Page 189 - Demo

Evaluationofopencranialvaultsurgery18711All post-op scans were voxel based aligned on the skull base and the final alignmentwasmanuallycheckedandcorrectedifnecessary Thepost-opscanofcase1-part1wasacquiredtwomonthsaftersurgerythescanofcase1-part2severaldaysaftersurgeryandthescanofcase2wasacquiredtwomonthsaftersurgeryRESULTSANDDISCUSSIONCASE1-PART1Duringsurgerythevariousmeasurementsweremeasuredoutwitharuleronthepatient’scranium Thepost-opCT-scanshowedasignificantvolumeincreaseAzigzagoverthemidlinecreatedfivegroovesthatfittedtogetherandequallydividedthenewlyformedgapsbetweenthebonesegmentsThesizepositionandlengthofthegroovesfollowedtheplanningThisprovedthatwewereabletoaccuratelydemarcatetheVSPonthepatient’sskullandperformedtheosteotomiesHowever,adiscrepancyofthecaudalosteotomyatthebaseofthereconstruction canbenoticed(Figure2) Thisindicates that the demarcation of thehorizontalosteotomylinewaslessaccurateBecausethelaterallengthbetweenthegrooves(thelengthofthegaps)wasmeasuredonthe VSP,itwaspossibletomimicthisduringsurgery ThishelpedtorealizetheaimedlateralextensionThiswasconfirmedbythepost-opscanthatshowedthatthelateraldiameterofthereconstructionmatchedthe VSP.Althoughthepost-opCT-scanindicatesthattheosteotomieswereperformedaccordingtotheplanningtherepositionofthebonesegmentsshowedadiscrepancy Theanglebetweentheleftandrightpartisflattercomparedtotheplanningwhichresultedinaslightlywider,butlowerreconstructionThevertexheightis7mmlowercomparedtotheplanningThisillustratesthedifficultyofreproducingtheexactangulationofbonesegmentsinsurgery