The Use of Virtual Surgical Planning for Reduction Cranioplasty

Abstract

Summary: Hydrocephalic macrocephaly may occur as a result of untreated hydrocephalus. Reduction cranioplasty is the treatment of choice for these patients when the weight of their head interferes with normal development and negatively impacts quality of life. However, this procedure has several associated risks, including prolonged anesthesia, significant blood loss, and death. Virtual surgical planning (VSP) has been shown to be a useful adjunct for orthognathic and craniofacial surgery. The following report details the application and advantages of this technology in the setting of a reduction cranioplasty. We report the case of a 2-year-old girl with severe hydrocephalic macrocephaly who underwent a reduction cranioplasty guided by VSP with computer-aided design and manufacturing (CAD/CAM). Prefabricated cutting guides and a concave assembly bowl were used for precise fixation of bony segments. Our patient underwent a successful reduction cranioplasty using VSP and CAD/CAM. This technology allowed precise remodeling of the cranial vault with minimal bony gaps in the final construct. Head circumference and intracranial volume were reduced from 70 cm and 4,575 cm3 to 62 cm and 2,645 cm3, respectively. VSP with CAD/CAM can serve as a useful adjunct in complex cases of cranioplasty allowing for an increase in the precision, the efficacy, and the esthetic result.

Correction of Severe Frontal Bossing with Coronal Brow Lift and Osteoplastic Frontal Sinus Setback Aided by Virtual Surgical Planning: A Case Report

“…8 Saleh et al also found that use of VSP in procedures such as reduction cranioplasty for macrocephaly decreases irregularities seen with free handed osteotomies and thus allows for improved aesthetic results. 9 Similarly, Day et al found utility of VSP in craniomaxillofacial trauma, especially in patients with multiple failed attempts at open reduction and internal fixation. Not only did VSP allow for virtual simulation of the surgery, it also allowed for physical simulation of the operation by utilizing 3D printed skull models based on preoperative CT scans.…”

3D-printed medical models supply chain: barriers modeling and analysis

“…3D-printed medical models (3DPMM) are an emerging product with a smart concept for medical pre-surgery planning widely spread in the health-care sector (Gibson et al , 2015; Saleh et al , 2020; Ganguli et al , 2018). A 3D-printed medical model is an entity that replicates the geometry or form of a biological structure (Yap et al , 2017).…”

“…A 3D-printed medical model is an entity that replicates the geometry or form of a biological structure (Yap et al , 2017). 3DPMM helps to solve complex pre-surgery planning problems that result in enhanced pre-visualizing of surgical intervention, the easy orientation of the exact defected area, deep understanding of anatomy and preparation of the proposed fixation (Lychagin et al , 2019; Saleh et al , 2020). 3DPMM finds various applications in pre-surgery planning for cranioplasty surgery, prosthetics, orthotics and dental research (Bibb et al , 2014).…”

“…Bibb et al (2014) discussed the design of medical modeling in medical applications. Saleh et al (2020) and Chim et al (2014) discussed virtual surgical planning in cranioplasty and craniofacial surgery and challenges during surgical reconstruction. Di Prima et al (2016) examined the 3D-printed medical products regulatory authority of the U.S. Food and Drug Administration (FDA).…”

“…From the literature, we identified 15 barriers in the 3D-printed medical model supply chain and studied their interrelationships through ISM and DEMATEL approaches. The identified barriers are limited materials options (Alkhaibary et al , 2020), lack of medical model accuracy (Chamo et al , 2020), slow production speed (Pavlov and Valkov, 2020), high customization cost (Sharma et al , 2020), easy to use (Kinsman et al , 2020), lack of reliable diagnosis data (Hambock et al , 2020), high image and scanning cost (Singh and Pandey, 2020), high-skilled data analyst (Sahoo et al , 2020), design and customization expert (Gebisa and Lemu, 2019; Gutierrez-Lopez et al , 2020), simulation accuracy (Tel et al , 2020), regulatory approval process (Kitchens, 2016; Giese et al , 2021), manual post-processing (Giese et al , 2021), autoclave (Aljamali et al , 2020; Cheng, 2020), pre-surgical planning (Saleh et al , 2020) and high surgery cost (Kinsman et al , 2020; Expert inputs, 2021) .…”