Introducing a new method for classifying skull shape abnormalities related to craniosynostosis

Otto D M Kronig,Mariëlle Jippes,Jifke F Veenland,Henri A Vrooman,Sophia A J Kronig,Terence Boen,Léon N A Van Adrichem

doi:10.1007/s00431-020-03643-2

Abstract

We present a novel technique for classification of skull deformities due to most common craniosynostosis. We included 5 children of every group of the common craniosynostoses (scaphocephaly, brachycephaly, trigonocephaly, and right- and left-sided anterior plagiocephaly) and additionally 5 controls. Our outline-based classification method is described, using the software programs OsiriX, MeVisLab, and Matlab. These programs were used to identify chosen landmarks (porion and exocanthion), create a base plane and a plane at 4 cm, segment outlines, and plot resulting graphs. We measured repeatability and reproducibility, and mean curves of groups were analyzed. All raters achieved excellent intraclass correlation scores (0.994–1.000) and interclass correlation scores (0.989–1.000) for identifying the external landmarks. Controls, scaphocephaly, trigonocephaly, and brachycephaly all have the peak of the forehead in the middle of the curve (180°). In contrary, in anterior plagiocephaly, the peak is shifted (to the left of graph in right-sided and vice versa). Additionally, controls, scaphocephaly, and trigonocephaly have a high peak of the forehead; scaphocephaly has the lowest troughs; in brachycephaly, the width/frontal peak ratio has the highest value with a low frontal peak.Conclusion: We introduced a preliminary study showing an objective and reproducible methodology using CT scans for the analysis of craniosynostosis and potential application of our method to 3D photogrammetry.What is Known:• Diagnosis of craniosynostosis is relatively simple; however, classification of craniosynostosis is difficult and current techniques are not widely applicable.What is New:• We introduce a novel technique for classification of skull deformities due to craniosynostosis, an objective and reproducible methodology using CT scans resulting in characteristic curves. The method is applicable to all 3D-surface rendering techniques.• Using external landmarks and curve analysis, specific and characteristic curves for every type of craniosynostosis related to the specific skull deformities are found.

Highlights

In normal skull development, the cranial sutures allow the brain to expand as the infant matures
We introduce a novel technique for classification of skull deformities due to craniosynostosis, an objective and reproducible methodology using CT
The method is applicable to all 3D-surface rendering techniques

Summary

Introduction

The cranial sutures allow the brain to expand as the infant matures. One or more sutures have prematurely fused to form a solid bone connection, resulting in a restriction of expansion of the cranial vault, normal growth of the brain, and deformation of the calvaria [1]. Craniosynostosis is usually diagnosed upon clinical judgment (medical history and physical examination, including anthropometry) and is confirmed by radiographic imaging. Classification of skull shape deformities is essential and could allow for type and severity to be classified and may aid in clinical as well as research

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