Estimation of the Craniectomy Surface Area by Using Postoperative Images

Area of Science:

• Neurosurgery
• Medical Imaging
• Computational Geometry

Background:

• Decompressive craniectomy (DC) is vital for reducing intracranial pressure from brain swelling.
• Accurate measurement of craniectomy surface area is challenging.
• Quantifying the decompressive effort is essential for evaluating surgical outcomes.

Purpose of the Study:

• To implement and compare three methods for estimating craniectomy surface area.
• To evaluate the accuracy and clinical acceptability of these estimation methods.
• To facilitate further research on the relationship between decompressive effort and craniectomy outcomes.

Main Methods:

• Utilized 118 pairs of preoperative and postoperative brain CT images.
• Estimated surface area using marching cube and quasi-Monte Carlo methods.
• Calculated surface area using a simplified AC method (length × height).

Main Results:

• Estimated surface areas ranged from 9.46 to 205.32 cm², with a median of 134.80 cm².
• Marching cube and quasi-Monte Carlo methods showed high agreement (RMSD: 7.53 cm²).
• The AC method also demonstrated clinically acceptable results compared to the other two methods (RMSD: 12.70–14.45 cm²).

Conclusions:

• Marching cube and quasi-Monte Carlo methods provide comparable surface area estimations.
• The AC method offers a clinically acceptable alternative for estimating craniectomy surface area.
• These findings support further investigation into the decompressive effort and surgical outcomes.