Three-dimensional preoperative virtual planning and template use for surgical correction of craniosynostosis

Samir Mardini, Saad Alsubaie, Cenk Cayci, Harvey Chim, Nicholas Wetjen

Research output: Contribution to journalArticle

31 Citations (Scopus)

Abstract

Background Surgical correction of craniosynostosis aims to remodel the cranial vault to achieve a morphology approaching that of age-matched norms. However, current surgical technique is highly subjective and based largely on the surgeon's artistic vision in creating a normal head shape. Here, we present our technique and report our experience with the use of virtual surgery using computer-assisted design (CAD)/computer-assisted manufacturing (CAM) techniques to create a prefabricated template for the planning of osteotomies and the placement of bone segments, to achieve standardised, objective and precise correction of craniosynostosis. Methods Four patients who underwent cranial vault remodelling (CVR; three metopic synostosis and one sagittal synostosis) underwent virtual surgical planning (VSP) preoperatively using CAD/CAM techniques. VSP allows pre-planning of osteotomies to achieve the desired cranial vault shape. Surgical osteotomies and placement of bone segments were performed intra-operatively based on prefabricated templates. Results All patients demonstrated markedly improved head shape postoperatively. One patient developed a subdural haematoma 6 weeks postoperatively subsequent to a fall where he hit his head. The haematoma was drained and a soft spot was present in that location 3 months postoperatively. Conclusion The use of virtual surgery and prefabricated cutting guides allows for a more precise and rapid reconstruction. Surgical osteotomies are pre-planned and rapidly performed using a template, and precise placement of calvarial bone segments is achieved without the need for subjective assessment of the desired calvarial shape. In addition, patients and families have a significantly better understanding of the disease process and anticipated surgery preoperatively with the visualisation achieved through virtual surgery. This results in better alignment of hopes and expectations between the parents and surgeons.

Original languageEnglish (US)
Pages (from-to)336-343
Number of pages8
JournalJournal of Plastic, Reconstructive and Aesthetic Surgery
Volume67
Issue number3
DOIs
StatePublished - Mar 2014

Fingerprint

Computer-Aided Design
Craniosynostoses
Osteotomy
Head
Bone and Bones
Hope
Subdural Hematoma
Needs Assessment
Hematoma
Parents
Surgeons

Keywords

  • CAD/CAM
  • Computer-aided design
  • Cranial vault remodelling
  • Craniosynostosis
  • Virtual surgical planning

ASJC Scopus subject areas

  • Surgery

Cite this

Three-dimensional preoperative virtual planning and template use for surgical correction of craniosynostosis. / Mardini, Samir; Alsubaie, Saad; Cayci, Cenk; Chim, Harvey; Wetjen, Nicholas.

In: Journal of Plastic, Reconstructive and Aesthetic Surgery, Vol. 67, No. 3, 03.2014, p. 336-343.

Research output: Contribution to journalArticle

Mardini, Samir ; Alsubaie, Saad ; Cayci, Cenk ; Chim, Harvey ; Wetjen, Nicholas. / Three-dimensional preoperative virtual planning and template use for surgical correction of craniosynostosis. In: Journal of Plastic, Reconstructive and Aesthetic Surgery. 2014 ; Vol. 67, No. 3. pp. 336-343.
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abstract = "Background Surgical correction of craniosynostosis aims to remodel the cranial vault to achieve a morphology approaching that of age-matched norms. However, current surgical technique is highly subjective and based largely on the surgeon's artistic vision in creating a normal head shape. Here, we present our technique and report our experience with the use of virtual surgery using computer-assisted design (CAD)/computer-assisted manufacturing (CAM) techniques to create a prefabricated template for the planning of osteotomies and the placement of bone segments, to achieve standardised, objective and precise correction of craniosynostosis. Methods Four patients who underwent cranial vault remodelling (CVR; three metopic synostosis and one sagittal synostosis) underwent virtual surgical planning (VSP) preoperatively using CAD/CAM techniques. VSP allows pre-planning of osteotomies to achieve the desired cranial vault shape. Surgical osteotomies and placement of bone segments were performed intra-operatively based on prefabricated templates. Results All patients demonstrated markedly improved head shape postoperatively. One patient developed a subdural haematoma 6 weeks postoperatively subsequent to a fall where he hit his head. The haematoma was drained and a soft spot was present in that location 3 months postoperatively. Conclusion The use of virtual surgery and prefabricated cutting guides allows for a more precise and rapid reconstruction. Surgical osteotomies are pre-planned and rapidly performed using a template, and precise placement of calvarial bone segments is achieved without the need for subjective assessment of the desired calvarial shape. In addition, patients and families have a significantly better understanding of the disease process and anticipated surgery preoperatively with the visualisation achieved through virtual surgery. This results in better alignment of hopes and expectations between the parents and surgeons.",
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