Semin Plast Surg
DOI: 10.1055/s-0044-1786759
Review Article

Neuroplastic Surgery Principles of Computerized Surgical Planning in Complex Cranioplasty Reconstruction

Colleen F. Perez
1   Divison of Neuroplastic and Reconstructive Surgery, Department of Otolaryngology – Head and Neck Surgery, Naval Medical Center Portsmouth, Portsmouth, Virginia
,
Chad R. Gordon
2   Division of Neuroplastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
› Author Affiliations
Funding None.

Abstract

This article explores the evolution and implementation of three-dimensional (3D) models and Computerized Surgical Planning (CSP) for complex cranioplasty reconstruction and the advances in neuroplastic surgery principles for improved surgical outcomes. Over recent years, CSP has revolutionized the field by employing detailed medical imaging to enhance the accuracy and efficacy of 3D models and for the creation of customized cranial implants (CCIs). The study discusses the advancements of solid alloplastic implants to the future of implants with sophisticated and integrated neurotechnology to treat or enhance patient outcomes. CSP can be used to identify and mitigate complications that can occur within cranioplasty reconstruction and to create CCIs to address the postoperative challenge of temporal hollowing. Despite the promising advancements, the article acknowledges the current limitations of CSP, including cost and technological accessibility, and proposes future directions for research and development. The findings suggest that with further improvements in imaging, biomaterials, and manufacturing techniques, CSP in neuroplastic surgery and other specialties will continue to significantly enhance the precision and personalized care of cranioplasty reconstruction.



