The Application Of Computer-assisted Three-dimensional Digital Technique In The Diagnoses And Management Of Congenital Craniosynostosis

Objective:Based on the three-dimensional digital technique, new three-dimensional measurement parameters and method were proposed. The referential classification criteria which can quantitative diagnose the disease were presented based on the measurement of the shape of the infant’s cranial vault and the development of the brain. To enhance the quality and safety of the operation, we do the surgery simulation to predict the effect and choose surgical procedure. Three-dimensional measurement should also be required after the operation and follow-up in order to provide evaluating indexes. Computer-assisted three-dimensional digital technique was applied to do the diagnoses, three-dimensional measurements, surgery simulation and a series of response evaluations, which related to craniofacial and mental development.Methods:The patients in our study were treated in the Department of Maxillofacial Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Science and Peking Union Medical College from2010to2013. The patients were under the treatment of bilateral or unilateral fronto-orbital bone flap advancement and frontal bone flap reconstruction. Three-dimensional measurement, computer-aided design, surgical simulation and the valuation of the management of congenital craniosynostosis were done with the ProPlan software of Materialise company. Based on the traditional cranial vault asymmetry index (CVAI), anterior cranial vault asymmetry index (ACVAI) and posterior cranial vault asymmetry index(PCVAI) were proposed to evaluate surgical outcomes. Cranial cavity volume was also be calculated with the computer in order to valuate the functional effect. A modified Binet Test was used to estimate the intelligence of the infants to clarify the developmental and functional status.Results:All the patients were gained satisfied treatment. With the computer-aided design, the operating time was reduced and blood loss was decreased. Significant differences were found in terms of cranial asymmetry and cranial cavity volume between pre-operation and post-operation (Wilcoxon test,p<0.5), whereas, the p (CVAI)=0.128>0.05, which means it is not precise enough to valuate the cranial image. ACVAI and PCVAI can objectively reflect the asymmetry of the cranial vault variation. The cranial cavity volumes of all the patients were corrected approximate to the normal extent. Two patients of our team were proved approximately to the normal children in terms of cranial cavity and intelligence. Conclusion:Computer-assisted three-dimensional technique is of great significance in the diagnoses and management of congenital craniosynostosis. Computer-aided design and planning provided valuable reference for the clinical surgery. The three-dimensional measurements can best reflect the outcome of the surgical procedure. One of the values that we modified were ACVAI and PCVAI, which can describe the anterior and posterior cranial vault asymmetry separately. Frontal-orbital bone advancement can correct the cranial cavity volume and promote the development of the brain.