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Quantitative Assessment of Shape Deformation of Regional Cranial Bone for Evaluation of Surgical Effect in Patients with Craniosynostosis

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Quantitative Assessment of Shape Deformation of Regional Cranial Bone for Evaluation of Surgical Effect in Patients with Craniosynostosis applied sciences Article Quantitative Assessment of Shape Deformation of Regional Cranial Bone for Evaluation of Surgical Effect in Patients with Craniosynostosis Min Jin Lee 1, Helen Hong 1,* and Kyu Won Shim 2,* 1 Department of Software Convergence, College of Interdisciplinary Studies for Emerging Industries, Seoul Women’s University, 621 Hwarang-ro, Nowon-gu, Seoul 01797, Korea; [email protected] 2 Department of Pediatric Neurosurgery, Craniofacial Reforming and Reconstruction Clinic, Yonsei University College of Medicine, Severance Children’s Hospital, 50 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea * Correspondence: [email protected] (H.H.); [email protected] (K.W.S.) Abstract: Surgery in patients with craniosynostosis is a common treatment to correct the deformed skull shape, and it is necessary to verify the surgical effect of correction on the regional cranial bone. We propose a quantification method for evaluating surgical effects on regional cranial bones by comparing preoperative and postoperative skull shapes. To divide preoperative and postoper- ative skulls into two frontal bones, two parietal bones, and the occipital bone, and to estimate the shape deformation of regional cranial bones between the preoperative and postoperative skulls, an age-matched mean-normal skull surface model already divided into five bones is deformed into a preoperative skull, and a deformed mean-normal skull surface model is redeformed into a postoperative skull. To quantify the degree of the expansion and reduction of regional cranial bones after surgery, expansion and reduction indices of the five cranial bones are calculated using the Citation: Lee, M.J.; Hong, H.; Shim, deformable registration as deformation information. The proposed quantification method overcomes K.W. Quantitative Assessment of the quantification difficulty when using the traditional cephalic index(CI) by analyzing regional Shape Deformation of Regional cranial bones and provides useful information for quantifying the surgical effects of craniosynostosis Cranial Bone for Evaluation of patients with symmetric and asymmetric deformities. Surgical Effect in Patients with Craniosynostosis. Appl. Sci. 2021, 11, Keywords: quantification; surgical effect; craniosynostosis; regional cranial bone; morphologi- 990. https://doi.org/10.3390/ app11030990 cal changes Academic Editor: Francesco Bianconi Received: 31 December 2020 Accepted: 18 January 2021 1. Introduction Published: 22 January 2021 Craniosynostosis is one of the most common causes of cranial malformations in infants. It is a condition in which one or more cranial sutures becomes prematurely fused, resulting Publisher’s Note: MDPI stays neutral in an abnormal morphology as well as limited brain growth and intracranial hypertension. with regard to jurisdictional claims in Craniosynostosis is classified according to the type of premature fused cranial suture published maps and institutional affil- involved, such as the sagittal, coronal, metopic, or lambdoid types [1]. Figure1 shows iations. the four types of craniosynostosis used in our study, such as the sagittal, bilateral coronal and unilateral coronal, and unilateral lambdoid synotoses. The normal skull in Figure1a shows that all sutures are open, presenting five cranial bones, the left and right frontal bones, the left and right parietal bones, and the occipital bone where the sagittal suture Copyright: © 2021 by the authors. is located between the two parietal bones, the coronal suture is located between the Licensee MDPI, Basel, Switzerland. frontal and parietal bones, and the lambdoid suture is located between the parietal and This article is an open access article occipital bones. Figure1b presents an example of sagittal synostosis, which accounts for distributed under the terms and 40~60% of all cases of craniosynostosis. In this type, premature fusion of the sagittal suture conditions of the Creative Commons causes the skull shape to show biparietal narrowing and elongation, because the lateral Attribution (CC BY) license (https:// growth of the skull is restricted and its anteroposterior growth continues. As shown in creativecommons.org/licenses/by/ Figure1c , bilateral coronal synostosis accounts for 5~10% of all cases of craniosynostosis, 4.0/). Appl. Sci. 2021, 11, 990. https://doi.org/10.3390/app11030990 https://www.mdpi.com/journal/applsci Appl. Sci. 2021, 11, x FOR PEER REVIEW 2 of 12 Appl. Sci. 2021, 11, 990 2 of 12 shown in Figure 1c, bilateral coronal synostosis accounts for 5~10% of all cases of cranio- synostosis, with premature fusion of both coronal sutures causing the