Development of a Novel Forehead Templating Technique for Surgical Correction of Craniosynostosis

INTRODUCTION AND OBJECTIVES: Craniosynostosis presents with abnormal cranial morphology and is often managed with open cranial vault remodeling. The inherently subjective nature of intraoperative bone reshaping can result in suboptimal aesthetics. The forehead, in particular, poses a significant challenge due to its high visibility. Yet, standardized surgical templates to guide reconstruction are not widely available. This study aims to develop a computed tomography (CT)-based forehead template to optimize outcomes. MATERIALS AND METHODS: Computed tomography (CT) imaging was collected from 9-month-old individuals. Poor quality scans and those with forehead pathology were excluded. Employing Advanced Neuroimaging Tools software, a composite skull template was generated from the included CT data sets utilizing key craniometric parameters, such as interparietal distance, forehead depth, and radix-to-forehead breakpoint length. Optimal sample size was determined based on craniometric measurement stability. The final template was manually segmented to isolate the frontal bone. RESULTS: A total of 154 CT scans were obtained. Of these, 100 were excluded due to underlying pathology and 28 due to incomplete or poor-quality imaging, leaving 26 for analysis. Mean age was 9.43 months. Across images, craniometric measurement differences were <2 mm, indicating high forehead image stability using 19 scans. The final 9-month guidance template was generated from this cohort. CONCLUSION: A reliable guidance template representing the average 9-month-old infant's forehead was successfully created utilizing computer-aided design. The high reproducibility of these results confirms the robustness of the methodology. The template can be used to achieve consistent, improved aesthetic outcomes while decreasing surgical times and complications.