Understanding the influence of surgical parameters on craniofacial surgery outcomes: a computational study

He, K. H.; Bruse, J. L.; Rodriguez-Florez, N.; Dunaway, D.; Jeelani, O.; Schievano, S.; Borghi, A.

Abstract

Sagittal craniosynostosis (SC) is a congenital condition whereby the newborn skull develops abnormally owing to the premature ossification of the sagittal suture. Spring-assisted cranioplasty (SAC) is a minimally invasive surgical technique to treat SC, where metallic distractors are used to reshape the newborn’s head. Although safe and effective, SAC outcomes remain uncertain owing to the limited understanding of skull−distractor interaction and the limited information provided by the analysis of single surgical cases. In this work, an SC population-averaged skull model was created and used to simulate spring insertion by means of the finite-element analysis using a previously developed modelling framework. Surgical parameters were varied to assess the effect of osteotomy and spring positioning, as well as distractor combinations, on the final skull dimensions. Simulation trends were compared with retrospective measurements from clinical imaging (X-ray and three-dimensional photogrammetry scans). It was found that the on-table post-implantation head shape change is more sensitive to spring stiffness than to the other surgical parameters. However, the overall end-of-treatment head shape is more sensitive to spring positioning and osteotomy size parameters. The results of this work suggest that SAC surgical planning should be performed in view of long-term results, rather than immediate on-table reshaping outcomes.

Citation

He, K. H., Bruse, J. L., Rodriguez-Florez, N., Dunaway, D., Jeelani, O., Schievano, S., & Borghi, A. (2024). Understanding the influence of surgical parameters on craniofacial surgery outcomes: a computational study. Royal Society Open Science, 11(4), Article 231158. https://doi.org/10.1098/rsos.231158

• Journal Article Type: Article
• Acceptance Date: Jan 29, 2024
• Online Publication Date: Apr 3, 2024
• Publication Date: 2024-04
• Deposit Date: Apr 22, 2024
• Publicly Available Date: Apr 22, 2024
• Journal: Royal Society Open Science
• Publisher: The Royal Society
• Peer Reviewed: Peer Reviewed
• Volume: 11
• Issue: 4
• Article Number: 231158
• DOI: https://doi.org/10.1098/rsos.231158
• Keywords: craniosynostosis, craniofacial surgery, design of experiments, pre-operative planning, finite-element modelling
• Public URL: https://durham-repository.worktribe.com/output/2378521