Abstract
Minimally invasive strip craniectomy is a well-established treatment for sagittal craniosynostosis, however the temporality of change in head shape has not been assessed. In this study, we perform head shape analysis to compare time-series-based clinical outcomes between three different surgical techniques across three academic centers for the treatment of sagittal craniosynostosis. Retrospective, longitudinal 3D images were collected from patients who underwent surgery for the correction of sagittal craniosynostosis for up to 5 years post-operation. The surgical methods studied include spring-assisted craniectomy, narrow-strip craniectomy plus orthotic helmet therapy, and wide-strip craniectomy with biparietal and bitemporal barrel stave wedge osteotomies plus orthotic helmet therapy. Postoperative 3D images were binned into six age groups. Cranial index measurements were calculated on 3D images. 3D whole-head composite images were generated for each procedure to visually represent longitudinal outcomes. The median with interquartile range (IQR) CI measurements at 3-5 years postoperative follow up were 75.9 [73.1-78.6] for spring-assisted, 75.9 [75.4-78.5] for narrow-strip, and 79.4 [76.4-81.9] for wide-strip. The wide-strip CI was significanly different from the spring-assissted and narrow strip groups (p < 0.001). Concerning 3D analysis, spring-assisted patients showed normalization of frontal bossing and skull height compared to age-matched controls, while wide-strip patients showed greater correction of occipital bulleting. Narrow-strip patients had intermediate results between these outcomes. There was no statistically significant regression in longitudinal CI measurements across the three techniques aimed at treating sagittal craniosynostosis. Longitudinal comparison of 3D head shape outcome demonstrated satisfactory correction of scaphocephalic deformity across all three surgical groups.
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