The surgical correction of craniostenosis in children is a time-consuming and taxing procedure. To facilitate this procedure, especially in infants with complex craniostenosis, we refined the computer-aided design and manufacturing technique (CAD/CAM) based on computed tomography (CT)-generated DICOM data. We used cutting guides and molding templates, which allowed the surgeon to reshape and fixate the supraorbital bar extracorporeally on a side table and to control the intracorporal fit without removing the template. To compare our traditional concept with the possibility of preoperative virtual planning (PVP) technique, the surgical treatment and courses of 16 infants with complex craniostenosis following fronto-orbital advancement (FOA) (age range 8-15months) were analyzed in two groups (group 1: traditional, control group n = 8, group 2: CAD/CAM planned, n = 8). While in both groups, the head accurately reshaped postoperatively during the follow-up; the CAD group 2 showed a significantly shorter operating time with a mean of 4h 25min compared with group 1 with a mean of 5h 37min (p = 0.038). Additionally, the CAD group 2 had a significantly lower volume of blood loss (380ml vs. 575ml mean, p = 0.047), lower blood transfusion volume (285ml vs. 400ml mean, p = 0.108), lower fresh frozen plasma (FFP) volume (140ml vs. 275ml mean, p = 0.019), shorter stay in the pediatric intensive care unit (PICU) (3 vs. 5days mean (p = 0.002), and shorter total length of hospital stay (6days vs. 8days mean, p = 0.002). CAD/CAM cutting guides and templates offer optimizing operative efficiency, precision, and accuracy in craniostenosis surgery in infants. As shown in this single-center observational study, the use of on-site templates significantly accelerates the reconstruction of the bandeau. The virtual 3D planning technique increases surgical precision without discernible detrimental effects.
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