SkullWiz is a computer-aided design program that transforms computer tomographic data of the neurocranium into a mathematical model that can be interactively manipulated to plan craniosynostosis surgery. Proper planning of this type of surgery involves reference to the underlying viscerocranium and to normal neurocranial dimensions, simulation of all basic surgical actions (closed and open osteotomy, translation, rotation, bending, removal, burring), and reference to the mechanical properties of calvarial bone at a given age. With SkullWiz, infinite trials are possible to develop a surgical plan that combines minimal action with maximum morphologic result. In contrast, physical models, e.g., foam milled or stereolitographic, provide just a single (or double, after gluing) opportunity to visualize three-dimensional morphology and simulate a treatment plan, without reference support. Validation of SkullWiz is difficult due to parameter variability. Its assets are therefore graphically exemplified in two common types of nonsyndromatic single-suture craniosynostosis-trigonocephaly and anterior plagiocephaly. SkullWiz is one of the most accurate planning tools currently available for craniosynostosis surgery. Accurate transfer of the planning by aluminium templates results in efficient and precise surgery by avoiding per-operative "chipping and fitting."
Objective: To discuss possible reasons for the synostosis of a coronal suture that was transplanted onto synostosis inducing dura in a scaphocephalic human cranium. Design: Case report. Setting: Supraregional teaching hospital, center for craniofacial anomalies. Patient: A bathmocephalic boy, followed from age 7½ to 26 months. Intervention: Radical synostosectomy, radial osteotomies in the parietal bone with outward fracturing of the barrel staves, and left-sided coronal suture transplantation onto the midline was undertaken at the age of 11 months. Methods: Computer tomography and clinical follow-up. Results: The sutural graft, initially deprived from tensile stress and quickly exposed to the anomalous dura, turned synostotic in one year. Conclusions: Both cell signaling and biomechanical theories on calvarial morphogenesis, sutural development, and synostosis can apply. An animal experiment is recommended to test which hypothesis prevails.
Both cell signaling and biomechanical theories on calvarial morphogenesis, sutural development, and synostosis can apply. An animal experiment is recommended to test which hypothesis prevails.
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