Dura-based automated vault expansion remodelling (DAVE-R): automated planning of volume expansion in fronto-orbital advancement for trigonocephaly

IF 1.3 4区医学 Q4 CLINICAL NEUROLOGY Child's Nervous System Pub Date : 2024-09-18 DOI:10.1007/s00381-024-06608-0

A. Dapaah, C. Duncan, C. Parks, A. Sinha, A. Hennedige, D. Richardson, V. N. Vakharia

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Abstract

Cranial vault remodelling for craniosynostosis aims to increase intracranial volume to facilitate brain growth, avoid the development of raised intracranial pressure and address cosmesis. The extent of vault expansion is predominantly limited by scalp closure and reconstruction technique. Virtual surgical planning tools have been developed to predict post-operative changes and guide expansion. We present a validation study of a novel ‘Dura-based Automated Vault Expansion-Remodeling’ (DAVE-R) model to guide pre-operative planning for fronto-orbital advancement and remodelling (FOAR).

Methods

Patients with trigonocephaly who underwent FOAR with pre- and post-operative imaging from 2018 to 2020 were identified from a prospectively maintained database. Post-operative scans, normative atlas and whole brain parcellation were registered to the pre-operative images to quantify the change in intracranial volume and morphology (utilising measurement of fronto-orbital advancement and bifrontozygomatic distance) compared to that predicted by the DAVE-R model.

Results

Ten patients were included. The DAVE-R model predicted bifrontozygomatic distances of 92.0 + / − 5.14 mm (mean + /SD), which closely matched the post-operative results of 92.7 + / − 6.02 mm (mean + / − SD); (t(d.f. 9) = -0.306, p = 0.77). The fronto-orbital advancement predicted by the DAVE-R method was 11.5 + / − 1.96 mm (mean + / − SD) which was significantly greater than 8.6 + / − 2.94 mm (mean ± SD); (t(d.f. 9) = 3.137, p = 0.01) achieved post-operatively.

Conclusions

We demonstrate that the DAVE-R model provides an objective means of extracting realistic surgical goals in patients undergoing FOAR for trigonocephaly that closely correlates with post-operative outcomes. The normative dural model warrants further study and validation for other forms of craniosynostosis correction.

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基于硬脑膜的自动穹隆扩张重塑（DAVE-R）：自动规划三头颅畸形前眶推进术的体积扩张

摘要颅骨发育不良的颅顶重塑旨在增加颅内容积，以促进大脑发育，避免颅内压升高，并改善外观。颅顶扩张的范围主要受头皮闭合和重建技术的限制。目前已开发出虚拟手术规划工具来预测术后变化并指导扩容。我们介绍了一项新颖的 "基于硬脑膜的自动穹隆扩张-重塑"（DAVE-R）模型的验证研究，该模型用于指导前眶推进和重塑（FOAR）的术前规划。方法从一个前瞻性维护的数据库中识别出2018年至2020年期间接受FOAR手术并进行术前和术后成像的三头颅患者。将术后扫描、标准地图册和全脑配型登记到术前图像上，以量化颅内体积和形态（利用测量前眶前移和双颧距离）与 DAVE-R 模型预测值相比的变化。DAVE-R 模型预测的双颧距离为 92.0 + / - 5.14 mm（平均 + / SD），与术后结果 92.7 + / - 6.02 mm（平均 + / - SD）非常吻合；（t(d.f. 9) = -0.306，p = 0.77）。DAVE-R方法预测的前眶前移量为11.5 + / - 1.96 mm（平均值 + / - SD），明显大于术后达到的8.6 + / - 2.94 mm（平均值 ± SD）；（t（d.f. 9）= 3.137，p = 0.01）。对于其他形式的颅畸形矫正，硬脑膜规范模型值得进一步研究和验证。

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来源期刊

Child's Nervous System 医学-临床神经学

CiteScore

3.00

自引率

7.10%

发文量

322

审稿时长

3 months

期刊介绍： The journal has been expanded to encompass all aspects of pediatric neurosciences concerning the developmental and acquired abnormalities of the nervous system and its coverings, functional disorders, epilepsy, spasticity, basic and clinical neuro-oncology, rehabilitation and trauma. Global pediatric neurosurgery is an additional field of interest that will be considered for publication in the journal.