Abstract
BackgroundComputer-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).MethodsSix 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.ResultsIn 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.ConclusionIn 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.
Highlights
The aim of cranial vault remodeling is to create sufficient cranial vault volume, to allow better midfacial development, and to create an esthetically acceptable form
A retrospective review was conducted for patients treated in the craniofacial center of University Hospital Leipzig, Germany, with a computer-assisted design (CAD)/CAM planned procedure for various indications for cranial vault remodeling in 2019
In 2019, six CAD/CAM planned patients with non-syndromic trigonocephaly were treated in our institution by fronto-orbital advancement
Summary
The aim of cranial vault remodeling is to create sufficient cranial vault volume, to allow better midfacial development, and to create an esthetically acceptable form. The use of computer-assisted design (CAD) and manufacturing (CAM) in the surgery of craniosynostosis has been described since 1996 [22]. Others used averaged datasets of healthy children of different ages to create the ideal skull model [10, 14, 18, 21]. Computer-assisted design and manufacturing (CAD/CAM) techniques have been implemented in craniosynostosis surgery to facilitate cranial remodeling. 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). Results In all cases, precise frontobasal advancement was possible with the CAD/CAM guides created by black bone MRI.
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