"Black Bone": the New Backbone in CAD/CAM-assisted Craniosynostosis Surgery?

Overview

Journal Acta Neurochir (Wien)

Specialty Neurosurgery

Date 2020 Jun 11

PMID 32519160

Citations 8

Authors

Bernd Lethaus

Dimitar Gruichev

Daniel Grafe

Alexander K Bartella

Sebastian Hahnel

Tsanko Yovev

Niels Christian Pausch

Matthias Krause

Affiliations

Soon will be listed here.

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.

Citing Articles

Craniofacial Imaging of Pediatric Patients by Ultrashort Echo-Time Bone-Selective MRI in Comparison to CT.

Kamona N, Ng J, Kim Y, D Vu B, Vossough A, Wagner C Acad Radiol. 2024; 31(11):4629-4642.

PMID: 39242296 PMC: 11525957. DOI: 10.1016/j.acra.2024.08.053.

Computer assisted skull base surgery: a contemporary review.

Bartella A, Hoshal S, Lethaus B, Strong E Innov Surg Sci. 2023; 8(3):149-157.

PMID: 38077490 PMC: 10709692. DOI: 10.1515/iss-2021-0020.

Virtual planning for mandible resection and reconstruction.

Probst F, Liokatis P, Mast G, Ehrenfeld M Innov Surg Sci. 2023; 8(3):137-148.

PMID: 38077486 PMC: 10709695. DOI: 10.1515/iss-2021-0045.

Black Bone MRI for Virtual Surgical Planning in Craniomaxillofacial Surgery.

Vyas K, Suchyta M, Hunt C, Gibreel W, Mardini S Semin Plast Surg. 2022; 36(3):192-198.

PMID: 36506277 PMC: 9729059. DOI: 10.1055/s-0042-1756451.

Imaging in Craniofacial Disorders With Special Emphasis on Gradient Echo Black-Bone and Zero Time Echo MRI Sequences.

Ganau M, Syrmos N, Magdum S J Pediatr Neurosci. 2022; 17(Suppl 1):S14-S20.

PMID: 36388002 PMC: 9648653. DOI: 10.4103/jpn.JPN_46_22.

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