Intracranial Volume in Relation to Parent Satisfaction and Expert Opinion: A Novel Look at Surgical Outcomes

Abstract

Factors like parent satisfaction and expert opinion have been proposed as outcome measures related to craniosynostosis (CS) surgery. However, there is no real tangible score for CS surgery outcomes. In our study, we aimed to explore different factors considered as a tangible outcome measure of CS surgery.

Methods: A retrospective cohort study of 23 patients with CS who were operated on in a tertiary care university hospital. Parents were interviewed to assess their satisfaction of aesthetic outcome. This was correlated to two expert opinions and to the amount of skull expansion.

Results: The mean follow-up duration was 2.24 ± 1.12 years. Twelve of the 23 fathers were satisfied, whereas 11 of the 23 mothers were satisfied. The overall combined satisfaction rate of both parents was on the higher side with no difference in between. There was a significant association between expansion rate of 7.65 ± 4.99% and the overall parent's satisfaction (P = 0.002). Additionally, there was a good correlation between both experts with statistically significant association (P = 0.004). No correlation was found between the parents' satisfaction and the experts' opinions.

Conclusions: The study is valuable, as it investigates the relationship between the expansion rate, parents' satisfaction, and expert opinion as predicted values of craniosynostosis surgery. The overall satisfaction correlated significantly well with the expansion rate. However, such numerical assessment is not a real guide for assessing clinical outcomes' as no association was found between expansion rate, satisfaction rate, and expert opinion.

Fig. 1.

Photographs of patient 1 that were presented to the experts for their opinion on the results. The assessment of this patient showed that both the mother and father were satisfied, whereas expert 1 scored Whitaker’s scale with value of 1 and expert 2 scored Whitaker’s scale with value of 1. A: Preoperative top view. B: Preoperative side view. C: Top view of the patient's head on 2 years follow up assessment point. D: Side view of the patient’s head at 2-year follow-up assessment.

Fig. 2.

Photographs of patient 2 that were pre presented to the experts for their opinion on the results in which the assessment of this patient showed that both the mother and father were satisfied . Expert 1 scored Whitaker’s scale with value of 4 and expert 2 scored Whitaker’s scale with value of 4. A, Preoperative top view. B, Preoperative side view. C, Top view of the patient's head on 2 years follow-up assessment point. D, Side view of the patient's head on 2 years follow-up assessment point.

Fig. 3.

Steps in the calculation process of the intracranial volume from patient head CT scans. A, ImagJ/FIJI application settings used in the calculation process. B, The bone surface area being highlighted in red after utilizing the thresholding feature in ImagJ/FIJI application. C, The isolated intracranial area as selected in ImagJ/FIJI application.