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Use of computer-assisted design and manufacturing to localize dural venous sinuses during reconstructive surgery for craniosynostosis

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Abstract

Objective

Cranial vault remodeling surgery for craniosynostosis carries the potential risk of dural venous sinus injury given the extensive bony exposure. Identification of the dural venous sinuses can be challenging in patients with craniosynostosis given the lack of accurate surface-localizing landmarks. Computer-aided design and manufacturing (CAD/CAM) has allowed surgeons to pre-operatively plan these complex procedures in an effort to increase reconstructive efficiency. An added benefit of this technology is the ability to intraoperatively map the dural venous sinuses based on pre-operative imaging. We utilized CAD/CAM technology to intraoperatively map the dural venous sinuses for patients undergoing reconstructive surgery for craniosynostosis in an effort to prevent sinus injury, increase operative efficiency, and enhance patient safety. Here, we describe our experience utilizing this intraoperative technology in pediatric patients with craniosynostosis.

Methods

We retrospectively reviewed the charts of children undergoing reconstructive surgery for craniosynostosis using CAD/CAM surgical planning guides at our institution between 2012 and 2016. Data collected included the following: age, gender, type of craniosynostosis, estimated blood loss, sagittal sinus deviation from the sagittal suture, peri-operative outcomes, and hospital length of stay.

Results

Thirty-two patients underwent reconstructive cranial surgery for craniosynostosis, with a median age of 11 months (range, 7–160). Types of synostosis included metopic (6), unicoronal (6), sagittal (15), lambdoid (1), and multiple suture (4). Sagittal sinus deviation from the sagittal suture was maximal in unicoronal synostosis patients (10.2 ± 0.9 mm). All patients tolerated surgery well, and there were no occurrences of sagittal sinus, transverse sinus, or torcular injury.

Conclusions

The use of CAD/CAM technology allows for accurate intraoperative dural venous sinus localization during reconstructive surgery for craniosynostosis and enhances operative efficiency and surgeon confidence while minimizing the risk of patient morbidity.

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Authors and Affiliations

  1. Division of Pediatric Neurosurgery, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Phipps 560A, Baltimore, MD, 21287, USA

    Rajiv R. Iyer, Adela Wu, George I. Jallo & Edward S. Ahn

  2. Department of Plastic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Alexandra Macmillan, Leila Musavi, Regina Cho, Joseph Lopez & Amir H. Dorafshar

Authors
  1. Rajiv R. Iyer
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  2. Adela Wu
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  3. Alexandra Macmillan
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  4. Leila Musavi
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  5. Regina Cho
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  6. Joseph Lopez
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  7. George I. Jallo
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  8. Amir H. Dorafshar
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  9. Edward S. Ahn
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Corresponding author

Correspondence to Edward S. Ahn.

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The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

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Iyer, R.R., Wu, A., Macmillan, A. et al. Use of computer-assisted design and manufacturing to localize dural venous sinuses during reconstructive surgery for craniosynostosis. Childs Nerv Syst 34, 137–142 (2018). https://doi.org/10.1007/s00381-017-3601-0

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  • DOI: https://doi.org/10.1007/s00381-017-3601-0

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