Department of Mechanical Engineering, University College London, London, UK.
Department of Neurosurgery, Radboudumc Nijmegen, Nijmegen, The Netherlands.
Childs Nerv Syst. 2023 Apr;39(4):989-996. doi: 10.1007/s00381-022-05792-1. Epub 2022 Dec 24.
The aim of this study was to investigate the biomechanics of endoscopically assisted strip craniectomy treatment for the management of sagittal craniosynostosis while undergoing three different durations of postoperative helmet therapy using a computational approach.
A previously developed 3D model of a 4-month-old sagittal craniosynostosis patient was used. The strip craniectomy incisions were replicated across the segmented parietal bones. Areas across the calvarial were selected and constrained to represent the helmet placement after surgery. Skull growth was modelled and three variations of helmet therapy were investigated, where the timings of helmet removal alternated between 2, 5, and 8 months after surgery.
The predicted outcomes suggest that the prolonging of helmet placement has perhaps a beneficial impact on the postoperative long-term morphology of the skull. No considerable difference was found on the pattern of contact pressure at the interface of growing intracranial volume and the skull between the considered helmeting durations.
Although the validation of these simulations could not be performed, these simulations showed that the duration of helmet therapy after endoscopically assisted strip craniectomy influenced the cephalic index at 36 months. Further studies require to validate these preliminary findings yet this study can lay the foundations for further studies to advance our fundamental understanding of mechanics of helmet therapy.
本研究旨在通过计算方法研究内镜辅助颅骨切开术治疗矢状缝早闭的生物力学,同时对术后佩戴头盔治疗的三种不同持续时间进行研究。
使用了先前开发的 4 个月大矢状缝早闭患者的三维模型。在分割的顶骨上复制了条状颅骨切开切口。选择了颅骨的多个区域并加以限制,以代表术后头盔的放置位置。模拟了颅骨生长,并研究了三种不同的头盔治疗方式,其中头盔的去除时间分别在术后 2、5 和 8 个月交替。
预测结果表明,延长头盔的佩戴时间可能对术后颅骨的长期形态有有益的影响。在所考虑的头盔佩戴持续时间内,在不断增长的颅内体积与颅骨之间的界面上,接触压力的模式没有明显差异。
尽管这些模拟的验证无法进行,但这些模拟表明,内镜辅助颅骨切开术后头盔治疗的持续时间会影响 36 个月时的头指数。需要进一步的研究来验证这些初步发现,但本研究可以为进一步的研究奠定基础,以推进我们对头盔治疗力学的基本理解。