Computer-Assisted Design and Manufacturing Assists Less Experienced Surgeons in Achieving Equivalent Outcomes in Cranial Vault Reconstruction

Cho, Regina S.; Lopez, Joseph; Musavi, Leila; Kachniarz, Bartlomiej; Macmillan, Alexandra; Badiei, B; Bello, Ricardo J.; Dorafshar, Amir H.

doi:10.1097/scs.0000000000005748

Cited by 13 publications

(7 citation statements)

References 28 publications

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“…This would reduce planning time, the need of a technician, and presumably costs. Although we were not able to demonstrate this statistically, there is a high potential to reduce OR time for very young patients by meticulous preoperative planning as shown by other CT-based studies [ 3 ].…”

Section: Discussionmentioning

confidence: 61%

“Black bone”: the new backbone in CAD/CAM-assisted craniosynostosis surgery?

et al. 2020

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Background Computer-assisted design and manufacturing (CAD/CAM) techniques have been implemented in craniosynostosis surgery to facilitate cranial remodeling. However, until now, computed tomography (CT) scans with ionizing radiation were necessary to plan the procedure and create guiding templates. The purpose of this study was to present our series using CAD/CAM techniques in planning and conducting fronto-orbital advancement surgery in patients with trigonocephaly with datasets acquired only by “black bone” magnetic resonance imaging (MRI). Methods Six consecutively operated cases from 2019 were included in this study. All patients suffered from non-syndromic trigonocephaly with no primary surgeries. All patients underwent cranial MRI including black bone sequences. Preoperative planning and guides were created based on the DICOM datasets. We analyzed demographic data, clinical data, and outcome measured by Whitaker score. Results In all cases, precise frontobasal advancement was possible with the CAD/CAM guides created by black bone MRI. The mean operation time and planning time were 222 and 32 min. The time on intensive and intermediate care unit (ICU/IMC) time was 4.5 days, respectively. All but one case were classified as Whitaker I. Conclusion In trigonocephaly treatment by frontobasal advancement, black bone MRI-based CAD/CAM craniosynostosis surgery is safe and feasible. It offers the major advantage of completely avoiding CT scans and ionizing radiation with superior imaging quality of intracranial structures. Thus, it improves intraoperative safety and—at the same time—has the potential to reduce operating room (OR) time.

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Section: Discussionmentioning

confidence: 61%

“Black bone”: the new backbone in CAD/CAM-assisted craniosynostosis surgery?

et al. 2020

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“…The growing experience with computer-planned and manufactured implants leads to minimized time for the individual steps. A comparable hypothesis was pursued in a study by Cho et al who investigated the use of CAD/CAM-assisted surgery for craniosynostosis and concluded that even less experienced surgeons achieved equivalent long-term results with this method (46). Accordingly, gaining knowledge when performing computer-assisted surgery could be proportional to experience.…”

Section: Discussionmentioning

confidence: 91%

Comparison of the Accuracy and Clinical Parameters of Patient-Specific and Conventionally Bended Plates for Mandibular Reconstruction

et al. 2021

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ObjectivesThis retrospective study compared two mandibular reconstruction procedures—conventional reconstruction plates (CR) and patient-specific implants (PSI)—and evaluated their accuracy of reconstruction and clinical outcome.MethodsOverall, 94 patients had undergone mandibular reconstruction with CR (n = 48) and PSI (n = 46). Six detectable and replicable anatomical reference points, identified via computer tomography, were used for defining the mandibular dimensions. The accuracy of reconstruction was assessed using pre- and postoperative differences.ResultsIn the CR group, the largest difference was at the lateral point of the condyle mandibulae (D2) -1.56 mm (SD = 3.8). In the PSI group, the largest difference between preoperative and postoperative measurement was shown at the processus coronoid (D5) with +1.86 mm (SD = 6.0). Significant differences within the groups in pre- and postoperative measurements were identified at the gonion (D6) [t(56) = -2.217; p = .031 <.05]. In the CR group, the difference was 1.5 (SD = 3.9) and in the PSI group -1.04 (SD = 4.9). CR did not demonstrate a higher risk of plate fractures and post-operative complications compared to PSI.ConclusionFor reconstructing mandibular defects, CR and PSI are eligible. In each case, the advantages and disadvantages of these approaches must be assessed. The functional and esthetic outcome of mandibular reconstruction significantly improves with the experience of the surgeon in conducting microvascular grafts and familiarity with computer-assisted surgery. Interoperator variability can be reduced, and training of younger surgeons involved in planning can be reaching better outcomes in the future.

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“…In addition, the utility of these new methods in training the next generation of craniofacial surgeons has significant potential. 12,44,55…”

Section: Minimizing Surgical Traumamentioning

confidence: 99%

A review of the management of single-suture craniosynostosis, past, present, and future

Proctor¹,

Meara

2019

Journal of Neurosurgery: Pediatrics

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BACKGROUNDCraniosynostosis is a condition in which 2 or more of the skull bones fuse prematurely. The spectrum of the disorder most commonly involves the closure of a single suture in the skull, but it can also involve syndromic diagnoses in which multiple skull bones and/or bones outside of the cranium are affected. Craniosynostosis can result in cosmetic deformity as well as potential limitations in brain growth and development, and the neurocognitive impact of the condition is just starting to be studied more thoroughly. Our knowledge regarding the genetics of this condition has also evolved substantially. In this review, the authors explore the medical and surgical advancements in understanding and treating this condition over the past century, with a focus on how the diagnosis and treatment have evolved.METHODSIn this review article, the authors, who are the leaders of a craniofacial team at a major academic pediatric hospital, focus on single-suture craniosynostosis (SSC) affecting the 6 major cranial sutures and discuss the evolution of the treatment of SSC from its early history in modern medicine through the current state of the art and future trends. This discussion is based on the authors’ broad experience and a comprehensive review of the literature.SUMMARYThe management of SSC has evolved substantially over the past 100 years. There have been major advances in technology and medical knowledge that have allowed for safer treatment of this condition through the use of newer techniques and technologies in the fields of surgery, anesthesia, and critical care. The use of less invasive surgical techniques along with other innovations has led to improved outcomes in SSC patients. The future of SSC treatment will likely be guided by elucidation of the causes of neurocognitive delay in these children and assessment of how the timing and type of surgery can mitigate adverse outcomes.

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Computer-Assisted Design and Manufacturing Assists Less Experienced Surgeons in Achieving Equivalent Outcomes in Cranial Vault Reconstruction

Cited by 13 publications

References 28 publications

“Black bone”: the new backbone in CAD/CAM-assisted craniosynostosis surgery?

“Black bone”: the new backbone in CAD/CAM-assisted craniosynostosis surgery?

Comparison of the Accuracy and Clinical Parameters of Patient-Specific and Conventionally Bended Plates for Mandibular Reconstruction

A review of the management of single-suture craniosynostosis, past, present, and future

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