CranioRate Metopic Craniosynostosis Severity Score is Not Associated with Intra- or Post-Operative Outcomes

Authors

• Caroline E. Baker, Pediatric Research Operations - Corewell Health West
• Rachel S. Lee, Michigan State University College of Human Medicine Medical Student
• Victoria Vespa, Michigan State University College of Human Medicine Medical Student
• O Parker Martienz, Plastic Surgery Resident - Corewell Health West
• Abigail Teitelbaum, General Surgery Resident - Corewell Health East
• Kongrit Chaiyasate, Plastic Surgery - Corewell Health East
• John A. Girotto, Plastic Surgery - Corewell Health West
• Anna R. Carlson, Pediatrics - Craniofacial Surgery - Corewell Health West

Document Type

Conference Proceeding - Restricted Access

Publication Date

5-8-2026

Abstract

Metopic craniosynostosis (CS), early fusion of the metopic suture, can lead to cranial dysmorphology and potential neurodevelopmental sequelae if left uncorrected. Predicting adverse perioperative outcomes aids in surgical planning and tempering caregiver expectations. CranioRate is a novel machine learning tool which uses computed tomography (CT) scans to objectively grade severity of metopic CS. This study aims to evaluate the relationship between CranioRate-determined severity of metopic CS and intra- and post-operative outcomes.

A retrospective cohort study was conducted on patients who underwent cranial vault reconstruction (CVR) for non-syndromic metopic CS between 2012-2024. Of the 93 patients identified, 13 were excluded for CT incompatibility with CranioRate. Patient demographics, intraoperative and postoperative outcomes, and preoperative CT scans were collected from the electronic medical record. Deidentified CTs were uploaded to CranioRate to generate metopic severity scores (MSS). MSS is given from 0-10 with 0 representing least severity relative to peers and 10 representing maximal severity. Univariable and multivariable analyses were conducted in R. Continuous variables are non-normal and presented as median [interquartile range].

Patients were 3.8 months [1.7-7.0] old at CT diagnosis and 5.7 months [4.8-10.5] at CVR. Patients were primarily male (77.5%). MSS was a median of 6.24 [3.8-7.2] for the cohort. Follow-up time was 3.5 [1.1-5.1] years. Procedural breakdown was 79.6% fronto-orbital advancement, 11.1% metopic strip craniectomy with orthotic molding, and 9.3% metopic strip craniectomy and spring placement. MSS was not associated with intraoperative blood loss volume, intraoperative transfusion, operative time, length of hospital stay, incidence of complications, reoperation, or helmet time (all p≥0.08). Severity was associated with anesthesia time on univariate (p=0.04) but not multivariable analysis (p=0.29). Age was inversely related to severity (p=0.01), and procedure type showed no association (p=0.40).

CranioRate's MSS was not associated with intra- or post-operative metrics or procedure type (FOA, strip craniectomy, or strip craniectomy with springs). The inverse relationship between age and MSS suggests earlier caregiver and provider recognition of the dysmorphology in more severe cases. MSS is a useful tool for describing metopic CS anatomy to families but does not reflect increased risk for adverse outcomes, validating efficacy and equity in CS surgery. Of note, 75% of our patient population is outside the recommended age range for the current CranioRate algorithym.

Recommended Citation

Baker CE, Lee RS, Vespa V, Martienz OP, Teitelbaum A, Chaiyasate K, Girotto JA, Carlson AR. CranioRate metopic craniosynostosis severity score is not associated with intra- or post-operative outcomes. Presented at: Research Day Corewell Health West; 2026 May 8; Grand Rapids, MI.

Comments

2026 Research Day Corewell Health West, Grand Rapids, MI, May 8, 2026. Abstract 2085