Computed Tomography in Patients With Craniosynostosis

Abstract

Background In patients with craniosynostosis, imaging remains up to the discretion of the plastic surgeon or neurosurgeon. To inform best practice guidelines, we sought to obtain data surrounding the frequency at which craniofacial surgeons order computed tomography (CT), as well as indications. We hypothesized that we would identify considerable variation in both imaging and associated indications. Methods We surveyed members of the American Society of Maxillofacial Surgeons and the American Society of Craniofacial Surgeons to measure the frequency of preoperative and postoperative head CTs, as well as indications. Initial items were piloted with 2 craniofacial surgeons and 1 neurosurgeon, using interviews to ensure content validity. χ2 Tests were used to measure associations between operative volume, years in practice, and imaging. Results Eighty-five craniofacial surgeons responded (13.8% response rate), with the majority (63.5%) having performed a craniosynostosis operation in the last month. Only 9.4% of surgeons never order preoperative CTs. Of those who do, the most common indications included diagnosis confirmation (31.2%) and preoperative planning (27.3%). About 25% of surgeons always obtain postoperative head CTs, usually to evaluate surgical outcomes (46.7%). Only 13.3% of respondents order 2 or more postoperative scans. Higher operative volume was associated with a lower likelihood of ordering preoperative head CTs (P = 0.008). Conclusions The majority of surgeons obtain preoperative head CTs, whereas only 25% obtain CTs postoperatively, often to evaluate outcomes. Because outcomes may be evaluated clinically, this is a poor use of resources and exposes children to radiation. Consensus guidelines are needed to create best practices and limit unnecessary studies.

Postoperative computed tomography imaging of pediatric patients with craniosynostosis: radiation dose and image quality comparison between multi-slice computed tomography and O-arm cone-beam computed tomography

“…The sutures of the calvaria and the skull base are most accurately identified on axial and 3-dimensional (D) surface-rendered CT images, which is currently considered the gold standard in the radiological diagnosis of craniosynostosis [8][9][10]. Preoperative CT images are used to confirm clinical diagnosis, assess structural anomalies and neurovascular anatomy and facilitate accurate surgical planning [10,11]. Postoperatively, CT images can be used to detect possible complications and evaluate the surgical outcome and adequacy of calvarial expansion [10,11].…”

“…Preoperative CT images are used to confirm clinical diagnosis, assess structural anomalies and neurovascular anatomy and facilitate accurate surgical planning [10,11]. Postoperatively, CT images can be used to detect possible complications and evaluate the surgical outcome and adequacy of calvarial expansion [10,11]. Additionally, postoperative evaluation is beneficial for the assessment of new surgical techniques and in medicolegal disputes.…”

CranioRate TM: An Image-Based, Deep-Phenotyping Analysis Toolset and Online Clinician Interface for Metopic Craniosynostosis

“…10,11 Furthermore, such low-dimensional craniometric measurements are nonintuitive for surgeons in that they typically measure cranial structures and parameters that are not directly useful for clinical decision-making. 12–14…”

“…10,11 Furthermore, such low-dimensional craniometric measurements are nonintuitive for surgeons in that they typically measure cranial structures and parameters that are not directly useful for clinical decision-making. [12][13][14] Machine learning technology has increased in popularity in plastic surgery, with many potential applications that improve patient care. 15,16 Precision medicine refers to treatments and Background: The diagnosis and management of metopic craniosynostosis involve subjective decision-making at the point of care.…”