A systematic review of the latest technologies in Cranial Vault Remodeling and its outcomes for correction of craniosynostosis

Authors

  • Devansh Saini PhDc, Industrial Engineering and Operations Research, Department of Mechanical and Industrial Engineering, University of Illinois, Chicago, USA
  • Quintin L Williams Jr. Clinical Assistant Professor, Department of Mechanical and Industrial Engineering, University of Illinois, Chicago, USA
  • Lee Alkureishi Assistant Professor, Plastic, Reconstructive and Cosmetic Surgery, The Craniofacial Center, University of Illinois, Chicago, USA
  • Pravin Patel Professor, Plastic, Reconstructive and Cosmetic Surgery, The Craniofacial Center, University of Illinois, Chicago, USA
  • Linping Zhao Research Assistant Professor, Plastic, Reconstructive and Cosmetic Surgery, The Craniofacial Center, University of Illinois, Chicago, USA
  • Prashant Banerjee Professor Emeritus, Department of Mechanical and Industrial Engineering, University of Illinois, Chicago, USA
  • Jida Huang Assistant Professor, Department of Mechanical and Industrial Engineering, University of Illinois, Chicago, USA
  • Mathew Mathew Associate Professor, Department of Bioengineering, University of Illinois, Chicago, USA

Abstract

Plastic surgeons often come across the dilemma of keeping operative time under check and achieving
the "perfect" shape while still compassing the desired functional and aesthetic outcomes on the patient.
This leads to a tradeoff between speed and accuracy in the operating room. Craniosynostosis (CS)
is a congenital disability that is caused when one or more sutures of an infant's skull fuses too early
before the brain is fully formed. This premature fusion of cranial sutures leads to abnormal head skull
shape, increased intracranial pressure (ICP), and neurodevelopmental impairment for the child in later
stages of life. Total Cranial Vault Remodeling (CVR) is a surgical procedure to treat this condition by
reshaping the cranial bones, thus imparting a normative head shape for a child's brain to grow. These
surgeries are usually lengthy and require the patient to be under prolonged anesthetic exposure and blood
transfusion. Moreover, CVR is highly dependent on the surgeon's experience and lacks repeatability
even though each case is specific and may require volatile manipulations that can often last hours. Based
on our research question, we deployed the PRISMA protocol, exhausting databases to find relevant
literature on this topic. The search strategy yielded a total of 399 research papers and after carefully
reviewing each study, 12 papers were included in the systematic review to better understand the current
engineering technologies being used effectively to improve the surgical outcomes for the correction of
CS. Computer-aided design and manufacturing (CAD/CAM), Virtual Surgery Planning (VSP), threedimensional
(3D) printing/CNC milling, resorbable plating system, 3D photogrammetry, 3D simulation,
and intraoperative navigation are several technologies that can result in improving surgical outcomes
for CVR surgery. Thus, there is a need to develop a workflow for the surgical treatment of CS using the
latest technology that can potentially help surgeons achieve predictable and reproducible results in the
operating room and be considered a standard across the craniofacial surgical community. A standardized
workflow may also result in improving the speed (operative time) by moving part of the surgery to a
more controlled pre-surgical planning environment and accuracy (precision) by achieving intricate and
precise cuts on the calvarial bone, resulting in fewer errors during the surgery.

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Published

2021-07-12

Issue

Vol. 1 No. 2

Section

Articles