Validation of an in-silico modelling platform for outcome prediction in spring assisted posterior vault expansion

Deliège, Lara; Misier, Karan Ramdat; Bozkurt, Selim; Breakey, William; James, Greg; Ong, Juling; Dunaway, David; Jeelani, Owase; Schievano, Silvia; Borghi, Alessandro

doi:10.1016/j.clinbiomech.2021.105424

Cited by 7 publications

(15 citation statements)

References 21 publications

(45 reference statements)

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“…The debate on optimising the method of correcting scaphocephaly is still a highly discussed topic within the literature [6,8]. With the advancements in computational modelling approaches, conclusions to such discussions could be addressed [e.g., 18,19]. The method of replicating the calvarial growth and bone formation discussed here was adopted from a previous study [18], presenting a promising method of replicating the impacts that postoperative calvarial healing could have on surgical outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…Material properties of the calvarial bones, the cranial sutures, and the ICV were all defined as linear isotropic and assigned an elastic modulus of 421 MPa, 30 MPa, and 10 MPa, respectively [16][17][18][19][20]. The replicated craniotomies were assigned an elastic modulus of 0.3 MPa, to represent the natural "gaps" made in situ and minimise the level of resistance on the simulated growth [16].…”

Section: Finite Element Model Developmentmentioning

confidence: 99%

“…In short, the level of pressure across the ICV surface was captured and quantified. Parameters to minimise the interpenetration between these surfaces during growth were previously established and described elsewhere [16][17][18][19].…”

Section: Boundary Conditionsmentioning

confidence: 99%

“…Using these detailed FE models, computational algorithms have been used to investigate the management of craniosynostosis. More advanced models have enabled us to accurately simulate the calvarial growth and bone formation under different types of surgical treatment [14][15][16][17][18][19]. Such models have the capability to investigate the biomechanics of craniosynostosis and to simulate the outcomes of various surgical parameters, such as postoperative helmet therapy.…”

Section: Introductionmentioning

confidence: 99%

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A preliminary analysis of replicating the biomechanics of helmet therapy for sagittal craniosynostosis

et al. 2022

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Purpose 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. Methods 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. Results 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. Conclusion 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.

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Section: Discussionmentioning

confidence: 99%

Section: Finite Element Model Developmentmentioning

confidence: 99%

Section: Boundary Conditionsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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A preliminary analysis of replicating the biomechanics of helmet therapy for sagittal craniosynostosis

et al. 2022

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“…Our group produced and validated a finite-element (FE) model based on a population of real patient anatomies that can predict the amount of spring expansion as well as the shape of the head post-expansion [ 11 ] within 5% error. Further validation in a larger cohort [ 12 ] and expansion to different craniofacial procedures [ 13 , 14 ] showed that FE modelling is a robust tool for assessing and predicting the skull response to spring distraction forces and is ready to be used for surgical planning.…”

Section: Introductionmentioning

confidence: 99%

Understanding the influence of surgical parameters on craniofacial surgery outcomes: a computational study

He,

Bruse,

Rodriguez-Florez

et al. 2024

R. Soc. Open Sci.

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Sagittal craniosynostosis (SC) is a congenital condition whereby the newborn skull develops abnormally owing to the premature ossification of the sagittal suture. Spring-assisted cranioplasty (SAC) is a minimally invasive surgical technique to treat SC, where metallic distractors are used to reshape the newborn’s head. Although safe and effective, SAC outcomes remain uncertain owing to the limited understanding of skull−distractor interaction and the limited information provided by the analysis of single surgical cases. In this work, an SC population-averaged skull model was created and used to simulate spring insertion by means of the finite-element analysis using a previously developed modelling framework. Surgical parameters were varied to assess the effect of osteotomy and spring positioning, as well as distractor combinations, on the final skull dimensions. Simulation trends were compared with retrospective measurements from clinical imaging (X-ray and three-dimensional photogrammetry scans). It was found that the on-table post-implantation head shape change is more sensitive to spring stiffness than to the other surgical parameters. However, the overall end-of-treatment head shape is more sensitive to spring positioning and osteotomy size parameters. The results of this work suggest that SAC surgical planning should be performed in view of long-term results, rather than immediate on-table reshaping outcomes.

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Spring-assisted posterior vault expansion—a single-centre experience of 200 cases

et al. 2021

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Purpose Children affected by premature fusion of the cranial sutures due to craniosynostosis can present with raised intracranial pressure and (turri)brachycephalic head shapes that require surgical treatment. Spring-assisted posterior vault expansion (SA-PVE) is the surgical technique of choice at Great Ormond Street Hospital for Children (GOSH), London, UK. This study aims to report the SA-PVE clinical experience of GOSH to date. Methods A retrospective review was carried out including all SA-PVE cases performed at GOSH between 2008 and 2020. Demographic and clinical data were recorded including genetic diagnosis, craniofacial surgical history, surgical indication and assessment, age at time of surgery (spring insertion and removal), operative time, in-patient stay, blood transfusion requirements, additional/secondary (cranio)facial procedures, and complications. Results Between 2008 and 2020, 200 SA-PVEs were undertaken in 184 patients (61% male). The study population consisted of patients affected by syndromic (65%) and non-syndromic disorders. Concerns regarding raised intracranial pressure were the surgical driver in 75% of the cases, with the remainder operated for shape correction. Median age for SA-PVE was 19 months (range, 2–131). Average operative time for first SA-PVE was 150 min and 87 for spring removal. Median in-patient stay was 3 nights, and 88 patients received a mean of 204.4 ml of blood transfusion at time of spring insertion. A single SA-PVE sufficed in 156 patients (85%) to date (26 springs still in situ at time of this analysis); 16 patients underwent repeat SA-PVE, whilst 12 underwent rigid redo. A second SA-PVE was needed in significantly more cases when the first SA-PVE was performed before age 1 year. Complications occurred in 26 patients with a total of 32 events, including one death. Forty-one patients underwent fronto-orbital remodelling at spring removal and 22 required additional cranio(maxillo)facial procedures. Conclusions Spring-assisted posterior vault expansion is a safe, efficient, and effective procedure based on our 12-year experience. Those that are treated early in life might require a repeat SA-PVE. Long-term follow-up is recommended as some would require additional craniomaxillofacial correction later in life.

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Validation of an in-silico modelling platform for outcome prediction in spring assisted posterior vault expansion

Cited by 7 publications

References 21 publications

A preliminary analysis of replicating the biomechanics of helmet therapy for sagittal craniosynostosis

A preliminary analysis of replicating the biomechanics of helmet therapy for sagittal craniosynostosis

Understanding the influence of surgical parameters on craniofacial surgery outcomes: a computational study

Spring-assisted posterior vault expansion—a single-centre experience of 200 cases

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