et al, 2006; Ruiz-Correa et al, 2006; Marcus et al, 2009; Gangopadhyay et al, 2014; Seruya et al, 2014). These measures include 3D vector analysis, point of maximal width, and scaphocephaly severity indices (Ruiz-Correa et al, 2006; Marcus et al, 2009; Gangopadhyay et al, 2014).…”

Section: Introductionmentioning

confidence: 99%

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Comparing Cephalic Index and Midsagittal Vector Analysis in Assessing Morphology in Sagittal Synostosis: A CT-Based Morphometric Analysis

Hong

Zellner

et al. 2018

The Cleft Palate-Craniofacial Journal

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Introduction: Assessment of cranial dysmorphism in sagittal synostosis is often subjective but objective measures can be applied. These include cephalic index (CI) and midsagittal vector analysis (MSVA). Objective: To assess discriminant validity, construct validity, and responsiveness of CI and MSVA measured from computed tomography (CT) in patients with sagittal synostosis. Methods: Patients with nonsyndromic isolated sagittal synostosis with complete preoperative (n = 30) and postoperative (n = 13) CT data were included. Age-matched control group (n = 24) comprised of normocephalic patients who underwent CT for reasons related to trauma. Outcome Measures: Retrospective CT evaluation of CI and MSVA was conducted and correlated with a dysmorphism numeric rating scale (D-NRS) that measured surgeon-rated severity of sagittal synostosis. Responsiveness of CI and MSVA was evaluated using dysmorphism global rating of change (D-GRC). Results: Thirty patients with sagittal synostosis were demographically similar to 24 normocephalic patients. The difference in CI and MSVA was statistically significant between normocephalic and scaphocephalic patients. Cephalic index had a good correlation with D-NRS ( r = −0.665, ρ = −0.667), but not with MSVA ( r = 0.250, ρ = 0.203). Change in CI ( r = 0.738, ρ = 0.657) was well correlated with D-GRC, but not with MSVA ( r = −0.409, ρ = −0.301). Conclusion: Cephalic index appears to quantify the severity of sagittal synostosis better than MSVA. Cephalic index also has better responsiveness than MSVA to measure a reduction in severity of disease; however, MSVA is a better descriptive craniometric measurement. Midsagittal vector analysis was able to quantify the shift in morphology in sagittal synostosis following surgical treatment.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Comparing Cephalic Index and Midsagittal Vector Analysis in Assessing Morphology in Sagittal Synostosis: A CT-Based Morphometric Analysis

Hong

Zellner

et al. 2018

The Cleft Palate-Craniofacial Journal

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“…David et al (2010) [19] concluded that CI, although the most commonly quoted outcome measure, provides limited information about global change in head shape. An improvement in CI infers an improvement in the degree of scaphocephaly, but ignores many of the other stigmatising features of scaphocephaly such as frontal bossing, occipital prominence and adverse cranial height [31].…”

Section: Discussionmentioning

confidence: 99%

Three-Dimensional Handheld Scanning to Quantify Head-Shape Changes in Spring-Assisted Surgery for Sagittal Craniosynostosis

Tenhagen

Bruse

Rodríguez-Flórez

et al. 2016

Journal of Craniofacial Surgery

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Three-dimensional (3D) imaging is an important tool for diagnostics, surgical planning, and evaluation of surgical outcomes in craniofacial procedures. Gold standard for acquiring 3D imaging is computed tomography that entails ionizing radiations and, in young children, a general anaesthesia. Three-dimensional photographic imaging is an alternative method to assess patients who have undergone calvarial reconstructive surgery. The aim of this study was to assess the utility of 3D handheld scanning photography in a cohort of patients who underwent spring-assisted correction surgery for scaphocephaly. Pre- and postoperative 3D scans acquired in theater and at the 3-week follow-up in clinic were postprocessed for 9 patients. Cephalic index (CI), head circumference, volume, sagittal length, and coronal width over the head at pre-op, post-op, and follow-up were measured from the 3D scans. Cephalic index from 3D scans was compared with measurements from planar x-rays. Statistical shape modeling (SSM) was used to calculate the 3D mean anatomical head shape of the 9 patients at the pre-op, post-op, and follow-up. No significant differences were observed in the CI between 3D and x-ray. Cephalic index, volume, and coronal width increased significantly over time. Mean shapes from SSM visualized the overall and regional 3D changes due to the expansion of the springs in situ. Three-dimensional handheld scanning followed by SSM proved to be an efficacious and practical method to evaluate 3D shape outcomes after spring-assisted cranioplasty in individual patients and the population.

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“…Although CI is the most accessible outcome measure following vault remodeling, its use in our study may not accurately reflect postoperative morphologic changes. Others have evaluated 3-dimensional computed tomography data in evaluating outcomes after treatment for craniosynostosis, 39 , 40 and future long-term assessment with CT volumetric analysis combined with neurocognitive evaluation may provide more detailed and representative information on the 3- and 4-dimensional effects of this novel technique.…”

Section: Discussionmentioning

confidence: 99%

Modification of the Melbourne Method for Total Calvarial Vault Remodeling

Hughes

Isaac

Hwang

et al. 2018

Plastic and Reconstructive Surgery - Global Open

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Background:Sagittal synostosis is the most common form of single suture synostosis. It often results in characteristic calvarial deformities, including a long, narrow head, frontal bossing, a bullet-shaped occiput, and an anteriorly placed vertex. Several methods for correcting the phenotypic deformities have been described, each with their own advantages and challenges. In this study, we describe a modification of the Melbourne method of total calvarial remodeling for correcting scaphocephaly.Methods:We conducted a retrospective review of all consecutive patients who underwent total calvarial remodeling using a modified version of the Melbourne technique from 2011 to 2015. We evaluated clinical photographs, computed tomographic imaging, and cephalic indices both pre- and postoperatively to determine morphologic changes after operation.Results:A total of 9 patients underwent the modified Melbourne technique for calvarial vault remodeling during the study period. Intraoperative blood loss was 260 mL (range, 80–400 mL), and mean intraoperative transfusion was 232 mL (range, 0–360 mL). The average length of stay in the hospital was 3.9 days. The mean cephalic indices increased from 0.66 to 0.74 postoperatively (P < 0.01).Conclusions:A modified Melbourne method for calvarial vault reconstruction addresses the phenotypic aspects of severe scaphocephaly associated with isolated sagittal synostosis and maintains a homeotopic relationship across the calvaria. It is associated with shorter operative times, lower blood loss, and lower transfusion requirements.

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Computed Tomography–Based Morphometric Analysis of Extended Strip Craniectomy for Sagittal Synostosis

Abstract: Twelve months following extended strip craniectomy and helmeting for sagittal synostosis, CT-based morphometric analysis demonstrated correction of cranial breadth, frontal bossing, and occipital bulleting. Skull length and vertex position did not fully correct.

Cited by 16 publications

References 27 publications

Comparing Cephalic Index and Midsagittal Vector Analysis in Assessing Morphology in Sagittal Synostosis: A CT-Based Morphometric Analysis

Comparing Cephalic Index and Midsagittal Vector Analysis in Assessing Morphology in Sagittal Synostosis: A CT-Based Morphometric Analysis

Three-Dimensional Handheld Scanning to Quantify Head-Shape Changes in Spring-Assisted Surgery for Sagittal Craniosynostosis

Modification of the Melbourne Method for Total Calvarial Vault Remodeling

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