Individualized Surgical Design For Infants And Young Children With Craniosynostosis Based On MIMICS Software

【Object】In this study,a new minimally invasive surgical method was designed for the treatment of sagittal synostosis and the individualized cranial vault remolding was designed for the treatment of plagiocephaly under the guidance of MIMICS software in children was discussed,which provided a theoretical basis for the individualized surgical design of craniostenosis guided by MIMICS software.【Methods】To collect the patients with craniostenosis who underwent neurosurgery in our hospital from July 2016 to July 2018.Selection criteria:a.The child was definitely diagnosed as sagittal synostosis and plagiocephaly,and had not received any relevant surgical treatment.b.The children with craniofacial syndrome such as Apert syndrome and Crouzon syndrome will be excluded.A plurality of small incisions minimally invasive technique(original)for sagittal synostosis was designed to achieve a pre-designed extensive floating bone flap.Realizing the different kinds of operation method based on the condition of the plagiocephaly patient,such as fronto-orbital reconstruction and cross-rotation of bilateral frontal bone,fronto-orbital advancement and replacement of bone flap,etc.The following surgical objectives should be achieved:1.the skull is basically symmetrical,the cranial vault asymmetry index(CVAI)and anterior cranial vault asymmetry index(ACVAI)are less than or equal to 3.5%.2.After operation,the intracranial volume basically reached the normal level.To collect the patients’s pre-postoperative cranial volume,operation time,age,intraoperative and postoperative bleeding and blood transfusion,length of stay(LOS),complications,appearance recovery in 1 month,3 months,6 months,1 year after operation.The appearance evaluation of sagittal synostosis is mainly performed by cranial index(CI),and the appearance evaluation of plagiocephaly was mainly performed by CVAI,ACVAI.The intracranial volume is calculated by MIMICS software,CI,CVAI,ACVAI will be analyzed.In addition,Abbott’s craniocerebral growth curve was used as a control,and the brain volume obtained from the postoperative patient was analyzed statistically.SAS 9.4software is used for statistical analysis.If the data conform to normal distribution,paired t-test is used for statistical analysis,the Paired t-test would be used for statistical analysis,otherwise,Wilcoxon signed ranks test will be used.【Outcome】From July 2016 to July 2018,18 patients met the inclusion criteria.There were 10 cases of sagittal synostosis and 8 cases of plagiocephaly.These cases of sagittal synostosis and plagiocephaly experienced surgery under the guidance of MIMIMICS operation design software,the appearances of skulls were alleviated,the shortest operation time of sagittal synostosis is 1.5 hours,the shortest hospital stay is 6 days,the blood loss ranged from 130 to 285 mL,postoperative 3-dimensional CT scan showed that the extensive floating bone formed well.The shortest operation time of plagiocephaly is 1.2hours,the shortest hospital stay is 4 days,the blood loss ranged from 70 to 250 mL,postoperative 3-dimensional CT scan showed that the reconstructed bone formed well.Preoperative CI ranged from 64.1 to 69 and postoperatively 69.3 to 74.5,P1=0.003<0.05;For sagittal synostosis,preoperative intracranial volume ranged from 960.2 to 1200cm~3,and ranged from 1058.3 to 1349.3cm~3 postoperatively,P2=0.028<0.05;There was no significant difference in cranial volume between the children have received operation 3 months ago and the normal,P3=0.33>0.05;For plagiocephaly,ACVAI and CVAI were more than 3.5%before operation,and most of them were less than 3.5%after operation,P4=0.008<0.05,P5=0.035<0.05;Preoperative intracranial volume ranged from 744.3 to 1220.9cm~3,and ranged from 867.2 to 1358.1cm~3 postoperatively,P6=0.011<0.05;And there was no significant difference in cranial volume between the children have received operation 3months ago and the norma,P7=0.83>0.05.No serious complications occurred during the follow-up time.All children receive good esthetic results.【Conclusion】The individualized surgical methods have achieved the goal of precise reduction of deformed skull,such as minimal invasive,short operation time and improvement of deformed appearance.CI of children with sagittal synostosis are in the normal range and the cranial volume increased significantly.The following-up showed that there was no significant difference in the cranial volume between normal children and children with craniostenosis.Individualized surgical design for infants and young children craniostenosis based on MIMICS software provides a new choice for patients.