Computer-Assisted Virtual Planning and Surgical Template Fabrication for Fronto-orbital Advancement

Aim: A novel technique using computer-assisted design (CAD) and computed assisted manufacturing (CAM) for the fabrication of individualized 3D printed surgical templates for fronto-orbital advancement surgery in craniosynostosis surgery is presented. Methods: Five patients underwent a fronto-orbital advancement surgery using the new technique. Four patients had a unilateral coronal synostosis and one patient a metopic synostosis. Virtual surgical planning was performed using SurgiCase (CMF, v5.0, Materialise, Belgium). A novel algorithm was developed combining virtual mirroring techniques and superposition of age-matched normative 3D pediatric skull models. Surgical templates were fabricated using a 3D printer, based on the virtual plan. Bifrontal craniotomy and the osteotomies for the orbital bandeau were performed based on the sterilized 3D templates. The remodeling was then done placing the bone plates within the negative 3D templates and fixing those using absorbable PDLLA plates and screws (SonicWeld, KLS Martin, Tuttlingen, Germany). Results: All patients showed a satisfying correction of cranial deformity postoperatively and at follow-up at 1 and 3 months. No surgery-related complications occurred. The cutting and positioning of the 3D surgical templates proved to be very accurate and easy to use as well as reproducible and efficient. Conclusions: Computer-assisted virtual planning and 3D template fabrication for fronto-orbital advancement surgery lead to reconstructions based on standardized measurements, preclude subjective remodeling, and seem to be overall safe and feasible. An ongoing prospective study with a planned follow-up of 5 years will be conducted at out institution for further evaluation of this novel technique.

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