Page 77 - Demo

Virtualplanning754INTRODUCTIONDuring open cranial vault reconstruction (OCVR) the cranial vault of a craniosynostosispatientisdissectedandreconstructedmoreoptimally ThegoalofthisprocedureistoincreasethecranialvolumeandcreateanaestheticallyimprovedcranialshapeSincetherearemanyoptionstodissectandreconstructacranialshapeafittingsurgicalstrategyisfundamentaltoachievethebestsurgicaloutcomeWithvirtualsurgicalplanning(VSP)itbecomespossibletocontemplatethesurgicalstrategybeforetheoperationisperformedBasedonacomputedtomography(CT)scanthebonystructuresofapatient’sskullcanbevisualizedinthreedimensions(3D)Nextosteotomiescanbesimulatedandtheresultingbonesegmentscaninturnvirtuallybepositionedonanewposition ThischapterpresentssevenreasonswhyVSPmakesanessentialcontributiontothetreatmentofOCVR1-SIMULATINGDIFFERENT TREATMENTSTRATEGIESMultiplesurgicalstrategiescanbeexploredtodeterminethebestfittingsolutionforeverypatientForeverytypeofcraniosynostosis(egscaphocephalytrigonocephaly orplagiocephaly) standardized or commonlyusedreconstructionapproachesareknownandthedecisionwhichstrategyisusedismostlybasedonthesubjectivepreferenceofthesurgeon12However,apparentlysmalldifferencesincranialmorphologyamongpatientsmightresultinadifferentoutcomeevenifthesamesurgicalstrategyisused34ThiscanbeillustratedbytheVSPofthreedifferenttrigonocephalypatients(Figure1)ThefrontalbonesofpatientAareconsistentlycurvedinthelateraldirectionaswellasintheupwarddirectionAcommonlyusedmethodofswappingandrotating the frontalsegments willresultinaflatandwideforeheadwithanelegantfitonthe(advanced)orbitalbarYetusingthesamestrategyinpatientBwillresultinthesmallandpointyforeheadsincethecurvatureofthefrontalsegmentsislessconstantinpatientBLikewisetheprominentmetopicridgeofpatientCrequiresanotherapproachtocreateaflatandwideforeheadSimilarlytheoutcomeofasurgicalapproachcanvarysignificantlyforpatientswithunilateralplagiocephalyAbilateraladvancementandreconstructionoftheorbitaeandtheforeheadcanbeusedtoachievesymmetryHowever,inmanycasesanunilateralreconstructionof theorbitalbarsuffices tocreateanadmirable