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Evaluationofopencranialvaultsurgery18511INTRODUCTIONOpencranialvaultreconstruction(OCVR)isamajorsurgicalprocedurewithimportantmorbiditythatcanbeperformedinmanydifferentwaysInChapter4weextensivelydescribedhowapre-operative(pre-op)threedimensional(3D)virtualsurgicalplanning(VSP)couldassiststhesurgicalteamduringthiscomplexandchallengingprocedureInshort VSPprovidesthepossibilitytoexploreOCVRprior tosurgerybysimulatingand visualizingin3D theeffectofdifferentscenariosTheoptimalpositionoftheosteotomiescanbeplannedandunnecessaryorinadequateosteotomiescanbeavoided ThereforeVSPmakesitpossibletofindthebestsurgicalstrategyforeveryindividualpatientMoreover,aproperpre-opplanwithoverallconsensusofthesurgicalteamwillmakethesurgeryitselfmorefluentandfaster1–3However,thequestionremainshowaccuratetheVSPcanberealizedduringsurgeryBecauseeachVSPistailoredforindividualpatientsthebestevaluationmethodistodirectlycomparethesurgicaloutcomewiththeVSP.Thereforeapost-operative(post-op)computedtomography(CT)scanwasacquiredforseveralpatientsthatallowedustocriticallyreviewandassessoursurgicalresultand VSP. Thishashelpedus toimproveourplanningstrategy transfermethodandsurgicalprocedure ThisreportevaluatestwoillustrativecasesdividedoverthreesurgeriesandelucidateswhatwehavelearnedfromthesecasesCASESERIESCASE1-PART1In2012a3monthsoldboysufferingfromscaphocephalyunderwentendoscopicallyassistedcraniosynostosissurgery(EACS)Helmettherapywasinitiatedaftersurgeryandwhentheboyturned1aniceroundandwidecranialshape with a CI of70 wasrealizedHowever, 3 yearslater theboy started to developheadachesAfterextensivecounsellinganintracranialpressure(ICP)monitoringdevicerevealedelevatedpressureAnOCVRwasperformedbasedona VSPattheage of 4 years Theprimary aim was to enlarge cranial volumeBecause therelativelyoldageofthispatientcouldpossiblelimittheosteosynthesisthesecondaryaimwastopreventlargegapsbetweenthereconstructedbonesegments(Figure2)
