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Generaldiscussionandfutureperspectives20312PART2–PLANNINGVIRTUALSURGICALPLANNINGIMPROVEMENTSInChapter4weconsideredsevenbenefitsofusingavirtualsurgicalplanning(VSP)foropencranialvaultreconstruction(OCVR)ofcraniosynostosispatientsSomebenefits are confirmedin theliterature which states thatitleads to a simpler,saferandmoreefficientworkflow9–11However,VSPisnot(yet)standardcareinmostcenters Animportantreason for thisis thatexperiencedsurgeonsareable toachievesatisfactoryresultswithout VSPandthereforetheadditionalpre-surgicaltimeandinvestmentin3DplanningtechnologydonotoutweighthebenefitsRegrettablyitisimpossibletoproperlyassessthesuccessoftherealizedclinicaloutcomeifthereisnopreoperativeplanavailableforcomparisonThismakesclaimsaboutaestheticaloutcomesrathersubjectiveandalsomakesitdifficultforourgroup topresentconvincingevidence Wecanhowever,shareourexperiencethatcomparingthepost-opCTscantothe VSPhashelpedourteamsignificantlytoimproveboththeplanningandthesurgeryitself(Chapter11) ThisillustratesthecoherencebetweenplanningandevaluationHowever,animportantdrawbackofthecurrentplanningprocessisthatitisdoneinaratherconventionalwayOnlyasinglesurgicalapproachcanbesimulatedatonetimeandthereisnopossibilitytodynamicallyadjusta(virtual)osteotomyafterthe(virtual)reconstructionhasbeenmade ThismakesvirtualplanningtimeconsumingandsomewhatcumbersomeIffutureupdatesallowdynamicallyadjustableosteotomiesdifferentsurgicalstrategiescouldbeevaluatedand testedfasterThismakesreal-timebackwardplanningpossible(benefit4inChapter4)andwillresultinfastervirtualplanningandmorecreativityduringtheplanningprocessAnotherlimitationofthecurrentworkflowisthatthecalculationofthe(intended)intracranialvolumewhenthebonesegmentsarevirtuallypositionedtotheirnewpositionisverycomplexandtime-consumingTheplanning’sworkflowwouldbesignificantlyimprovedifthiscalculationcouldbeautomatedandimplementedinsuchawaythattheintendedvolumecouldbeshowedinreal-timeduringtheplanningprocessforeveryscenarioormodificationInsummarytheactualimpactofvirtualsurgicalplanningisverydifficulttoquantifybutasdescribedinChapter4ourexperiencewasverypositiveAlthoughadditionalpre-surgicaltimeand3DexpertiseisrequiredforplanningandpreparationforOCVRasforrenaltumorresections(describedinChapter5)