Volumetric Analysis and Photo Scoring of Metopic Craniosynostosis: Attempting to Overcome the Subjective Criteria in Selection for Surgery and in Evaluation of Results.

BACKGROUND: The treatment of trigonocephalies remains controversial. Key questions involve the indications for surgery, as well as its optimal timing, the most effective surgical tools, the best surgical technique, and the ideal type of plates for fixation.

OBJECTIVE: This study aimed to identify surgical and patient-related factors influencing aesthetic satisfaction, evaluated using the Whitaker and ERN Cranio Photoscore indices. The secondary objective was to evaluate the intracranial volume increase in relation to functional outcomes.

RESULTS: Forty-eight patients were included. The mean preoperative Oi angle was 97.3 degrees, and preoperative intracranial volume averaged 904.4 cm3, increasing to 1244.2 cm3 postoperatively; when compared with the control group, the majority of operated children had lower volumes before surgery that normalized afterward; preoperatively, younger children had lower volumes. Piezosurgery required no heterologous bone grafts, in contrast to other tools. At postoperative MRI scans in 22 patients, no signs of increased ICP were detected. Eight cases with developmental delays, but none had clinical signs of increased ICP. The photo score evaluated preoperative severity of deformities and cosmetic outcomes: frontal wedging and biparietal widening were corrected in all, hypotelorism in 45/48 and improved in 3, while temporal hallowing remained or reappeared in 10/48, none deserving secondary correction up to now, due to progressive spontaneous improvement.

CONCLUSIONS: This study highlights the impact of open cranioplasty on aesthetic correction and volume normalization, with low complications and no need for reoperations. The ERN Cranio photo score, here applied for self-revaluation, may, in the future, become an objective tool if extended to cooperative studies.