A Novel Technique to Secure the Skull Post in a Thin Skull Allowing for Surgical Navigation in Infants

Several surgical procedures have been described to correct the deformities associated with craniosynostosis. To simplify the prediction of results, virtual planning techniques and image-guided surgery have been used. Digital planning can be transferred to the operating room using osteotomy and cutting guides or surgical navigation. We describe a novel bone fixation method that allows for anchoring of a cranial dynamic reference frame (DRF) in a steady manner. DRF can be used for registration and as a reference for surgical navigation in an infant's skull. We describe this novel technique to overcome the problems of DRF fixation on an infant's thin and weak calvarium. We fixed the DRF to the cranium using this new system. A 6-hole X-shaped miniplate was placed using 5 screws, leaving 1 of the central holes free. The self-drilling screw that anchors the DRF in position was placed in the free central hole, avoiding calvarial bone breakage and allowing for surgical navigation. To the best of our knowledge, the present study is the first report of this DRF anchorage modification for surgical navigation during surgery of craniosynostosis in an infant.