Page 188 - Demo

186Chapter11CASE1-PART2Unfortunately2yearslatertheheadachecomplaintsofthisboystartedagainandelevatedICPwasmeasuredBasedonanewCT-scancranialvolumeandcircumferenceshoweda+1standarddeviationfromnormalYetwhentheCTscanwascomparedtotheCT-scanfrom2yearsearlier,thecranialgrowthinthisintervalseemed tobelimitedInorder toprovidesufficient volumeandreduceICP,asecondOCVRwasperformedwherewasaimedtoenlargethecranialvolumewithatleast15ÊSE2The second case was a 7 months old boy that suffered from trigonocephaly Becausethepatientwasolderthan6monthsEACSwasnotanoptionandanOCVRwasindicated Thepre-opCTscanshowedamoderate-severetrigonocephalywithaprominentmetopicridge Thereforeanopenreconstructionwithafronto-orbitaladvancementwasplannedandperformedattheageof12monthsMETHODS3DreconstructionswerecreatedusingMaxilim(V230MedicimNV,MechelenBelgium)basedonaCT-scan(slicethickness05mmsliceincrement05mmAquilionONEToshibaTochigiJapan)InavirtualenvironmenttheVSPwasdesignedandvariousscenariosweretested(Blender3Dv279theBlenderfoundationAmsterdamtheNetherlands)Figures23and7showthe VSPofcase1-part1case1-part2andcase2respectivelyIncase1-part1the VSPwasconvertedtomultiplemeasurementsthatindicatethedistancefromaclearanatomicallandmarktoanessentialpointintheplanning(egthecornersofanosteotomyline)(Figure1)Duringsurgerythesemeasurements and aruler wereused to demarcate the 3Dplanning on thepatientFor case1- part 2 and case 2 surgical guides for the demarcation and reconstructionwerecreatedin3DStudioMax(AutodeskSanRafaelCAUSA)and3Dprintedusingselectivelaser-sintering(KLSMartingroup TuttlingenGermany)