Top

Published in:

01-06-2021 | Magnetic Resonance Imaging | Original Article - Pediatric Neurosurgery

“Black bone”: the new backbone in CAD/CAM-assisted craniosynostosis surgery?

Authors: Bernd Lethaus, Dimitar Gruichev, Daniel Gräfe, Alexander K. Bartella, Sebastian Hahnel, Tsanko Yovev, Niels Christian Pausch, Matthias Krause

Published in: Acta Neurochirurgica | Issue 6/2021

Abstract

Background

Computer-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).

Methods

Six 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.

Results

In 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.

Conclusion

In 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.

Burge J, Saber NR, Looi T, French B, Usmani Z, Anooshiravani N, Kim P, Forrest C, Phillips J (2011) Application of CAD/CAM prefabricated age-matched templates in cranio-orbital remodeling in craniosynostosis. J Craniofac Surg 22:1810–1813. https://doi.org/10.1097/SCS.0b013e31822e8045CrossRefPubMed

Chim H, Wetjen N, Mardini S (2014) Virtual surgical planning in craniofacial surgery. Semin Plast Surg 28:150–158. https://doi.org/10.1055/s-0034-1384811CrossRefPubMedPubMedCentral

Cho RS, Lopez J, Musavi L, Kachniarz B, Macmillan A, Badiei B, Bello R, Dorafshar AH (2019) Computer-assisted design and manufacturing assists less experienced surgeons in achieving equivalent outcomes in cranial vault reconstruction. J Craniofac Surg 30:2034–2038. https://doi.org/10.1097/SCS.0000000000005748CrossRefPubMed

Eley KA, McIntyre AG, Watt-Smith SR, Golding SJ (2012) "Black bone" MRI: a partial flip angle technique for radiation reduction in craniofacial imaging. Br J Radiol 85:272–278. https://doi.org/10.1259/bjr/95110289CrossRefPubMedPubMedCentral

Eley KA, Watt-Smith SR, Golding SJ (2012) "Black bone" MRI: a potential alternative to CT when imaging the head and neck: report of eight clinical cases and review of the Oxford experience. Br J Radiol 85:1457–1464. https://doi.org/10.1259/bjr/16830245CrossRefPubMedPubMedCentral

Eley KA, Watt-Smith SR, Golding SJ (2017) "Black bone" MRI: a novel imaging technique for 3D printing. Dentomaxillofac Radiol 46:20160407. https://doi.org/10.1259/dmfr.20160407CrossRefPubMedPubMedCentral

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 28:463–467. https://doi.org/10.1097/SCS.0000000000003219CrossRefPubMed

Engel M, Castrillon-Oberndorfer G, Hoffmann J, Freudlsperger C (2012) Value of preoperative imaging in the diagnostics of isolated metopic suture synostosis: a risk-benefit analysis. J Plast Reconstr Aesthet Surg 65:1246–1251. https://doi.org/10.1016/j.bjps.2012.03.038CrossRefPubMed

Frush DP, Donnelly LF, Rosen NS (2003) Computed tomography and radiation risks: what pediatric health care providers should know. Pediatrics 112:951–957. https://doi.org/10.1542/peds.112.4.951CrossRefPubMed

10.

Hochfeld M, Lamecker H, Thomale UW, Schulz M, Zachow S, Haberl H (2014) Frame-based cranial reconstruction. J Neurosurg Pediatr 13:319–323. https://doi.org/10.3171/2013.11.PEDS1369CrossRefPubMed

11.

Icrp KPL, Ringertz H, Donoghue V, Frush D, Rehani M, Appelgate K, Sanchez R (2013) ICRP publication 121: radiological protection in paediatric diagnostic and interventional radiology. Ann ICRP 42:1–63. https://doi.org/10.1016/j.icrp.2012.10.001CrossRef

12.

Lehner M, Wendling-Keim D, Kunz M, Deininger S, Zundel S, Peraud A, Mast G (2020) On-site CAD templates reduce surgery time for complex craniostenosis repair in infants: a new method. Childs Nerv Syst. https://doi.org/10.1007/s00381-019-04474-9

13.

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 Gonzalez 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:e346–e358. https://doi.org/10.1016/S2352-3026(18)30092-9CrossRefPubMedPubMedCentral

14.