shape of the skull towith be prematurebroad, high, fusion and short. of both Unilateral coronal suturescoronal causing synostosis, the shapeshown of in the Figure skull 1d, to beaccounts broad, forhigh, 20~25% and short. of all Unilateral cases of craniosynostosis, coronal synostosis, and shown premature in Figure fusion1d, accountsof one side for the 20~25% coronal of sutureall cases flattens of craniosynostosis, the forehead toward and premature one side fusion and causes of one it side to theprotrude coronal on suture the opposite flattens side.the forehead Figure 1e toward presents one an side example and causesof unilat iteral to protrude lambdoid on synostosis, the opposite which side. accounts Figure for1e 0~5%presents of all an cases example of craniosynostosis, of unilateral lambdoid with synostosis,premature whichfusion accountsof one side for 0~5%of the oflambdoid all cases sutureof craniosynostosis, flattening the withback prematureof the skull fusionon one of side one and side causing of the lambdoidit to protrude suture on flatteningthe oppo- the back of the skull on one side and causing it to protrude on the opposite side. site side. (a) (b) (c) (d) (e) Figure 1. VolumeVolume rendering images of normal skull ( firstfirst row) and skulls of four four types types of of craniosynostosis craniosynostosis patients ( second to fifth fifth rows:: sagittal, bilateral coronal, unilateral coronal, coronal, and and unilambdoid unilambdoid synsotoses). synsotoses). ( (aa)) Front Front view, view, ( (bb)) back back view, view, ( (cc)) top view, (d) right view, (e) left view. (LFB: left frontal bone, RFB: right frontal bone, LPB: left parietal bone, RPB: right top view, (d) right view, (e) left view. (LFB: left frontal bone, RFB: right frontal bone, LPB: left parietal bone, RPB: right parietal bone, OB: occipital bone). parietal bone, OB: occipital bone). AnalyzingAnalyzing the surgical effectseffects ofof craniosynostosis craniosynostosis requires requires a quantitativea quantitative assessment assessment of ofthe the morphological morphological changes changes in the in the skull skull before before and afterand after the surgery, the surgery, but it but is still it is performed still per- formedby a clinician’s by a clinician’s visual inspection visual inspection of the overall of the headoverall shape head or shape by measuring or by measuring the cephalic the cephalicindex (CI) index [2,3] (CI) and [2,3] cranial and vault cranial asymmetry vault asymmetry index (CVAI) index [4 ,(CVAI)5]. The CI[4,5]. is usually The CI calculatedis usually calculatedas the ratio as of the the ratio maximum of the maximum width of the width skull of dividedthe skull by divided the maximum by the maximum length from length the top view of the volume as rendered by a 3D CT, and is commonly used as a severity index Appl. Sci. 2021, 11, 990 3 of 12 for sagittal and bilateral coronal cases characterized by a symmetric shape. However, it is difficult to determine the maximum skull width and length consistently, since the location of the most prominent points seen from the top view depends on the skull shape of synostosis [6,7]. The CVAI is calculated by dividing the difference between two diagonal cranial diameters, 30 degrees from the Y-axis, by the short cranial diagonal diameter and multiplying by 100 in the cross-sectional plane at level 3. The level 3 is one-third of the distance from the reference plane including nasion and both tragion to the vertex. The CVAI is used as a severity index for unilateral coronal and unilateral lambdoid cases characterized by an asymmetric shape. However, it is difficult to reflect the deformation, in which case the position of the prominent area is different from the position of the estimated diagonal diameter with 30 degrees from the Y-axis. Recently, several methods by which to make quantitative assessments of the surgical effects of craniosynostosis have been suggested. Tenhagen [8] et al. compared the measure- ments for nine patients with sagittal synostosis before and after surgery in 3D scan datasets, which measures the cephalic index, head circumference length passing through glabella and occipital prominence, sagittal length over the head from the nasion in the sagittal plane, coronal width over the head from the left to the right tragion in the coronal plane, and head volume above the Frankfort horizontal plane. Liaw [9] et al. compared head volumes divided into six regions for 98 normal subjects and 30 patients with sagittal synostosis before and after surgery in 3D scan datasets. A skull is divided into three areas through two planes, passing through the pituitary fossa and rotating at two angles (84 degrees clockwise on the anterior axis and 31 degrees clockwise on the posterior axis), with the final six areas defined by dividing the mid-sagittal plane. Weathers [10] et al. compared the measurements for two patients with metopic synostosis before and after
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