Wood Jeyhan S, Purzycki Adam, Thompson Jim, David Lisa R, Argenta Louis C
*Division of Plastic Surgery, University of North Carolina, Chapel Hill, Chapel Hill †Department of Plastic & Reconstructive Surgery, Wake Forest Baptist Health, Winston-Salem, NC.
J Craniofac Surg. 2015 May;26(3):616-9. doi: 10.1097/SCS.0000000000001573.
Le Fort III osteotomy is commonly used in the surgical correction of midface hypoplasia, specifically in patients with syndromic craniosynostosis. These osteotomies can be associated with significant complications, which are often the result of incomplete or inaccurate osteotomies. Brainlab, a technology first developed for neurosurgery, has been applied to numerous surgical subspecialties. The aim of this study was to report our initial experience using the Brainlab VectorVision2 and Brainlab Curve (Brainlab, Westchester, IL) as an intraoperative guidance system for osteotomy placement during Le Fort III advancement. Three pediatric patients with syndromic craniosynostosis and midface hypoplasia scheduled to undergo Le Fort III advancement were scanned preoperatively with 0.6-mm computed tomography cuts, which were then uploaded to the Brainlab system. All surgeries commenced with rigid fixation of the Brainlab registration device to the patient's skull. The navigation system was used intraoperatively to accurately determine osteotomy sites and trajectories. External distractors were placed without complication. Mean length of surgery was 331 minutes, and mean estimated blood loss was 500 mL. No transfusion was required with a mean postoperative hemoglobin of 8.3 g/dL. The application of Brainlab technology to Le Fort III advancement proved useful in establishing precise osteotomy lines and trajectories. Looking forward, this technology could be applied to a minimal dissection technique in order to avoid extensive blood loss. Further study would be needed to determine possible benefits such as reduced complications or operative time when using an intraoperative navigation system for image-guided osteotomy placement during Le Fort III advancement.
勒福Ⅲ型截骨术常用于中面部发育不全的手术矫正，特别是患有综合征性颅缝早闭的患者。这些截骨术可能会伴有严重并发症，这往往是截骨不完整或不准确所致。Brainlab是一项最初为神经外科手术开发的技术，已应用于众多外科亚专业。本研究的目的是报告我们使用Brainlab VectorVision2和Brainlab Curve（Brainlab，伊利诺伊州韦斯特切斯特）作为术中引导系统在勒福Ⅲ型前移术中放置截骨术的初步经验。三名计划接受勒福Ⅲ型前移术的患有综合征性颅缝早闭和中面部发育不全的儿科患者术前进行了0.6毫米层厚的计算机断层扫描，然后将扫描数据上传至Brainlab系统。所有手术均从将Brainlab注册设备牢固固定在患者颅骨上开始。术中使用导航系统准确确定截骨部位和轨迹。外置牵引器放置顺利，无并发症。平均手术时间为331分钟，平均估计失血量为500毫升。术后平均血红蛋白为8.3 g/dL，无需输血。将Brainlab技术应用于勒福Ⅲ型前移术被证明有助于确定精确的截骨线和轨迹。展望未来，该技术可应用于微创解剖技术，以避免大量失血。还需要进一步研究以确定在勒福Ⅲ型前移术中使用术中导航系统进行图像引导截骨术放置时可能带来的益处，如减少并发症或缩短手术时间。
