Skip to main content
Top
Published in: Child's Nervous System 4/2020

01-04-2020 | Original Article

On-site CAD templates reduce surgery time for complex craniostenosis repair in infants: a new method

Authors: Markus Lehner, D. Wendling-Keim, M. Kunz, S. Deininger, S. Zundel, A. Peraud, G. Mast

Published in: Child's Nervous System | Issue 4/2020

Login to get access

Abstract

Introduction

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.

Method and patients

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 8–15 months) were analyzed in two groups (group 1: traditional, control group n = 8, group 2: CAD/CAM planned, n = 8).

Results

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 4 h 25 min compared with group 1 with a mean of 5 h 37 min (p = 0.038). Additionally, the CAD group 2 had a significantly lower volume of blood loss (380 ml vs. 575 ml mean, p = 0.047), lower blood transfusion volume (285 ml vs. 400 ml mean, p = 0.108), lower fresh frozen plasma (FFP) volume (140 ml vs. 275 ml mean, p = 0.019), shorter stay in the pediatric intensive care unit (PICU) (3 vs. 5 days mean (p = 0.002), and shorter total length of hospital stay (6 days vs. 8 days mean, p = 0.002).

Conclusion

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.
Appendix
Available only for authorised users
Literature
2.
go back to reference Bertelsen TI (1958) The premature synostosis of the cranial sutures. Acta Ophthalmol Suppl 36(Suppl 51):1–176PubMed Bertelsen TI (1958) The premature synostosis of the cranial sutures. Acta Ophthalmol Suppl 36(Suppl 51):1–176PubMed
3.
go back to reference Rigi M, Almarzouqi SJ, Morgan ML, Lee AG (2015) Papilledema: epidemiology, etiology, and clinical management. Eye Brain 7:47–57PubMedPubMedCentral Rigi M, Almarzouqi SJ, Morgan ML, Lee AG (2015) Papilledema: epidemiology, etiology, and clinical management. Eye Brain 7:47–57PubMedPubMedCentral
4.
go back to reference Mathijssen IM (2015) Guideline for care of patients with the diagnoses of craniosynostosis: working group on craniosynostosis. J Craniofac Surg 26(6):1735–1807PubMedPubMedCentralCrossRef Mathijssen IM (2015) Guideline for care of patients with the diagnoses of craniosynostosis: working group on craniosynostosis. J Craniofac Surg 26(6):1735–1807PubMedPubMedCentralCrossRef
5.
go back to reference Hankinson TC, Fontana EJ, Anderson RC, Feldstein NA (2010) Surgical treatment of single-suture craniosynostosis: an argument for quantitative methods to evaluate cosmetic outcomes. J Neurosurg Pediatr 6(2):193–197PubMedCrossRef Hankinson TC, Fontana EJ, Anderson RC, Feldstein NA (2010) Surgical treatment of single-suture craniosynostosis: an argument for quantitative methods to evaluate cosmetic outcomes. J Neurosurg Pediatr 6(2):193–197PubMedCrossRef
6.
go back to reference Renier D, Sainte-Rose C, Marchac D, Hirsch JF (1982) Intracranial pressure in craniostenosis. J Neurosurg 57(3):370–377PubMedCrossRef Renier D, Sainte-Rose C, Marchac D, Hirsch JF (1982) Intracranial pressure in craniostenosis. J Neurosurg 57(3):370–377PubMedCrossRef
7.
go back to reference Kunz M, Lehner M, Heger A, Armbruster L, Weigand H, Mast G, Peraud A (2014) Neurodevelopmental and esthetic results in children after surgical correction of metopic suture synostosis: a single institutional experience. Childs Nerv Syst 30(6):1075–1082PubMedCrossRef Kunz M, Lehner M, Heger A, Armbruster L, Weigand H, Mast G, Peraud A (2014) Neurodevelopmental and esthetic results in children after surgical correction of metopic suture synostosis: a single institutional experience. Childs Nerv Syst 30(6):1075–1082PubMedCrossRef
