Zhong Shuting, Huang Gary J, Susarla Srinivas M, Swanson Edward W, Huang Judy, Gordon Chad R
*The University of Illinois College of Medicine, Rockford, Illinois; ‡Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; §Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Neurosurgery. 2015 Jun;11 Suppl 2:220-9; discussion 229. doi: 10.1227/NEU.0000000000000679.
The development of computer-assisted design, virtual modeling, and computed tomography has allowed precise customization of implants for patients who undergo neurosurgical or craniofacial surgery procedures. However, such techniques and implant designs have not adequately addressed temporal asymmetry due to postoperative bone resorption, temporalis muscle malposition/foreshortening, and/or temporal fat pad atrophy.
We hypothesized that an alteration in customized craniofacial implant (CCI) design with a strategic extension inferolaterally and excessive material bulking would provide simultaneous reconstruction of coexisting temporal skull defects and therefore reduce the effect of soft tissue deformities.
A single-surgeon, single-institution retrospective cohort study was performed to include 10 consecutive subjects who underwent cranioplasty reconstruction with modified implants during a 3-year period. Implants were placed with the use of our previously described pericranial-onlay technique. With the use of a computed tomography-based, computer-assisted design/manufacturing methodology, novel dual-purpose implants were designed to prevent and/or correct persistent temporal hollowing. The efficacy of the new CCI shape and design for cranial restoration of temporal symmetry was analyzed in both 2 and 3 dimensions.
In 2-dimensional analyses, the modified implant provided enhanced lateral projection (21%; 1.06 cm(3)) in areas closest to the temporal arch. Three-dimensional volumetric analyses demonstrated that additional bulking totaled 24 ± 11 cm(3) (range, 9-43 cm), which essentially replaced 40 ± 13.7% (range, 26%-60%) of the absent temporal volume contributing to persistent temporal hollowing.
Computer-designed, dual-purpose CCIs can be safely created with unprecedented shape to prevent and/or eradicate postoperative temporal deformity.
计算机辅助设计、虚拟建模和计算机断层扫描技术的发展，使得为接受神经外科或颅面外科手术的患者精确定制植入物成为可能。然而，由于术后骨吸收、颞肌位置异常/缩短和/或颞脂肪垫萎缩，这些技术和植入物设计尚未充分解决颞部不对称问题。
我们假设，通过向外侧下进行策略性延伸和增加材料体积来改变定制颅面植入物（CCI）的设计，能够同时修复并存的颞骨颅骨缺损，从而减少软组织畸形的影响。
进行了一项单医生、单机构的回顾性队列研究，纳入了在3年期间连续接受改良植入物颅骨成形术重建的10名受试者。植入物采用我们之前描述的帽状腱膜下铺置技术放置。利用基于计算机断层扫描的计算机辅助设计/制造方法，设计了新型两用植入物，以预防和/或纠正持续性颞部凹陷。从二维和三维角度分析了新型CCI形状和设计对颞部对称性颅骨修复的疗效。
在二维分析中，改良植入物在最靠近颞弓的区域提供了增强的外侧投影（21%；1.06 cm³）。三维体积分析表明，额外增加的体积总计24±11 cm³（范围为9 - 43 cm），基本上替代了导致持续性颞部凹陷的缺失颞部体积的40±13.7%（范围为26% - 60%）。
通过计算机设计的两用CCI能够安全制造出前所未有的形状，以预防和/或消除术后颞部畸形。
