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Updated: Mar 22, 2026
Midface Hypoplasia and Cranial Base Morphology in Syndromic Craniosynostosis: A Comparative Analysis Study Using a Predictive Regression Model
Published on: November 4, 2025
A new quantitative image-based method for evaluation of bony temporal hollowing in metopic synostosis
Linn Hagmarker1, Madiha Bhatti Söfteland2, Giovanni Maltese2
1a Department of Radiation Physics , Institute for Clinical Sciences, Sahlgrenska Academy, Göteborg University, Sahlgrenska University Hospital , Göteborg , Sweden.
Insights
This study introduces a new computer tool for objectively measuring temporal hollowing after cranioplasty surgery for metopic synostosis. The tool provides quantitative data to assess surgical outcomes, improving upon subjective assessments.
Area of Science:
- Craniofacial Surgery
- Medical Imaging Analysis
- Pediatric Neurosurgery
Background:
- Premature craniosynostosis requires surgical correction (cranioplasty) in infants.
- Temporal hollowing is a common, undesirable outcome post-cranioplasty for metopic synostosis.
- Current assessment of temporal hollowing relies on subjective judgment.
Purpose of the Study:
- To develop a quantitative, semi-automatic computer tool.
- To objectively measure bony temporal hollowing after cranioplasty.
- To provide a more accurate assessment of surgical results for metopic synostosis.
Main Methods:
- Utilized MATLAB for image segmentation of computed tomography (CT) scans.
- Defined outermost cranial contours and limited images dorsally.
- Compared patient contours to sex- and age-matched controls to calculate temporal hollowing.
Main Results:
- Demonstrated good reliability with intra-user coefficient of variation (CV) at 5.0% and inter-user CV at 3.0%.
- Successfully applied the tool in a clinical setting with 14 pediatric patients.
- Evaluated outcomes for both spring-assisted cranioplasty and bone graft techniques.
Conclusions:
- Presents a novel tool for objective measurement of temporal hollowing.
- Offers a quantitative method to evaluate surgical success in cranioplasty for metopic synostosis.
- Aims to improve functional and cosmetic outcomes by providing objective data.
Objective:
Premature craniosynostosis is a congenital disorder causing a skull deformity. For both functional and cosmetic reasons, the deformity is surgically treated with a cranioplasty before the age of 1 year. Temporal hollowing is a common and undesirable remaining deformity after cranioplasty for metopic synostosis. The most common method to determine the degree of temporal hollowing is subjective judgement of the temporal region. The aim of the present project was to develop a quantitative semi-automatic computer tool for objective measurement of bony temporal hollowing.
Methods:
Using MATLAB, a tool was developed to segment computed tomography images, defining the outermost contour. The images were dorsally limited to the widest point of the head. In each case, a sex- and age-matched control was identified and the contours compared. The bony temporal hollowing of the cases was calculated.
Results:
The intra-user coefficient of variation (CV) was 5.0% (95% CI = 4.2%-6.2%) and the inter-user CV was 3.0% (95% CI = 2.1%-8.6%). For clinical testing purposes, the tool was used in 14 patients, seven of whom had been operated on with a spring-assisted cranioplasty and seven with a cranioplasty using a bone graft.
Conclusions:
In summary, this study presents a new tool for objective measurement of the surgical result after cranioplasty for metopic synostosis.
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