Article thumbnail

Objective Three-Dimensional Analysis of Cranial Morphology

By Jeffrey R Marcus, Leahthan F Domeshek, Rajesh Das, Sean Marshall, Roger Nightingale, Tracey H Stokes and Srinivasan Mukundan


Objective: The lack of adequate means to objectively characterize cranial shape contributes to ongoing controversies in the surgical management of craniosynostosis. Cranial shape analysis must address relevant clinical questions objectively and thoroughly and must be broadly applicable across the spectrum of normal and abnormal. Herein, we demonstrate and statistically validate an automated computed tomography (CT)-based application for 3-dimensional characterization of skull morphology. The technology is intended for application to diagnostic imaging, surgical planning, and outcomes assessment. Methods: Three-dimensional vector analysis (3DVA) was applied to craniofacial CT data, generating three-dimensional cranial surface point clouds. Validation: To assess accuracy, measurements derived from the 3DVA analysis of a CT scan of a skull phantom were compared to those made directly from the Digital Imaging and Communications in Medicine data on a Vitrea workstation. To assess reproducibility, 3 readers independently analyzed human head CT scans using 3DVA. Application: A normative database of 86 age-incremental pediatric patients was created. Preoperative craniosynostosis case datasets were analyzed using 3DVA and were compared with age-matched normative datasets. Results: Accuracy and reproducibility of less than 1% mean error and less than 0.5 mm standard error in all cases validated 3DVA-derived distances. Three-dimensional vector analysis point clouds provide qualitative and quantitative representations of morphology. Regional dysmorphology in craniosynostosis cases is demonstrated graphically. Conclusions: Three-dimensional vector analysis generated accurate, reproducible, and comprehensive craniofacial morphometric data. 3DVA may be used for paired data analysis (eg, a single subject undergoing surgical correction), comparative group data analysis, and craniofacial data archiving. The technique can provide objective characterization of craniofacial morphology previously not possible

Topics: Article
Publisher: Open Science Company, LLC
OAI identifier:
Provided by: PubMed Central

To submit an update or takedown request for this paper, please submit an Update/Correction/Removal Request.

Suggested articles


  1. (1992). Anthropometric growth study of the head. Cleft Palate Craniofac J.
  2. Clinical outcome of the modified pi-plasty procedure for sagittal synostosis.
  3. (1995). Correction of scaphocephaly secondary to ventricular shunting procedures. Plast Reconstr Surg.
  4. Cranial vault growth in craniosynostosis.
  5. (1952). HaasLL.Roentgenologicalskullmeasurementsandtheirdiagnosticapplications.AmJRoentgenolRadium Ther Nucl Med.
  6. (1999). Sagittal craniosynostosis outcome assessment for two methods and timings of intervention. Plast Reconstr Surg.
  7. (1988). Sagittal synostosis–its clinical significance and the results of three different methods of craniectomy. Childs Nerv Syst.
  8. Sagittal synostosis: quantitative assessment of presenting deformity and surgical results based on CT scans. Plast Reconstr Surg.
  9. (2001). Sagittal synostosis: results of surgical treatment in 210 patients. Childs Nerv Syst.
  10. (2007). SchmelzerRE,PerlynCA,KaneAA,PilgramTK,GovierD,MarshJL.Identifyingreproduciblepatternsof calvarial dysmorphology in nonsyndromic sagittal craniosynostosis may affect operative intervention and outcomes assessment. Plast Reconstr Surg.
  11. (2003). Spring-mediated cranioplasty compared with the modified pi-plasty for sagittal synostosis. Scand J Plast Reconstr Surg Hand Surg.
  12. (1990). Stedman’s Medical Dictionary. 25th ed.
  13. (1997). Surgical management of sagittal synostosis: a comparative analysis of strip craniectomy and calvarial vault remodeling. Pediatr Neurosurg.
  14. Tables of cranial and orbital measurements, cranial volume, and derived indexes in males and females from 7 days to 20 years of age.
  15. (2001). The reversal exchange technique of total calvarial reconstruction for sagittal synostosis. Plast Reconstr Surg.
  16. (1992). WaitzmanAA,PosnickJC,ArmstrongDC,PronGE.Craniofacialskeletalmeasurementsbasedoncomputed tomography: part I. Accuracy and reproducibility.
  17. (1992). WaitzmanAA,PosnickJC,ArmstrongDC,PronGE.Craniofacialskeletalmeasurementsbasedoncomputed tomography: part II. Normal values and growth trends. Cleft Palate Craniofac J.