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.0b013e31822e8045
[DOI: 10.1097/SCS.0b013e31822e8045]
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-0034-1384811
[DOI: 10.1055/s-0034-1384811]
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.0000000000005748
[DOI: 10.1097/SCS.0000000000005748]
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/95110289
[DOI: 10.1259/bjr/95110289]
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/16830245
[DOI: 10.1259/bjr/16830245]
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.20160407
[DOI: 10.1259/dmfr.20160407]
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.0000000000003219
[DOI: 10.1097/SCS.0000000000003219]
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.2012.03.038
[DOI: 10.1016/j.bjps.2012.03.038]
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.112.4.951
[DOI: 10.1542/peds.112.4.951]
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.PEDS1369
[DOI: 10.3171/2013.11.PEDS1369]
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.2012.10.001
[DOI: 10.1016/j.icrp.2012.10.001]
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
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)30092-9
[DOI: 10.1016/S2352-3026(18)30092-9]
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.0b013e3181bf7e1b
[DOI: 10.1097/PRS.0b013e3181bf7e1b]
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.2006.101782
[DOI: 10.1136/adc.2006.101782]
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.30264
[DOI: 10.1002/ijc.30264]
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)60815-0
[DOI: 10.1016/S0140-6736(12)60815-0]
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/s00381-011-1630-7
[DOI: 10.1007/s00381-011-1630-7]
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/s00381-012-1721-0
[DOI: 10.1007/s00381-012-1721-0]
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.FOCUS14852
[DOI: 10.3171/2015.3.FOCUS14852]
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-w
[DOI: 10.1038/s41598-018-21662-w]
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)80024-2
[DOI: 10.1016/s1010-5182(96)80024-2]
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 80:195–212
[DOI: 10.1097/00006534-198708000-00006]
