Long Term Morphometric Outcomes in Patients with Untreated Craniosynostosis
Elizabeth G. Zellner, MD1, Sultan Al-Shaqsi, MD2, Christopher R. Forrest, MD3, John Phillips, MD3.
1Westchester Medical Center, Valhalla, NY, USA, 2University of Toronto, Toronto, ON, USA, 3Hospital for Sick Children, Toronto, ON, Canada.
BACKGROUND: Patients with craniosynostosis have abnormal head shapes compared to normal infants. There is minimal information in the literature to indicate how the cranial deformity changes with time. The purpose of this study was to characterize changes in cranial morphology with age in unrepaired craniosynostosis.
METHODS: All patients identified with craniosynostosis at the Hospital for Sick Children between 2008 and 2017 who did not undergo subsequent surgery and had at least two 3dMD photographs at different time points were included in the study. 3D images were analyzed using Mirror3D and Vectra software to calculate cranial volume, cranial index and cranial height. Images were scaled for growth and compared to normative skulls. 2D measurements of area under the curve (AUC) were calculated for each patient's frontal profile. A 3D skull mesh created with a simplifying decimation algorithm was also used to calculate a curvature analysis.
RESULTS: 26 patients met inclusion criteria (mean age 25 months, SD 24 months; 9 females, 17 males; 14 sagittal, 8 metopic, 2 unicoronal, 2 bicoronal). 18 patients had the first scan under 12 months of age. Skull volume revealed no significant difference in trajectory in study patients vs normal controls (p < 0.01). Cranial index was also stable over time, with consistent scores among specific types of craniosynostosis. The slope of change over time was not statistically different from 0 (slope < -0.002, Pr>|t|>0.15). Even when patients presented early, the slope of change in CI was still indistinguishable from 0 over the first 12 months of life. Regarding frontal morphology, there was no significant increase of area under the curve(AUC) over time in patients with craniosynostosis (p < 0.05). Using the 3D mesh analaysis, no worsening of the skull shape from the normal database was noted for the patients with craniosynostosis.
CONCLUSIONS: The skull deformity in patients with craniosynostosis does not appear to worsen over time. Volume change is consistent with normal controls and CI remains stable over time. Anterior AUC and 3D curvature analyses also remain stable. This data set represents the largest analysis of unrepaired craniosynostosis in the literature and supports the hypothesis that cranial morphology is stable over time in unrepaired craniosynostosis.
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