Renier H-cranioplasty Modifies Skull Shape More Than Total Vault Remodeling in Nonsyndromic Scaphocephaly: Artificial Intelligence–based Study
Steeven Bibas, Quentin Hennocq, Nicolas Kogane, Thomas Bongibault, Ludovic Bénichou, Olivier Lienhard, Eric Arnaud, Giovanna Paternoster, Nicolas Garcelon, Roman Hossein KhonsariBackground:
Scaphocephaly, the most common single-suture craniosynostosis, results from premature sagittal suture closure. Surgery aims to restore normal skull morphology and prevent raised intracranial pressure. We used artificial intelligence–based methods to assess craniofacial morphology in patients with nonsyndromic scaphocephaly, comparing pre- and postoperative 2-dimensional (2D) facial photographs with controls to evaluate the outcomes of 2 age-specific techniques and identify the key morphological parameters.
Methods:
We analyzed a database of 1369 patients (1979–2023) using 1544 2D frontal and lateral photographs, including 358 patients with scaphocephaly—130 treated with Renier H-cranioplasty and 119 with total vault remodeling (TVR). Our approach combined automatic facial landmark detection, point–cloud superimposition, geometric morphometrics, texture analysis, classification algorithms, and generation of synthetic patient faces. Patients treated with Renier H-cranioplasty were compared with those treated with TVR.
Results:
Significant morphological differences were found between patients with scaphocephaly and controls, both before and after surgery. Postoperatively, patients retained a distinguishable craniofacial phenotype, indicating that surgery did not fully normalize the skull shape. Early Renier H-cranioplasty reduced the anteroposterior diameter more effectively than late TVR. Both techniques had limited impact on posterior cranial vault morphology.
Conclusions:
Artificial intelligence–based analysis of 2D facial photographs provided valuable insights into diagnosis and surgical morphological outcomes in scaphocephaly. Postoperatively, patients maintained a nonnormalized phenotype, with early correction yielding better results than late remodeling. Further studies are needed to correlate these shape modifications with intracranial pressure values.