Renier H-cranioplasty Modifies Skull Shape More Than Total Vault Remodeling in Nonsyndromic Scaphocephaly: Artificial
Steeven Bibas1,2, Quentin Hennocq1,2, Nicolas Kogane1,2,3,4
1From the Craniofacial Growth and Form, Imagine Institute, Paris, France.
Background:
Scaphocephaly, the most common single-suture craniosynostosis, results from premature sagittal suture closure. Surgery aims to restore normal skull morphology and prevent raised intracranial pressure. We used artificial intelligence-based methods to assess craniofacial morphology in patients with nonsyndromic scaphocephaly, comparing pre- and postoperative 2-dimensional (2D) facial photographs with controls to evaluate the outcomes of 2 age-specific techniques and identify the key morphological parameters.
Methods:
We analyzed a database of 1369 patients (1979-2023) using 1544 2D frontal and lateral photographs, including 358 patients with scaphocephaly-130 treated with Renier H-cranioplasty and 119 with total vault remodeling (TVR). Our approach combined automatic facial landmark detection, point-cloud superimposition, geometric morphometrics, texture analysis, classification algorithms, and generation of synthetic patient faces. Patients treated with Renier H-cranioplasty were compared with those treated with TVR.
Results:
Significant morphological differences were found between patients with scaphocephaly and controls, both before and after surgery. Postoperatively, patients retained a distinguishable craniofacial phenotype, indicating that surgery did not fully normalize the skull shape. Early Renier H-cranioplasty reduced the anteroposterior diameter more effectively than late TVR. Both techniques had limited impact on posterior cranial vault morphology.
Conclusions:
Artificial intelligence-based analysis of 2D facial photographs provided valuable insights into diagnosis and surgical morphological outcomes in scaphocephaly. Postoperatively, patients maintained a nonnormalized phenotype, with early correction yielding better results than late remodeling. Further studies are needed to correlate these shape modifications with intracranial pressure values.
