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Management of Total Frontal Bone Loss After Surgery for Craniosynostosis: The Modified Visor Bone Flap With Brain
Alyssa B Valenti1,2, Paul Asadourian2, Sergio Guadix3
1Department of Surgery, Division of Plastic Surgery, Columbia University Medical Centeragb, New York, NY, USA.
Insights
Virtual surgery planning (VSP) enables patient-specific autologous bone reconstruction for pediatric frontal bone loss. This innovative technique improves safety and efficiency, achieving significant clinical improvement and re-ossification.
Area of Science:
- Neurosurgery
- Pediatric Plastic Surgery
- Biomedical Engineering
Background:
- Craniosynostosis surgery complications range from 11-36%, often due to poor soft tissue coverage and infection risk.
- Autologous cranioplasty is preferred in pediatric patients over synthetic options due to growth potential and better outcomes.
- Complex reconstructions are necessary for bone loss resulting from infection or osteomyelitis.
Purpose of the Study:
- To present a novel surgical approach for near total bifrontal bone loss in a pediatric patient using virtual surgery planning (VSP).
- To demonstrate the feasibility of creating patient-specific autologous bone grafts for extensive cranial defects.
- To propose a treatment algorithm for pediatric frontal bone loss unsuitable for alloplastic implants.
Main Methods:
- Utilized virtual surgery planning (VSP) and computer-assisted design/manufacturing (CAD/CAM) for a patient-specific autologous solution.
- Calculated cranial bone surface area to determine optimal graft configuration for maximal coverage.
- Planned and executed a Modified Visor Bone Flap with Posterior Brain Cage reconstruction using available cranial bone struts.
Main Results:
- Achieved near complete re-ossification of the cranial vault with significant clinical improvement in an 18-month-old female.
- Demonstrated successful reconstruction of total frontal bone loss using the VSP-guided autologous technique.
- 3D reconstructions confirmed the efficacy of the surgical approach before and after intervention.
Conclusions:
- Virtual surgery planning significantly enhances the safety and efficiency of complex autologous cranial bone reconstructions.
- This technique offers a viable solution for extensive frontal bone loss in young children where alloplastic materials are contraindicated.
- The study proposes a valuable treatment algorithm for managing severe pediatric cranial defects.
Abstract:
Complications after craniosynostosis surgery occur in 11% to 36% of cases and may be precipitated by poor soft tissue coverage and concomitant exposure of non-sterile regions; sequelae may result in infection, osteomyelitis, and bone loss requiring complex reconstruction. In the pediatric population, autologous cranioplasty remains the gold standard due to growth potential and a more favorable complication profile than synthetic cranioplasty. Virtual surgery planning (VSP) and computer-assisted design (CAD)/computer-assisted manufacturing (CAM) technology can be utilized to create innovative, patient-specific autologous solutions, similar to the approach with synthetic cranioplasty. A novel surgical approach using VSP was used for an 18-month-old female with near total bifrontal bone loss. Surface area measurements were used to determine the amount of bone available to replace the infected frontal bone. VSP was utilized to determine the most efficient construct configuration possible to achieve maximal coverage via calculation of cranial bone surface area measurements. Surgical reconstruction of the defect was planned as a Modified Visor Bone Flap with Posterior Brain Cage. A construct was fashioned from available cranial bone struts to obtain widespread coverage. 3D Recon images from before and after surgery demonstrate almost complete re-ossification of the cranial vault with significant resulting clinical improvement. Reconstruction of total frontal bone loss is possible by utilizing this technique. VSP can improve the safety and efficiency of complex autologous cranial bone reconstructions. We propose a treatment algorithm to address the problem of near total frontal bone loss in young children for whom alloplastic implants are not suitable.
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