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Objective Quantification of Surgical Overcorrection and Long-Term Morphologic Changes in Patients with Metopic Craniosynostosis
Justin Beiriger, BSE, Wenzheng Tao, PhD, Lucas Dvoracek, MD, John Smetona, MD, Ross Whitaker, MD, Jesse Goldstein, MD
UPMC
2022-01-12
Presenter: Justin W Beiriger
Affidavit:
The majority of the work on this project represents the original work of the presenting medical student, Justin Beiriger
Director Name: Vu Nguyen
Author Category: Medical Student
Presentation Category: Clinical
Abstract Category: Craniomaxillofacial
Introduction
Surgical correction of metopic craniosynostosis is variable, with many different techniques in practice. Surgical overcorrection has been debated, with techniques ranging from no overcorrection to significant overcorrection of the bandeau anteriorly and temporal regions laterally. The purpose of this study is to objectively quantify the degree of overcorrection using our surgical technique and longitudinal morphological changes.
Methods
Patients with preoperative and postoperative CT scans who underwent fronto-orbital advancement for metopic craniosynostosis were included. Long-term imaging was also included. CranioRate, a novel shape analysis algorithm, was used to quantify the severity of metopic synostosis at each time point; Metopic Severity Score (MSS) measures "metopic-ness" and Cranial Morphology Deviation (CMD) measures cumulative difference from a normal skull.
Results
Fifty-five patients were included, average age at surgery 1.3 years. Twenty patients underwent long-term CT scan at an average of 1.8 years postoperatively. MSS increased postoperatively as a result of overcorrection then regressed to a normal value. CMD decreased past normal postoperatively then improved to a normal value. There was a significant relationship between preoperative MSS and long-term MSS (R2=0.70) but not between preoperative MSS and postoperative MSS (R2=0.01).
Conclusion
MSS and CMD show precise postoperative results that quantify surgical overcorrection and capture the normalization of head shape over time. All patients had statistically similar postoperative metopic severity, but more severe patients had worse long-term severity, which reinforces that the metopic growth potential remains postoperatively following surgery. This novel study demonstrates the quantification of short- and long-term follow-up in metopic patients.
