Quantitative and Qualitative Assessment of Morphology in Sagittal Synostosis: Mid-Sagittal Vector Analysis
Abstract
Consensus remains lacking regarding the optimal surgical treatment modality for sagittal synostosis. There is, however, wide agreement that objective analytical methods are required to demonstrate the characteristic morphology of the condition and to substantiate the benefits of specified surgical techniques. Simple calculated anthropomorphic indices, such as the cranial index, are commonly used but fail to provide satisfactory representation of morphology, which is far more complex than can be represented by its simple length-width ratio. Techniques to provide more comprehensive, yet practical, assessment of morphology are needed for analytic purposes. Herein, we introduce vector analysis as an objective, computed tomography (CT)-based morphometric technique for assessment of cranial morphology; this work represents the first application of the technique mid-sagittal vector analysis (MSVA). MSVA is a single plane application that was devised to address dysmorphology in sagittal synostosis. It was our hypothesis that MSVA would quantitatively and qualitatively depict preoperative morphology and postoperative correction in specific regions. Sixteen patients undergoing cranial reshaping surgery for sagittal synostosis were included in the study. All patients underwent routine preoperative and 1 year postoperative CT scans, from which the MSVA was derived. MSVA is a radial vector analysis in which distances to the cranial surface are measured from a single reference point origin in the sagittal plane. Preoperative morphology, characterized by respective vectors, was analyzed in three regions: the frontal, vertex, and occipital regions. Comparison with postoperative paired data was conducted for each patient. The analysis of postoperative change demonstrated (1) decrease in prominence in the frontal and occipital regions, (2) increase in height and forward translation of the vertex, and (3) ability to distinguish and qualify frontal versus occipital bossing and correction thereof. We conclude that the longitudinal differences associated with scaphocephaly are well characterized and differentiated by MSVA. Quantitative and qualitative assessment identifies three relevant regions affected by the condition and its treatment: the frontal, vertex, and occipital regions. The transverse dimension is not addressed in this single plane analysis; a more comprehensive application will require additional planes of analysis and the development of a normative database.
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Marcus et al. (2006) introduced Mid-Sagittal Vector Analysis as a CT-based morphometric technique that quantified preoperative deformity and postoperative correction in sagittal craniosynostosis.
“Marcus et al. introduced Mid-Sagittal Vector Analysis (MSVA) as a CT-based morphometric technique to assess cranial morphology in sagittal craniosynostosis in 2006.”
From Developments in diagnostic and surgical techniques in children with sagittal suture craniosynostosis: a systematic review spanning the last 30 years (2025) · cites this paper as [28]
Marcus et al. analysed pre- and postoperative CT scans of 16 patients and identified three key affected regions: frontal, vertex, and occipital.
“Pre- and postoperative CT scans of 16 patients were analysed, identifying three key affected regions: frontal, vertex, and occipital.”
From Developments in diagnostic and surgical techniques in children with sagittal suture craniosynostosis: a systematic review spanning the last 30 years (2025) · cites this paper as [28]
Marcus et al. emphasized that the CI is a relative measure that cannot differentiate between frontal and occipital bossing or quantify deformity severity.
“Marcus et al. have emphasised already in 2006 in their study that the CI is a relative measure that cannot differentiate between frontal and occipital bossing or quantify deformity severity.”
From Developments in diagnostic and surgical techniques in children with sagittal suture craniosynostosis: a systematic review spanning the last 30 years (2025) · cites this paper as [28]
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Evaluation Tools for Craniosynostosis
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- Authors
- Marcus, J. R., Stokes, T. H., Mukundan, S., & Forrest, C. R.
- Affiliations
- Duke University (US)
- University of Toronto (CA)
- Corresponding author
- Forrest, Christopher R.
- Venue
- Journal of Craniofacial Surgery
- Published
- 2006-07
- Volume
- 17
- Issue
- 4
- Pages
- 680-686
- ISSN
- 1049-2275 (ISSN-L)
- OpenAlex
- W1966739961
- Cited by
- 50
- References
- 32
- Citations by year
- 2026: 1 · 2025: 3 · 2024: 3 · 2023: 5 · 2022: 5 · 2021: 1 · 2020: 1 · 2019: 2 · 2018: 2 · 2017: 4 · 2016: 3 · 2015: 4 · 2014: 2 · 2013: 3 · 2012: 2
- FWCI
- 0.57
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Craniofacial Surgery (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Craniofacial Disorders and Treatments
- Health Sciences › Medicine › Surgery › Pectus Deformity Diagnosis and Treatment
- Health Sciences › Medicine › Surgery › Scoliosis diagnosis and treatment
- Keywords
- sagittal synostosis, craniosynostosis, skull morphology, scaphocephaly, frontal bossing, cranial index, postoperative correction
- MeSH terms
- Cephalometry, Child, Preschool, Cranial Sutures, Craniosynostoses, Craniotomy, Follow-Up Studies, Forecasting, Frontal Bone, Humans, Infant, Longitudinal Studies, Nasal Bone, Occipital Bone, Parietal Bone, Sella Turcica, Tomography, X-Ray Computed, Treatment Outcome
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