Page 178 - Demo

176Chapter10OCVRgroupandshowedanaturalandappealingsphericalshapeofthecraniumThiscontrastswithLeetalwhoreportedthatEACSresultsinalowervertexheightcomparedtoOCVR7 Thisisaninterestingfindingandalthoughwedidnotmeasureheadheight this couldbe a valuable additional3Dmeasurement710133940whencomparingdifferentsurgicalstrategies(conventionalorminimalinvasive)suchasspring-mediatedcranioplasties354142DuringthefirstmonthsafterEACSthemajoreffectofthegrowthappearstoexpandandenlargethehead(Figure6andFigure7)Afterthesefirst3-6monthsthisexpandingeffectmainlypresentinthecranialwidthreachesitslimitsHowever,thehelmettherapyiscontinuedonaverageuntilaround10monthsaftersurgeryBasedontheresultsitisunsurewhetherthehelmettherapystillbenefitstheoutcomeafterthis3-6monthperiodAsstatedbeforewhenlookingatthegrowthmapsof9-12monthsand12-15monthsgrowthseemstobeanterior-posteriororientedresultinginadeclineofCIaround9-12monthsThiscouldbeduetothestoppingofthehelmettherapyatthattimebutasimilaranterior-posteriorgrowthorientationisseeningrowthmapsofnormalreferencesatthesameage15Thissuggeststhatperhapsthisgrowthpatternresemblesanaturalpre-definedpatternandinsteadofhavingarelapsepatientsmayrathershifttowardsanormalcranialgrowthpatternafterEACSandhelmettherapyItwouldbeinteresting tosee whetherothergroupscouldconfirm these findingsasthismightsuggest thatearlyre-openingofa fusedsuturecouldinvokerestorationofthenormalgrowthpotentialoftheheadOntheotherhandhelmettherapyseemstoincreaseCIregardlessofbeingimplementedbeforeorwithoutsurgeryalthoughthelatterraisesconcernsregardingintracranialpressure3443–45LIMITATIONSAlthough thisstudyused anextensivedatasetit wasnot alwayspossible tocollect3Dphotosontheexacttimepointsduetologistictechnologicalorpatientspecificreasonsandthisresultedinnon-continuousfollow-upFurthermorethelimitedamountof3Dphotosandunequalgenderdistributionwasthereasonwhygenderswerecombinedinthe3DgrowthmapsDuetoourinstitution’spreferencetoperformEACSifpossibledata forOCVRcaseswaslimitedanditwasthereforedifficulttocreatemeaningfullongitudinalgrowthmapsforOCVR