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The Use of Virtual Surgical Planning for Reduction Cranioplasty
Eli Saleh1, Alexander Govshievich1, Julian Justino1
1Division of Plastic and Reconstructive Surgery, University of Montreal.
Insights
Reduction cranioplasty effectively treats hydrocephalic macrocephaly. Virtual surgical planning (VSP) with computer-aided design and manufacturing (CAD/CAM) enhances precision and outcomes for this complex cranial surgery.
Area of Science:
- Neurosurgery
- Craniofacial Surgery
- Medical Technology
Background:
- Hydrocephalic macrocephaly, resulting from untreated hydrocephalus, necessitates intervention when head size impedes development.
- Reduction cranioplasty is the standard surgical treatment, but carries significant risks like prolonged anesthesia and blood loss.
Observation:
- This report details the use of Virtual Surgical Planning (VSP) with computer-aided design and manufacturing (CAD/CAM) in a reduction cranioplasty case.
- A 2-year-old girl with severe hydrocephalic macrocephaly underwent the procedure, utilizing prefabricated cutting guides and a concave assembly bowl for precise bone segment fixation.
Findings:
- The VSP with CAD/CAM guided reduction cranioplasty was successful, achieving precise cranial vault remodeling with minimal bony gaps.
- Patient's head circumference decreased from 70 cm to 62 cm, and intracranial volume reduced from 4,575 cm³ to 2,645 cm³.
Implications:
- VSP with CAD/CAM demonstrates significant potential as an adjunct in complex cranioplasty procedures.
- This technology enhances surgical precision, efficacy, and aesthetic outcomes in treating hydrocephalic macrocephaly.
Abstract:
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.
