Sagittal Craniosynostosis: Comparing Surgical Techniques using 3D Photogrammetry

OBJECTIVE: The aim of this study is to compare three surgical interventions to correct sagittal synostosis: frontobiparietal remodeling (FBR), extended strip craniotomy (ESC), and spring assisted correction (SAC), based on 3D photogrammetry and operation characteristics.

METHODS: All patients diagnosed with non-syndromic sagittal synostosis, born between 1991 and 2019, who underwent FBR, ESC or SAC, and had at least one postoperative 3D photogrammetry image taken during one of six follow-up moments until the age of six, were considered for this study. Operation characteristics, postoperative complications, re-interventions, and presence of intracranial hypertension were collected. To assess cranial growth, orthogonal cranial slices and 3D photocephalometric measurements were extracted automatically and evaluated from 3D photogrammetry images.

RESULTS: A total of 322 postoperative 3D images from 218 patients were included. After correcting for age and gender, no significant differences were observed in 3D photocephalometric measurements. Mean cranial shapes suggest that postoperative growth and shape gradually normalize with higher OFC and ICV values compared to normal, regardless of type of surgery. Flattening of the vertex seems to persist after surgical correction. Our cranial 3D mesh processing tool has been made publicly available as a part of this study.

CONCLUSION: Our findings suggest that until the age of six, there are no significant differences between the FBR, ESC, and SAC in their ability to correct sagittal synostosis with regard to 3D photocephalometric measurements. Therefore, efforts should be made to ensure early diagnosis so that minimally invasive surgery is still a viable treatment option.