Utility of CT scans in the management of craniosynostosis: a survey of craniofacial units in Australia and New Zealand

Introduction: The aim of this study is to understand current practices in the use of computed tomography (CT) scans in the routine assessment and management of infants and children with craniosynostosis among surgeons in Australia and New Zealand. No consensus exists in the literature about the utility of CT scans in this patient population. Methods: A survey was distributed to craniofacial units across Australia and New Zealand, targeting nine paediatric craniofacial programs and requesting information about the routine use of CT scans in the management of craniosynostosis. Results: The response rate was 49 per cent with the majority (75%) of responding surgeons having more than 10 years of experience in craniofacial surgery. Input from all units was obtained. Ninety-five per cent of surgeons order preoperative CT scans for single-suture craniosynostosis, with the stated indication being confirmation of diagnosis (85%), characterisation of cranial morphology (70%), detection of raised intracranial pressure (65%) and screening for associated anomalies (85%). The majority (85%) of surgeons used standard radiologic protocols. Only 10 per cent of respondents do routine postoperative CT scans. In multiple-suture and syndromic craniosynostosis, the use of routine postoperative CT scans was greater. Access issues were a factor in many units due to rural locations. Conclusion: Routine CT scans are employed in the diagnosis and management of infants and children with craniosynostosis in craniofacial units in Australia and New Zealand. Variability in practice suggests an opportunity for standardisation of protocols. Accessibility to CT scans and ethical issues regarding radiation exposure are an issue in many units.