Stereolithographic skull models in the surgical planning of fronto-supraorbital bar advancement for non-syndromic trigonocephaly

摘要

Background Fronto-supraorbital bar advancement in the treatment for trigonocephaly is associated with extensive intraoperative blood loss and compensatory erythrocyte transfusions. Since both are related to the length of surgery, efforts have been focused on optimizing preoperative preparations. The utilization of three-dimensional skull models in surgical planning allows for familiarization with the patient's anatomy, the optimization of osteotomies, the preparation of bone grafts and the selection of fixation plates. Methods Stereolithographic skull models were used in the surgical planning for five patients with non-syndromic trigonocephaly treated in Wilhelmina Children's Hospital in 2012. A comparison group was composed of six patients with non-syndromic trigonocephaly treated by the same surgical team. Once all patients had received surgery, a retrospective chart review was performed to identify the volumes of perioperative blood loss and erythrocyte transfusions and the length of the procedure. Furthermore, the educational value of the models was assessed in a round table discussion with the surgical team and residents. Results In the model group patients were transfused a mean 24 ml/kg (27% of Estimated Blood Volume [EBV]) compared to 16 ml/kg (18% of EBV) in the comparison group (P = 0.359) for a mean perioperative blood loss of 53 ml/kg (60% of EBV) in the model group against 40 ml/kg (41% of EBV) in the comparison group (P = 0.792). The mean length of surgery in the model groups was 256 min versus 252 min in the comparison group (P = 0.995). Evaluation of educational purposes demonstrated that the models had a role in the instruction of residents and communication to parents, but did not improve the insight of experienced surgeons. Conclusion The usage of stereolithographic skull models in the treatment of non-syndromic trigonocephaly does not reduce the mean volume of perioperative erythrocyte transfusions, the mean volume of perioperative blood loss nor the mean length of the surgical procedure. Nonetheless, the models do facilitate the education of the patient's parents as well as support the training of residents.