Craniosynostosis surgery: workflow based on virtual surgical planning, intraoperative navigation and 3D printed patient-specific guides and templates

Abstract

Craniosynostosis must often be corrected using surgery, by which the affected bone tissue is remodeled. Nowadays, surgical reconstruction relies mostly on the subjective judgement of the surgeon to best restore normal skull shape, since remodeled bone is manually placed and fixed. Slight variations can compromise the cosmetic outcome. The objective of this study was to describe and evaluate a novel workflow for patient-specific correction of craniosynostosis based on intraoperative navigation and 3D printing. The workflow was followed in five patients with craniosynostosis. Virtual surgical planning was performed, and patient-specific cutting guides and templates were designed and manufactured. These guides and templates were used to control osteotomies and bone remodeling. An intraoperative navigation system based on optical tracking made it possible to follow preoperative virtual planning in the operating room through real-time positioning and 3D visualization. Navigation accuracy was estimated using intraoperative surface scanning as the gold-standard. An average error of 0.62 mm and 0.64 mm was obtained in the remodeled frontal region and supraorbital bar, respectively. Intraoperative navigation is an accurate and reproducible technique for correction of craniosynostosis that enables optimal translation of the preoperative plan to the operating room.

New Technologies to Improve Surgical Outcome during Open-Cranial Vault Remodeling

“…First of all, most of these technologies are costly, and this factor may restrict their integration into clinical practice in some centers with limited budgets. However, many of the previously mentioned technological developments are based on free and open-source software New Technologies to Improve Surgical Outcome during Open-Cranial Vault Remodeling DOI: http://dx.doi.org /10.5772/intechopen.94536 platforms [12,53], which could reduce the costs associated with its integration on the surgical workflow. Also, CAD/CAM guides and templates can be designed and manufactured in-hospital to reduce cost and production time [60,61].…”

“…Using a 3D reconstruction of the cranial surface as a reference, surgical cutting guides are designed to fit into the affected anatomical region (Figure 4a) and to guide the location of osteotomies as defined during the planning stage (Figure 4b) [12]. In addition, shaping templates can also be designed to assist during the intraoperative remodeling of the cranial vault [8,46].…”

“…Fabrication of the patient-specific surgical cutting guides and templates must ensure a fast availability and secure sterilization without the risk of deformation. For this reason, manufacturing is commonly performed with selective laser sintering and polyamide material [12]. Other approaches have proposed the use of stainless steel templates [48].…”

“…Although multiple CT scans or 3D photographs could be acquired during surgery for more accurate and continuous guidance, this methodology would be limited by the increased operative time and, in the case of CT imaging, by the increased exposure to ionizing radiation. An intraoperative navigation system has been specifically developed for realtime guidance during craniosynostosis reconstructions surgeries [12]. This system tracks the position of a surgical tool, which can then record points along the surface of the remodeled bone tissue.…”

“…Nowadays, diagnosis and surgical correction of craniosynostosis are still highly dependent on the subjective assessment and artistic judgment of surgeons [12]. They must determine the degree of the deformity and the best approach for remodeling of the cranial vault to restore normal calvarial shape.…”