Personalized Optimal Planning for the Surgical Correction of Metopic Craniosynostosis

Abstract

We introduce a quantitative and automated method for personalized cranial shape remodeling via fronto-orbital advancement surgery. This paper builds on an objective method for automatic quantification of malformations caused by metopic craniosynostosis in children and presents a framework for personalized interventional planning. First, skull malformations are objectively quantified using a statistical atlas of normal cranial shapes. Then, we propose a method based on poly-rigid image registration that takes into account both the clinical protocol for fronto-orbital advancement and the physical constraints in the skull to plan the creation of the optimal post-surgical shape. Our automated surgical planning technique aims to minimize cranial malformations. The method was used to calculate the optimal shape for 11 infants with age 3.8±3.0 month old presenting metopic craniosynostosis and cranial malformations. The post-surgical cranial shape provided for each patient presented a significant average malformation reduction of 49% in the frontal cranial bones, and achieved shapes whose malformations were within healthy ranges. To our knowledge, this is the first work that presents an automatic framework for an objective and personalized surgical planning for craniosynostosis treatment.

Keywords: Craniosynostosis; fronto-orbital advancement; image registration; interventional planning.

Fig. 1

Metopic craniosynostosis and fronto-orbital advancement. (a) Axial plane view of the CT image on one patient with metopic craniosynostosis. White arrows show major areas with malformations. The orange arrow shows ridging on the fused metopic suture. (b) Cranial volume of the patient in (a) extracted from CT, together with its closest normal shape (green) estimated as in [4]. The coronal sutures are delineated in blue and the fused metopic suture is shown in red. (c) Representation of the personalized optimal shape to target during a frontoorbital advancement intervention, where the left (LF) and right frontal (RF) bones are advanced forward with respect to the left (LP) and right parietal (RP) bones.

Fig. 2

Surgical planning. (a) Lateral (top) and axial (bottom) views of the malformations (color coded) estimated on one patient’s skull shape, together with its closest normal shape (white wireframe). (b) Suggested cut lines (red) based on coronal and metopic sutures segmentation, together with the optimal position for the frontal bones computed with the proposed method, shown as a wireframe. (c) Malformations estimated on the optimal post-surgical shape, together with its closest normal shape (white wireframe).