8.
go back to reference Salyer KE, Hall JD (1990) Bandeau--the focal point of frontocranial remodeling. J Craniofac Surg 1(1):18–31PubMedCrossRef Salyer KE, Hall JD (1990) Bandeau--the focal point of frontocranial remodeling. J Craniofac Surg 1(1):18–31PubMedCrossRef
9.
go back to reference Renier D, Lajeunie E, Arnaud E, Marchac D (2000) Management of craniosynostoses. Childs Nerv Syst 16(10–11):645–658PubMedCrossRef Renier D, Lajeunie E, Arnaud E, Marchac D (2000) Management of craniosynostoses. Childs Nerv Syst 16(10–11):645–658PubMedCrossRef
10.
go back to reference Mommaerts MY, Jans G, Vander Sloten J, Staels PF, van der Perre G, Gobin R (2001) On the assets of CAD planning for craniosynostosis surgery. J Craniofac Surg 12(6):547–554PubMedCrossRef Mommaerts MY, Jans G, Vander Sloten J, Staels PF, van der Perre G, Gobin R (2001) On the assets of CAD planning for craniosynostosis surgery. J Craniofac Surg 12(6):547–554PubMedCrossRef
11.
go back to reference Danelson KA, Gordon ES, David LR, Stitzel JD (2009) Using a three dimensional model of the pediatric skull for pre-operative planning in the treatment of craniosynostosis - biomed 2009. Biomed Sci Instrum 45:358–363PubMed Danelson KA, Gordon ES, David LR, Stitzel JD (2009) Using a three dimensional model of the pediatric skull for pre-operative planning in the treatment of craniosynostosis - biomed 2009. Biomed Sci Instrum 45:358–363PubMed
12.
go back to reference Mardini S et al (2014) Three-dimensional preoperative virtual planning and template use for surgical correction of craniosynostosis. J Plast Reconstr Aesthet Surg 67(3):336–343PubMedCrossRef Mardini S et al (2014) Three-dimensional preoperative virtual planning and template use for surgical correction of craniosynostosis. J Plast Reconstr Aesthet Surg 67(3):336–343PubMedCrossRef
13.
go back to reference Pappa H, Richardson D, Webb AA, May P (2009) Individualized template-guided remodeling of the fronto-orbital bandeau in craniosynostosis corrective surgery. J Craniofac Surg 20(1):178–179PubMedCrossRef Pappa H, Richardson D, Webb AA, May P (2009) Individualized template-guided remodeling of the fronto-orbital bandeau in craniosynostosis corrective surgery. J Craniofac Surg 20(1):178–179PubMedCrossRef
14.
go back to reference Seruya M, Borsuk DE, Khalifian S, Carson BS, Dalesio NM, Dorafshar AH (2013) Computer-aided design and manufacturing in craniosynostosis surgery. J Craniofac Surg 24(4):1100–1105PubMedCrossRef Seruya M, Borsuk DE, Khalifian S, Carson BS, Dalesio NM, Dorafshar AH (2013) Computer-aided design and manufacturing in craniosynostosis surgery. J Craniofac Surg 24(4):1100–1105PubMedCrossRef
15.
go back to reference Hochfeld M, Lamecker H, Thomale UW, Schulz M, Zachow S, Haberl H (2014) Frame-based cranial reconstruction. J Neurosurg Pediatr 13(3):319–323PubMedCrossRef Hochfeld M, Lamecker H, Thomale UW, Schulz M, Zachow S, Haberl H (2014) Frame-based cranial reconstruction. J Neurosurg Pediatr 13(3):319–323PubMedCrossRef
16.
