Weighing In on the Controversy: Preoperative Imaging in Unicoronal Craniosynostosis Leads to Strategic Changes in Surgical Care

Ulma, Raquel M.; Ranganathan, Kavitha; Vercler, Christian J.; Garton, Hugh; Maher, Cormac O.; Muraszko, Karin M.; Buchman, Steven R.

doi:10.1097/prs.0000000000007830

Cited by 4 publications

(4 citation statements)

References 18 publications

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“…Also, although it is thought that neurologically significant findings are much more common in syndromic patients, prior work has demonstrated that certain anomalies, such as Chiari malformations, ventriculomegaly, and choroid fissure cysts may be found in more than 6% of patients and thus merit appropriate follow-up and may require intervention 9 . Additionally, variations in vascular anatomy seen on preoperative CTs in patients with unicoronal synostosis changed the neurosurgical approach in 41.4% of the senior author's patients 10 . Given this evidence, it seems prudent to confirm the patient's diagnosis and rule out additional intracranial abnormalities before proceeding with surgical intervention.…”

Section: Discussionmentioning

confidence: 99%

“…9 Additionally, variations in vascular anatomy seen on preoperative CTs in patients with unicoronal synostosis changed the neurosurgical approach in 41.4% of the senior author's patients. 10 Given this evidence, it seems prudent to confirm the patient's diagnosis and rule out additional intracranial abnormalities before proceeding with surgical intervention. Aside from diagnostic purposes, surgeons may also require preoperative CT scans for VSP.…”

Section: Discussionmentioning

confidence: 99%

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Computed Tomography in Patients With Craniosynostosis

et al. 2021

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Computed Tomography in Patients With Craniosynostosis

et al. 2021

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“…The strategy of OI generation is used by companies for the middle and threshold levels of opportunities for strategic changes, and the strategy of simulating strategic changes is used for the unique level of opportunities for strategic changes [39]. In such conditions, in order to ensure the anticipatory nature of strategic enterprise management, one should focus on ensuring the key competencies of the management system in the area of strategic change generation, which will meet the unique level of strategic changes in the target market and support the implementation of the active strategy of stimulating strategic changes [40].…”

Section: One Can Draw the Following Conclusionmentioning

confidence: 99%

Managing Strategic Changes in Personnel Resistance to Open Innovation in Companies

Bilichenko

Tolmachev

Полозова

et al. 2022

Journal of Open Innovation: Technology, Market, and Complexity

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The aim of the work is to develop theoretical, methodological, and applied foundations and practical recommendations for managing strategic changes in personnel resistance to open innovations in companies. The following special methods were used in the research process: Comparative and economic-statistical analysis—to assess the level of unique, threshold, and average opportunities for resistance to changes in open innovation; ranking—to assess the development of corporate culture. The main method of study was expert evaluation through questionnaires. The experts were middle managers of five branches of international car companies in Poland: Fiat, Opel, Toyota, Volkswagen, and Volvo. The reason for choosing these companies is that they collectively occupy 85% of the Polish automotive market. Resistance to open innovations usually arises at the individual level of personnel and is addressed through informational and motivational measures. According to the study, the threat to strategic change management in companies is system resistance for Opel and Toyota. This allowed us to draw a conclusion on the development of a predominantly fiduciary corporate culture, which minimizes the resistance to open innovation in companies. Approbation of the approaches of the companies under study proved that in the current conditions, there is a combination of different types of strategies. Recommendations regarding the choice of change strategies are substantiated for all the companies under study.

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“…Patients with craniofacial deformities typically present in early infancy and are conventionally diagnosed through clinical examination, ultrasound, or imaging modalities like Computed Tomography (CT) or Magnetic Resonance Imaging (MRI) [8,9]. However, the use of tomographic techniques, especially in young patients, necessitates general anesthesia and carries the risk of radiation exposure in CT imaging, a concern given the increased susceptibility to malignancies during early development [10,11].…”

Section: Introductionmentioning

confidence: 99%

The Use of Artificial Intelligence for the Classification of Craniofacial Deformities

Kuehle,

Ringwald,

Bouffleur

et al. 2023

JCM

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Positional cranial deformities are a common finding in toddlers, yet differentiation from craniosynostosis can be challenging. The aim of this study was to train convolutional neural networks (CNNs) to classify craniofacial deformities based on 2D images generated using photogrammetry as a radiation-free imaging technique. A total of 487 patients with photogrammetry scans were included in this retrospective cohort study: children with craniosynostosis (n = 227), positional deformities (n = 206), and healthy children (n = 54). Three two-dimensional images were extracted from each photogrammetry scan. The datasets were divided into training, validation, and test sets. During the training, fine-tuned ResNet-152s were utilized. The performance was quantified using tenfold cross-validation. For the detection of craniosynostosis, sensitivity was at 0.94 with a specificity of 0.85. Regarding the differentiation of the five existing classes (trigonocephaly, scaphocephaly, positional plagiocephaly left, positional plagiocephaly right, and healthy), sensitivity ranged from 0.45 (positional plagiocephaly left) to 0.95 (scaphocephaly) and specificity ranged from 0.87 (positional plagiocephaly right) to 0.97 (scaphocephaly). We present a CNN-based approach to classify craniofacial deformities on two-dimensional images with promising results. A larger dataset would be required to identify rarer forms of craniosynostosis as well. The chosen 2D approach enables future applications for digital cameras or smartphones.

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Weighing In on the Controversy: Preoperative Imaging in Unicoronal Craniosynostosis Leads to Strategic Changes in Surgical Care

Cited by 4 publications

References 18 publications

Computed Tomography in Patients With Craniosynostosis

Computed Tomography in Patients With Craniosynostosis

Managing Strategic Changes in Personnel Resistance to Open Innovation in Companies

The Use of Artificial Intelligence for the Classification of Craniofacial Deformities

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