Cranial morphology in 3-dimensional laser scans before and after open craniectomy for scaphocephaly

Scaphocephaly occurs by premature synostosis of the sagittal suture and makes up 40% of all craniosynostoses. With various operative techniques available, the indication for surgery is mainly aesthetic, and the evaluation of postoperative results can vary severely. This study presents a modified open, butterfly-shaped craniectomy for the surgical correction of scaphocephaly. The cranial morphology before and after the surgery is assessed using 3-dimensional laser scans. We retrieved the clinical data of 41 patients operated on at our institution between 2012 and 2022. Pre- and postoperative 3-dimensional laser scans at the ages of 4.7 (preoperative), 8.5 (follow-up 1), and 13.5 months (follow-up 2) were compared to measure the effect of butterfly-shaped craniectomy on cranial morphology during infancy. Median age at surgery was 5.2 months. At follow-up 1, the cephalic ratio (CR) was significantly increased (p < 0.0001). While the skull continued to grow, the CR did not differ between follow-ups 1 and 2. Additionally, the anterior-posterior volume ratio (APVR), calculated by the ratio of the sum of the 2 two frontal quadrants over the sum of the 2 two posterior quadrants of a skull's volume, reduced significantly at both follow-ups. 3-dimensional head scans offer a feasible, radiation-free tool to assess postoperative cranial morphology after surgical correction of scaphocephaly. Butterfly-shaped craniectomy leads to a significant decrease of the CR during the first 3 months after the surgery, while corrective potential seems to be limited to this time frame postoperatively. The APVR may be a useful tool to indicate a shift of volume distribution from the frontal to the posterior cranial vault during the follow-up of these patients.