go back to reference Saber NR, Phillips J, Looi T, Usmani Z, Burge J, Drake J, Kim PC (2012) Generation of normative pediatric skull models for use in cranial vault remodeling procedures. Childs Nerv Syst 28(3):405–410PubMedCrossRef Saber NR, Phillips J, Looi T, Usmani Z, Burge J, Drake J, Kim PC (2012) Generation of normative pediatric skull models for use in cranial vault remodeling procedures. Childs Nerv Syst 28(3):405–410PubMedCrossRef
17.
go back to reference Probst FA et al (2010) Calvarial reconstruction by customized bioactive implant. Handchir Mikrochir Plast Chir 42(6):369–373PubMedCrossRef Probst FA et al (2010) Calvarial reconstruction by customized bioactive implant. Handchir Mikrochir Plast Chir 42(6):369–373PubMedCrossRef
18.
go back to reference Rodriguez-Florez N, Bruse JL, Borghi A, Vercruysse H, Ong J, James G, Pennec X, Dunaway DJ, Jeelani NUO, Schievano S (2017) Statistical shape modelling to aid surgical planning: associations between surgical parameters and head shapes following spring-assisted cranioplasty. Int J Comput Assist Radiol Surg 12(10):1739–1749PubMedPubMedCentralCrossRef Rodriguez-Florez N, Bruse JL, Borghi A, Vercruysse H, Ong J, James G, Pennec X, Dunaway DJ, Jeelani NUO, Schievano S (2017) Statistical shape modelling to aid surgical planning: associations between surgical parameters and head shapes following spring-assisted cranioplasty. Int J Comput Assist Radiol Surg 12(10):1739–1749PubMedPubMedCentralCrossRef
19.
go back to reference Stricker PA, Goobie SM, Cladis FP, Haberkern CM, Meier PM, Reddy SK, Nguyen TT, Cai L, Polansky M, Szmuk P, Fiadjoe J, Soneru C, Falcon R, Petersen T, Kowalczyk-Derderian C, Dalesio N, Budac S, Groenewald N, Rubens D, Thompson D, Watts R, Gentry K, Ivanova I, Hetmaniuk M, Hsieh V, Collins M, Wong K, Binstock W, Reid R, Poteet-Schwartz K, Gries H, Hall R, Koh J, Bannister C, Sung W, Jain R, Fernandez A, Tuite GF, Ruas E, Drozhinin O, Tetreault L, Muldowney B, Ricketts K, Fernandez P, Sohn L, Hajduk J, Taicher B, Burkhart J, Wright A, Kugler J, Barajas-DeLoa L, Gangadharan M, Busso V, Stallworth K, Staudt S, Labovsky KL, Glover CD, Huang H, Karlberg-Hippard H, Capehart S, Streckfus C, Nguyen KT, Manyang P, Martinez JL, Hansen JK, Levy HM, Brzenski A, Chiao F, Ingelmo P, Mujallid R, Olutoye OA, Syed T, Benzon H, Bosenberg A, Pediatric Craniofacial Collaborative Group (2017) Perioperative outcomes and management in pediatric complex cranial vault reconstruction: a multicenter study from the Pediatric Craniofacial Collaborative Group. Anesthesiology 126(2):276–287PubMedCrossRef Stricker PA, Goobie SM, Cladis FP, Haberkern CM, Meier PM, Reddy SK, Nguyen TT, Cai L, Polansky M, Szmuk P, Fiadjoe J, Soneru C, Falcon R, Petersen T, Kowalczyk-Derderian C, Dalesio N, Budac S, Groenewald N, Rubens D, Thompson D, Watts R, Gentry K, Ivanova I, Hetmaniuk M, Hsieh V, Collins M, Wong K, Binstock W, Reid R, Poteet-Schwartz K, Gries H, Hall R, Koh J, Bannister C, Sung W, Jain R, Fernandez A, Tuite GF, Ruas E, Drozhinin O, Tetreault L, Muldowney B, Ricketts K, Fernandez P, Sohn L, Hajduk J, Taicher B, Burkhart J, Wright A, Kugler J, Barajas-DeLoa L, Gangadharan M, Busso V, Stallworth K, Staudt S, Labovsky KL, Glover CD, Huang H, Karlberg-Hippard H, Capehart S, Streckfus C, Nguyen KT, Manyang P, Martinez JL, Hansen JK, Levy HM, Brzenski A, Chiao F, Ingelmo P, Mujallid R, Olutoye OA, Syed T, Benzon H, Bosenberg A, Pediatric Craniofacial Collaborative Group (2017) Perioperative outcomes and management in pediatric complex cranial vault reconstruction: a multicenter study from the Pediatric Craniofacial Collaborative Group. Anesthesiology 126(2):276–287PubMedCrossRef