Marcus JR, Domeshek LF, Loyd AM, Schoenleber JM, Das RR, Nightingale RW, Mukundan S Jr (2009) Use of a three-dimensional, normative database of pediatric craniofacial morphology for modern anthropometric analysis. Plast Reconstr Surg 124:2076–2084. https://doi.org/10.1097/PRS.0b013e3181bf7e1bCrossRefPubMed

15.

Mazrani W, McHugh K, Marsden PJ (2007) The radiation burden of radiological investigations. Arch Dis Child 92:1127–1131. https://doi.org/10.1136/adc.2006.101782CrossRefPubMedPubMedCentral

16.

Nikkila A, Erme S, Arvela H, Holmgren O, Raitanen J, Lohi O, Auvinen A (2016) Background radiation and childhood leukemia: a nationwide register-based case-control study. Int J Cancer 139:1975–1982. https://doi.org/10.1002/ijc.30264CrossRefPubMed

17.

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 Gonzalez A (2012) Radiation exposure from CT scans in childhood and subsequent risk of leukaemia and brain tumours: a retrospective cohort study. Lancet 380:499–505. https://doi.org/10.1016/S0140-6736(12)60815-0CrossRefPubMedPubMedCentral

18.

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 28:405–410. https://doi.org/10.1007/s00381-011-1630-7CrossRefPubMed

19.

Schweitzer T, Bohm H, Meyer-Marcotty P, Collmann H, Ernestus RI, Krauss J (2012) Avoiding CT scans in children with single-suture craniosynostosis. Childs Nerv Syst 28:1077–1082. https://doi.org/10.1007/s00381-012-1721-0CrossRefPubMed

20.

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:E5. https://doi.org/10.3171/2015.3.FOCUS14852CrossRefPubMed

21.

Tolhuisen ML, de Jong GA, van Damme RJM, van der Heijden F, Delye HHK (2018) Cranial shape comparison for automated objective 3D craniosynostosis surgery planning. Sci Rep 8:3349. https://doi.org/10.1038/s41598-018-21662-wCrossRefPubMedPubMedCentral

22.

Vander Sloten J, Degryse K, Gobin R, Van der Perre G, Mommaerts MY (1996) Interactive simulation of cranial surgery in a computer aided design environment. J Craniomaxillofac Surg 24:122–129. https://doi.org/10.1016/s1010-5182(96)80024-2CrossRefPubMed

23.

Whitaker LA, Bartlett SP, Schut L, Bruce D (1987) Craniosynostosis: an analysis of the timing, treatment, and complications in 164 consecutive patients. Plast Reconstr Surg 80:195–212CrossRefPubMed

Title: “Black bone”: the new backbone in CAD/CAM-assisted craniosynostosis surgery?
Authors: Bernd Lethaus
Dimitar Gruichev
Daniel Gräfe
Alexander K. Bartella
Sebastian Hahnel
Tsanko Yovev
Niels Christian Pausch
Matthias Krause
Publication date: 01-06-2021
Publisher: Springer Vienna
Keywords: Magnetic Resonance Imaging
Magnetic Resonance Imaging
Computed Tomography
Ionizing Radiation
Computed Tomography
Craniosynostosis
Published in: Acta Neurochirurgica / Issue 6/2021
Print ISSN: 0001-6268
Electronic ISSN: 0942-0940
DOI: https://doi.org/10.1007/s00701-020-04445-z

At a glance: The STEP trials

Springer Medicine

“Black bone”: the new backbone in CAD/CAM-assisted craniosynostosis surgery?

Abstract

Background

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 6/2021

Arterial collateral anatomy predicts the risk for intra-operative changes in somatosensory evoked potentials in patients undergoing carotid endarterectomy: a prospective cohort study

Diploic veins as collateral venous pathways in patients with dural venous sinus invasion by meningiomas

How I do it: Subtemporal transtentorial approach for cavernous malformation of the pons

Carotid endarterectomy restores decreased vision due to chronic ocular ischemia

Feasibility of occipital condyle screw placement in patients with Chiari malformation type I: a computed tomography-based morphometric study

Correction to: on the need of creating multicenter registries for more suitable matched cohort studies to elucidate best multidisciplinary care strategies for patients with Chiari malformations