Kung Woon-Man, Wang Yao-Chin, Tzeng I-Shiang, Chen Yu-Te, Lin Muh-Shi
Department of Exercise and Health Promotion, College of Kinesiology and Health, Chinese Culture University, Taipei 11114, Taiwan.
Graduate Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University, Taipei 11031, Taiwan.
Brain Sci. 2021 Mar 27;11(4):428. doi: 10.3390/brainsci11040428.
: Decompressive craniectomy (DC) can be used to augment intracranial space and halt brainstem compromise. However, a widely adopted recommendation for optimal surgical extent of the DC procedure is lacking. In the current study, we utilized three-dimensional (3D) computer-assisted design (CAD) skull models with defect contour elevation for quantitative assessment. : DC was performed for 15 consecutive patients, and 3D CAD models of defective skulls with contour elevations (0-50 mm) were reconstructed using commercial software. Quantitative assessments were conducted in these CAD subjects to analyze the effects of volumetric augmentation when elevating the length of the contour and the skull defect size. The final positive results were mathematically verified using a computerized system for numerical integration with the rectangle method. : Defect areas of the skull CAD models ranged from 55.7-168.8 cm, with a mean of 132.3 ± 29.7 cm. As the contour was elevated outward for 6 mm or above, statistical significance was detected in the volume and the volume-increasing rate, when compared to the results obtained from the regular CAD model. The volume and the volume-increasing rate increased by 3.665 cm, 0.285% ( < 0.001) per 1 mm of contour elevation), and 0.034% ( < 0.001) per 1 cm of increase of defect area, respectively. Moreover, a 1 mm elevation of the contour in Groups 2 (defect area 125-150 cm) and 3 (defect area >150 cm, as a proxy for an extremely large skull defect) was shown to augment the volume and the volume-increasing rate by 1.553 cm, 0.101% ( < 0.001) and 1.126 cm, 0.072% ( < 0.001), respectively, when compared to those in Group 1 (defect area <125 cm). The volumetric augmentation achieved by contour elevation for an extremely large skull defect was smaller than that achieved for a large skull defect. : The 3D CAD skull model contour elevation method can be effectively used to simulate the extent of a space-occupying swollen brain and to quantitatively assess the extent of brainstem protection in terms of volume augmentation and volume-increasing rate following DC. As the tangential diameter (representing the degree of DC) exceeded the plateau value, volumetric augmentation was attenuated. However, an increasing volumetric augmentation was detected before the plateau value was reached.
减压性颅骨切除术（DC）可用于扩大颅内空间并阻止脑干受压。然而，目前缺乏关于DC手术最佳手术范围的广泛采用的建议。在本研究中，我们利用具有缺损轮廓抬高的三维（3D）计算机辅助设计（CAD）颅骨模型进行定量评估。
连续15例患者接受了DC手术，并使用商业软件重建了具有轮廓抬高（0 - 50毫米）的缺损颅骨的3D CAD模型。对这些CAD模型进行定量评估，以分析抬高轮廓长度和颅骨缺损大小时体积增加的效果。最终的阳性结果使用计算机化系统通过矩形法进行数值积分进行数学验证。
颅骨CAD模型的缺损面积范围为55.7 - 168.8平方厘米，平均为132.3±29.7平方厘米。与常规CAD模型的结果相比，当轮廓向外抬高6毫米或以上时，在体积和体积增加率方面检测到统计学显著性。轮廓每抬高1毫米，体积和体积增加率分别增加3.665立方厘米、0.285%（P<0.001），缺损面积每增加1平方厘米，体积增加率增加0.034%（P<0.001）。此外，与第1组（缺损面积<125平方厘米）相比，第2组（缺损面积125 - 150平方厘米）和第3组（缺损面积>150平方厘米，代表极大的颅骨缺损）轮廓每抬高1毫米，体积和体积增加率分别增加1.553立方厘米、0.101%（P<0.001）和1.126立方厘米、0.072%（P<0.001）。极大颅骨缺损通过轮廓抬高实现的体积增加小于大颅骨缺损。
3D CAD颅骨模型轮廓抬高方法可有效用于模拟占位性肿胀脑的范围，并从DC术后体积增加和体积增加率方面定量评估脑干保护范围。当切线直径（代表DC程度）超过平台值时，体积增加减弱。然而，在达到平台值之前检测到体积增加不断增加。