20.
go back to reference Soleman J, Thieringer F, Beinemann J, Kunz C, Guzman R (2015) Computer-assisted virtual planning and surgical template fabrication for frontoorbital advancement. Neurosurg Focus 38(5):E5PubMedCrossRef Soleman J, Thieringer F, Beinemann J, Kunz C, Guzman R (2015) Computer-assisted virtual planning and surgical template fabrication for frontoorbital advancement. Neurosurg Focus 38(5):E5PubMedCrossRef
22.
go back to reference White N, Marcus R, Dover S, Solanki G, Nishikawa H, Millar C, Carver ED (2009) Predictors of blood loss in fronto-orbital advancement and remodeling. J Craniofac Surg 20(2):378–381PubMedCrossRef White N, Marcus R, Dover S, Solanki G, Nishikawa H, Millar C, Carver ED (2009) Predictors of blood loss in fronto-orbital advancement and remodeling. J Craniofac Surg 20(2):378–381PubMedCrossRef
23.
go back to reference Seruya M, Oh AK, Rogers GF, Boyajian MJ, Myseros JS, Yaun AL, Keating RF (2012) Factors related to blood loss during fronto-orbital advancement. J Craniofac Surg 23(2):358–362PubMedCrossRef Seruya M, Oh AK, Rogers GF, Boyajian MJ, Myseros JS, Yaun AL, Keating RF (2012) Factors related to blood loss during fronto-orbital advancement. J Craniofac Surg 23(2):358–362PubMedCrossRef
24.
go back to reference Seruya M, Oh AK, Rogers GF, Han KD, Boyajian MJ, Myseros JS, Yaun AL, Keating RF (2012) Blood loss estimation during fronto-orbital advancement: implications for blood transfusion practice and hospital length of stay. J Craniofac Surg 23(5):1314–1317PubMedCrossRef Seruya M, Oh AK, Rogers GF, Han KD, Boyajian MJ, Myseros JS, Yaun AL, Keating RF (2012) Blood loss estimation during fronto-orbital advancement: implications for blood transfusion practice and hospital length of stay. J Craniofac Surg 23(5):1314–1317PubMedCrossRef
25.
go back to reference Martin JP, Wang JS, Hanna KR, Stovall MM, Lin KY (2015) Use of tranexamic acid in craniosynostosis surgery. Plast Surg (Oakv) 23(4):247–251CrossRef Martin JP, Wang JS, Hanna KR, Stovall MM, Lin KY (2015) Use of tranexamic acid in craniosynostosis surgery. Plast Surg (Oakv) 23(4):247–251CrossRef
26.
go back to reference Seruya M, Oh AK, Rogers GF, Boyajian MJ, Myseros JS, Yaun AL, Keating RF (2012) Controlled hypotension and blood loss during frontoorbital advancement. J Neurosurg Pediatr 9(5):491–496PubMedCrossRef Seruya M, Oh AK, Rogers GF, Boyajian MJ, Myseros JS, Yaun AL, Keating RF (2012) Controlled hypotension and blood loss during frontoorbital advancement. J Neurosurg Pediatr 9(5):491–496PubMedCrossRef
27.
go back to reference Pearce MS, Salotti JA, Little MP, McHugh K, Lee C, Kim KP, Howe NL, Ronckers CM, Rajaraman P, Sir Craft AW, Parker L, Berrington de González A (2012) Radiation exposure from CT scans in childhood and subsequent risk of leukaemia and brain tumours: a retrospective cohort study. Lancet 380(9840):499–505PubMedPubMedCentralCrossRef Pearce MS, Salotti JA, Little MP, McHugh K, Lee C, Kim KP, Howe NL, Ronckers CM, Rajaraman P, Sir Craft AW, Parker L, Berrington de González A (2012) Radiation exposure from CT scans in childhood and subsequent risk of leukaemia and brain tumours: a retrospective cohort study. Lancet 380(9840):499–505PubMedPubMedCentralCrossRef
28.
