S15-03 SESSION 15: PLANNING/IMAGING - PART I COMPUTER-ASSISTED CRANIOFACIAL SURGERY - EXPERIENCES FROM THE COPENHAGEN CENTER FOR CRANIOFACIAL SURGERY

Abstract

Introduction: Computer assisted surgery (CAS) has through virtuel surgical simulation and computer aided design/computer aided manufactoring (cad-cam) of preoperative fabrication of surgical cutting guides and positioning guides and implants has revolutionized both orthognathic and reconstructive jaw surgery. The purpose of this study was to investigate the utility of computer-assisted surgery for cranial vault remodelling in syndromic and nonsyndromic patients utilizing patientsspecific cutting and poristioning guides. Methods: A retrospective review was performed from 2015 - 2019 of all patients undergoing computer-assisted cranial remodelling of syndromic and nonsyndromic craniosynostosis. Forty-nine patients (17 female, 32 males) was included in this report. DICOM data based on preoperative CT-scans was used for individual 3D-models and virtual surgical simulation in “TruMatch” (Depuy-Synthes). Subsequently surgical guides (cutting and positioning) was fabricated and utiliized in order to transfer the virtuel plan to the patient intraoperatively. All bone cutting was performed by piezo surgery. For all patients pre-and “postoperative” assesment of intracraniel volume was performed as part of the preoperative planning. Results: The computer-assisted cranial-vault remodellingprocedures was succesfully carried out in all patients. All guides for cutting and positioning worked well and were helpfull in the control the spatiel position of the osteotomised bone segments. The “shrinken” outcome cranium is efficient for back-table assemble. The pre and “postoperative” intracranial corrections differed among the different types of craniosynostosis (trigocephalic, plagiocephalic, scaphocepalic etc. Overall surgical time was reduced. Conclusion: Computer assistyed technologies are very usable for surgical corrections of both the cranium and the remaining craniofacial framework. Preoperative virtuel surgical planning has refined cranial vault remodelling of syndromic and nonsyndromic craniosynostosis. The use of patientspecific CT-guided modelling with fabrication of osteotomy and positioning guides shortens surgical time and for effecient utilization of time in the operating theater, ability to correct more challenging deformities and provide improved predicted quatification of postoperative position of the mobilised bone plates and vault segments and overall improved patient outcome.