Craniosynostosis

Low-Cost Desktop-Based Three-Dimensional-Printed Patient-Specific Craniofacial Models in Surgical Counseling, Consent Taking, and Education of Parent of Craniosynostosis Patients: A Comparison With Conventional Visual Explanation Modalities

BACKGROUND

Craniosynostosis is a complex craniofacial deformity. Surgical decision, if needed, is always hard on the parent and requires the use of multimodalities of explanation. To the authors' knowledge, there have been no studies tackling family counseling about the deformity and surgical decision-making process with the use of low-cost patient-specific three-dimensional (3D)-printed models.

METHODS

A cross-sectional study investigating the utility of patient-specific 3D-printed models using a desktop-based 3D printer. Questionnaire was constructed and validated screening the demographics, knowledge, expectation, and surgical decision-making process supplied using Likert. Data were collected consecutively from each parent first after explanation with conventional 3D computed tomography (CT) images, and then repeated after the 3D-printed model has been presented.

RESULTS

Fourteen parents were screened. Majority of parents considered the pathology to have a potential effect of child's functional and aesthetic outcomes. After using the 3D-printed models, the participants had a clear vision and needed not to read any more about the condition (P = 0.05, P = 0.019, respectively). Agreement for surgical management was in favor of the 3D-printed models compared with CT images (P = 0.028). Explanation with CT images yielded higher mean score in knowledge about potential complications compared with 3D models (P value = 0.007). For the 3D models, average printing time was 26 hours, and a mean cost of 5.2$.

CONCLUSION

The utility of desktop 3D printing is an affordable modality to provide adequate information about craniosynostosis and can assist surgical decision-making. Knowledge and adaptation of such cheap technology represents a great skill aiding clinical practice.

Prenatal ultrasound diagnosis of fetal craniosynostosis

OBJECTIVE

Craniosynostosis is defined as the premature closure of the calvarial sutures. The prevalence of this heterogeneous condition is 1 in 2000 and approximately 100 different forms have been described with an established genetic transmission in half of them. Prenatal diagnosis of craniosynostosis relies mainly on identification of associated anomalies and molecular analysis of fetal DNA, which is only feasible in some syndromic forms and in well-documented families. The objective of this study was to investigate the value of prenatal ultrasound examination of cranial sutures in fetuses at risk for craniosynostosis.

METHODS

Forty fetuses at risk for craniosynostosis on the basis of either a family history (Group 1, n = 16) or skull deformity suspected on a first-level fetal ultrasound examination (Group 2, n = 24) were retrospectively investigated. Craniosynostosis was suspected on the basis of skull deformities when present, however the diagnosis was only made in cases where there was a loss of hypoechogenicity of the normal sutures. All infants had both clinical and radiological investigations performed postnatally.

RESULTS

In Group 1, serial ultrasound examination from 12 weeks' gestation onwards led to accurate prenatal diagnosis in all 16 cases. Dysmorphism and skull deformity preceded closure of the sutures by 4 to 16 weeks. In Group 2, prenatal diagnosis was correct in 23/24 cases. There were no false-negative results in either group.

CONCLUSIONS

This series questions further the uncertain genetic determinism of craniosynostosis and seems to rule out the hypothesis of a deformation sequence following primary closure of the cranial sutures. It also suggests that ultrasound examination is useful to demonstrate closure of the sutures in the third trimester of pregnancy in most affected cases.