go back to reference Lehner M et al (2018) iTRAPS- interdisciplinary trauma room algorithm in pediatric surgery. Notfall Rettungsmedizin 21(2):90–99CrossRef Lehner M et al (2018) iTRAPS- interdisciplinary trauma room algorithm in pediatric surgery. Notfall Rettungsmedizin 21(2):90–99CrossRef
29.
30.
go back to reference Eley KA, Watt-Smith SR, Golding SJ (2017) Three-dimensional reconstruction of the craniofacial skeleton with gradient echo magnetic resonance imaging (“black bone”): what is currently possible? J Craniofac Surg 28(2):463–467PubMedCrossRef Eley KA, Watt-Smith SR, Golding SJ (2017) Three-dimensional reconstruction of the craniofacial skeleton with gradient echo magnetic resonance imaging (“black bone”): what is currently possible? J Craniofac Surg 28(2):463–467PubMedCrossRef
31.
go back to reference Little MP, Wakeford R, Borrego D, French B, Zablotska LB, Adams MJ, Allodji R, de Vathaire F, Lee C, Brenner AV, Miller JS, Campbell D, Pearce MS, Doody MM, Holmberg E, Lundell M, Sadetzki S, Linet MS, Berrington de González A (2018) Leukaemia and myeloid malignancy among people exposed to low doses (< 100 mSv) of ionising radiation during childhood: a pooled analysis of nine historical cohort studies. Lancet Haematol 5(8):e346–e358PubMedPubMedCentralCrossRef Little MP, Wakeford R, Borrego D, French B, Zablotska LB, Adams MJ, Allodji R, de Vathaire F, Lee C, Brenner AV, Miller JS, Campbell D, Pearce MS, Doody MM, Holmberg E, Lundell M, Sadetzki S, Linet MS, Berrington de González A (2018) Leukaemia and myeloid malignancy among people exposed to low doses (< 100 mSv) of ionising radiation during childhood: a pooled analysis of nine historical cohort studies. Lancet Haematol 5(8):e346–e358PubMedPubMedCentralCrossRef
32.
go back to reference Iyer RR, Wu A, Macmillan A, Musavi L, Cho R, Lopez J, Jallo GI, Dorafshar AH, Ahn ES (2018) Use of computer-assisted design and manufacturing to localize dural venous sinuses during reconstructive surgery for craniosynostosis. Childs Nerv Syst 34(1):137–142PubMedCrossRef Iyer RR, Wu A, Macmillan A, Musavi L, Cho R, Lopez J, Jallo GI, Dorafshar AH, Ahn ES (2018) Use of computer-assisted design and manufacturing to localize dural venous sinuses during reconstructive surgery for craniosynostosis. Childs Nerv Syst 34(1):137–142PubMedCrossRef
33.
go back to reference Safi AF, Kreppel M, Grandoch A, Kauke M, Nickenig HJ, Zöller J (2018) Clinical evaluation of standardized fronto-orbital advancement for correction of isolated trigonocephaly. J Craniofac Surg 29(1):72–75PubMedCrossRef Safi AF, Kreppel M, Grandoch A, Kauke M, Nickenig HJ, Zöller J (2018) Clinical evaluation of standardized fronto-orbital advancement for correction of isolated trigonocephaly. J Craniofac Surg 29(1):72–75PubMedCrossRef
34.
go back to reference Bennett KG, Liang F, Ranganathan K, Muraszko KM, Vercler CJ, Buchman SR (2018) Surgical hypercorrection of trigonocephaly: evaluation of surgical outcomes. J Craniofac Surg 29(1):56–61PubMedCrossRef Bennett KG, Liang F, Ranganathan K, Muraszko KM, Vercler CJ, Buchman SR (2018) Surgical hypercorrection of trigonocephaly: evaluation of surgical outcomes. J Craniofac Surg 29(1):56–61PubMedCrossRef
35.
go back to reference Ghaffar A, Hussain Z, Qasmi SA, Chaudhry SH (2016) Calvarial remodelling surgery: neurosurgical experience of multidisciplinary craniofacial reconstruction. J Pak Med Assoc 66(12):1611–1615PubMed Ghaffar A, Hussain Z, Qasmi SA, Chaudhry SH (2016) Calvarial remodelling surgery: neurosurgical experience of multidisciplinary craniofacial reconstruction. J Pak Med Assoc 66(12):1611–1615PubMed
