Virtual Surgical Planning for Correction of Delayed Presentation Scaphocephaly Using a Modified Melbourne Technique

Background: Late treatment of scaphocephaly presents challenges including need for more complex surgery to achieve desired head shape. Virtual surgical planning for total vault reconstruction may mitigate some of these challenges, but has not been studied in this unique and complex clinical setting. Methods: A retrospective chart review was conducted for patients with scaphocephaly who presented to our institution between 2000 and 2014. Patients presenting aged 12 months or older who underwent virtual surgical planning-assisted cranial vault reconstruction were included. Patient demographic, intraoperative data, and postoperative outcomes were recorded. Pre- and postoperative anthropometric measurements were obtained to document the fronto-occipital (FO) and biparietal (BP) distance and calculate cephalic index (CI). Virtual surgical planning predicted, and actual postoperative anthropometric measurements were compared. Results: Five patients were identified who fulfilled inclusion criteria. The mean age was 50.6 months. One patient demonstrated signs of elevated intracranial pressure preoperatively. Postoperatively, all but one needed no revisional surgery (Whitaker score of 1). No patient demonstrated postoperative evidence of bony defects, bossing, or suture restenosis. The mean preoperative, simulated, and actual postoperative FO length was 190.3, 182, and 184.3 mm, respectively. The mean preoperative, simulated, and actual postoperative BP length was 129, 130.7, and 131 mm, respectively. The mean preoperative, simulated, and actual postoperative CI was 66, 72, and 71.3, respectively. Conclusions: Based on our early experience, virtual surgical planning using a modified Melbourne technique for total vault remodeling achieves good results in the management of late presenting scaphocephaly. Address correspondence and reprint requests to Amir H. Dorafshar, MBChB, FACS, FAAP, Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, JHOC 8150, 600 North Wolfe Street, Baltimore, MD 21287; E-mail: adorafs1@jhmi.edu Received 27 July, 2017 Accepted 10 November, 2017 This study was presented as an oral presentation at the American Association of Plastic Surgery Annual Meeting 2016. AM and JL equally contributed to this work. Dr. Amir Dorafshar receives indirect research support and is entitled to royalties from KLS Martin. Dr. Amir Dorafshar also receives research support from De Puy Synthes. The remaining authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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