36.
go back to reference Hormozi AK, Shahverdiani R, Mohammadi HR, Zali A, Mofrad HR (2011) Surgical treatment of metopic synostosis. J Craniofac Surg 22(1):261–265PubMedCrossRef Hormozi AK, Shahverdiani R, Mohammadi HR, Zali A, Mofrad HR (2011) Surgical treatment of metopic synostosis. J Craniofac Surg 22(1):261–265PubMedCrossRef
37.
go back to reference van der Meulen JJ et al (2008) Bitemporal depressions after cranioplasty for trigonocephaly: a long-term evaluation of (supra) orbital growth in 92 patients. J Craniofac Surg 19(1):72–79PubMedCrossRef van der Meulen JJ et al (2008) Bitemporal depressions after cranioplasty for trigonocephaly: a long-term evaluation of (supra) orbital growth in 92 patients. J Craniofac Surg 19(1):72–79PubMedCrossRef
38.
go back to reference Melissa LoPresti BD, Buchanan EP, Monson L, Lam S (2017) Virtual surgical planning and 3D printing in repeat calvarial vault reconstruction for craniosynostosis: technical note. J Neurosurg Pediatr 19(4):490–494CrossRef Melissa LoPresti BD, Buchanan EP, Monson L, Lam S (2017) Virtual surgical planning and 3D printing in repeat calvarial vault reconstruction for craniosynostosis: technical note. J Neurosurg Pediatr 19(4):490–494CrossRef
39.
go back to reference Queiros C, Joly A, Paré A, Listrat A, Travers N, Goga D, Laure B (2017) Use of cutting guides during craniosynostosis sequelae surgery: a comparative study between computer-assisted planning and post-operative results. J Craniomaxillofac Surg 45(7):1062–1068PubMedCrossRef Queiros C, Joly A, Paré A, Listrat A, Travers N, Goga D, Laure B (2017) Use of cutting guides during craniosynostosis sequelae surgery: a comparative study between computer-assisted planning and post-operative results. J Craniomaxillofac Surg 45(7):1062–1068PubMedCrossRef
40.
go back to reference Ghizoni E, de Souza JPSAS, Raposo-Amaral CE, Denadai R, de Aquino HB, Raposo-Amaral CA, Joaquim AF, Tedeschi H, Bernardes LF, Jardini AL (2018) 3D-printed craniosynostosis model: new simulation surgical tool. World Neurosurg 109:356–361PubMedCrossRef Ghizoni E, de Souza JPSAS, Raposo-Amaral CE, Denadai R, de Aquino HB, Raposo-Amaral CA, Joaquim AF, Tedeschi H, Bernardes LF, Jardini AL (2018) 3D-printed craniosynostosis model: new simulation surgical tool. World Neurosurg 109:356–361PubMedCrossRef
41.
go back to reference Fisher M, Medina M 3rd, Bojovic B, Ahn E, Dorafshar AH (2016) Indications for computer-aided design and manufacturing in congenital craniofacial reconstruction. Craniomaxillofac Trauma Reconstr 9(3):235–241PubMedPubMedCentralCrossRef Fisher M, Medina M 3rd, Bojovic B, Ahn E, Dorafshar AH (2016) Indications for computer-aided design and manufacturing in congenital craniofacial reconstruction. Craniomaxillofac Trauma Reconstr 9(3):235–241PubMedPubMedCentralCrossRef
Metadata
Title
On-site CAD templates reduce surgery time for complex craniostenosis repair in infants: a new method
Authors
Markus Lehner
D. Wendling-Keim
M. Kunz
S. Deininger
S. Zundel
A. Peraud
G. Mast
Publication date
01-04-2020
Publisher
Springer Berlin Heidelberg
Published in
Child's Nervous System / Issue 4/2020
Print ISSN: 0256-7040
Electronic ISSN: 1433-0350
DOI
https://doi.org/10.1007/s00381-019-04474-9

Other articles of this Issue 4/2020

Child's Nervous System 4/2020 Go to the issue