Publication History

Article published online:
23 May 2024

© 2024. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 
  • References

  • 1 Gordon CR, Huang J, Brem H. Neuroplastic surgery. J Craniofac Surg 2018; 29 (01) 4-5
  • 2 Gordon CR. The special field of neuroplastic surgery. J Craniofac Surg 2021; 32 (01) 3-7
  • 3 Gordon CR, Fisher M, Liauw J. et al. Multidisciplinary approach for improved outcomes in secondary cranial reconstruction: introducing the pericranial-onlay cranioplasty technique. Neurosurgery 2014; 10 (02, Suppl 2): 179-189 , discussion 189–190
  • 4 Ben-Shalom N, Wolff A, Santiago GF, Gordon CR. Principles of neuroplastic surgery: management of scalp defects and neurocranial reconstruction. In: Quinones-Hinojosa A. ed. Schmidek and Sweet: Operative Neurosurgical Techniques. 7th ed. Philadelphia, PA:: Elsevier; 2022: 1465-1477
  • 5 Ben-Shalom N, Anderson W, Gordon CR. Brain-computer interfacing: prospects and technical aspects of functional cranial implants. In: Quinones-Hinojosa A. ed. Schmidek and Sweet: Operative Neurosurgical Techniques. 7th ed. Philadelphia, PA:: Elsevier;; 2022: 1272-1282.e1
  • 6 Zhong S, Huang GJ, Susarla SM, Swanson EW, Huang J, Gordon CR. Quantitative analysis of dual-purpose, patient-specific craniofacial implants for correction of temporal deformity. Neurosurgery 2015; 11 (Suppl. 02) 220-229 , discussion 229
  • 7 Santiago GF, Terner J, Wolff A. et al. Post-neurosurgical temporal deformities: various techniques for correction and associated complications. J Craniofac Surg 2018; 29 (07) 1723-1729
  • 8 Gordon CR, Yaremchuk MJ. Temporal augmentation with methyl methacrylate. Aesthet Surg J 2011; 31 (07) 827-833
  • 9 Ibrahim Z, Santiago GF, Huang J, Manson PN, Gordon CR. Algorithmic approach to overcome scalp deficiency in the setting of secondary cranial reconstruction. J Craniofac Surg 2016; 27 (01) 229-233
  • 10 Lopez J, Zhong SS, Sankey EW. et al. Time interval reduction for delayed implant-based cranioplasty reconstruction in the setting of previous bone flap osteomyelitis. Plast Reconstr Surg 2016; 137 (02) 394e-404e
  • 11 Shay T, Belzberg M, Asemota AO. et al. Risk of complications in primary versus revision-type cranioplasty. J Craniofac Surg 2020; 31 (02) 423-427
  • 12 Wolff A, Santiago GF, Belzberg M. et al. Adult cranioplasty reconstruction with customized cranial implants: preferred technique, timing, and biomaterials. J Craniofac Surg 2018; 29 (04) 887-894
  • 13 Gordon CR, Tamargo RJ, Brem H, Huang J. Discussion of effect of reflection of temporalis muscle during cranioplasty with titanium mesh after standard trauma craniectomy. J Craniofac Surg 2016; 27 (03) 654-655
  • 14 Asemota A, Santiago GF, Zhong S, Gordon CR. Comparative cost analysis of single and multi-stage temporal deformity correction following neurosurgical procedures. J Craniofac Surg 2018; 29 (01) 130-138
  • 15 Wolff A, Santiago G, Weingart J, Huang J, Gordon CR. Introducing the rectus fascia scalp augmentation flap technique: a new method for improving scalp durability in cranioplasty reconstruction. J Craniofac Surg 2018; 29 (07) 1733-1736
  • 16 Huang GJ, Zhong S, Susarla SM, Swanson EW, Huang J, Gordon CR. Craniofacial reconstruction with poly(methyl methacrylate) customized cranial implants. J Craniofac Surg 2015; 26 (01) 64-70
  • 17 Berli JU, Thomaier L, Zhong S. et al. Immediate single-stage cranioplasty following calvarial resection for benign and malignant skull neoplasms using customized craniofacial implants. J Craniofac Surg 2015; 26 (05) 1456-1462
  • 18 Wolff AY, Santiago GF, Belzberg M. et al. Full-thickness skin grafting for local defect coverage following scalp adjacent tissue transfer in the setting of cranioplasty. J Craniofac Surg 2019; 30 (01) 115-119
  • 19 Santiago G, Wolff A, Huang J, Weingart J, Brem H, Gordon CR. Dural reconstruction with autologous rectus fascia: a new technique for addressing large-sized defects during cranioplasty. J Craniofac Surg 2019; 30 (02) 326-329
  • 20 Ben-Shalom N, Asemota AO, Beizberg M. et al. Cranioplasty with customized craniofacial implants and intraoperative resizing for single-stage reconstruction following oncologic resection for skull neoplasms. J Craniofac Surg 2022; 33 (06) 1641-1647
  • 21 Belzberg M, Mitchell KA, Ben-Shalom N. et al. Cranioplasty outcomes from 500 consecutive neuroplastic surgery patients. J Craniofac Surg 2022; 33 (06) 1648-1654
  • 22 Shay T, Mitchell KA, Belzberg M. et al. Translucent customized cranial implants made of clear polymethylmethacrylate: an early outcome analysis of 55 consecutive cranioplasty cases. Ann Plast Surg 2020; 85 (06) e27-e36
  • 23 Belzberg M, Shalom NB, Yuhanna E. et al. Sonolucent cranial implants: cadaveric study and clinical findings supporting diagnostic and therapeutic transcranioplasty ultrasound. J Craniofac Surg 2019; 30 (05) 1456-1461
  • 24 Gordon CR, Santiago GF, Huang J. et al. First in-human experience with complete integration of a neuromodulation device within a customized cranial implant. Oper Neurosurg (Hagerstown) 2018; 15 (01) 39-45
  • 25 Gordon CR, Wolff A, Santiago GF. et al. First-in-human experience with integration of a hydrocephalus shunt device within a customized cranial implant. Oper Neurosurg (Hagerstown) 2019; 17 (06) 608-615
  • 26 Mitchell KS, Anderson W, Shay T. et al. First-in-human experience with integration of wireless intracranial pressure monitoring device with a customized cranial implant. Oper Neurosurg (Hagerstown) 2020; 19 (03) 341-350
  • 27 Wikipedia. Convection enhanced delivery. 2023 . Wikipedia. Accessed April 14, 2024 at: https://en.wikipedia.org/wiki/Convection_enhanced_delivery
  • 28 Gordon C. High-profile, anatomy-specific craniofacial implants for combined hard and soft tissue reconstruction with embedded technology for medicine delivery (U.S. Patent No. 11471267). U.S. Patent and Trademark Office. 2022 . Accessed April 17, 2024 at: https://patents.google.com/patent/US11471267B2/en?oq=11471267
  • 29 Gordon C. Patient-specific craniofacial implants (U.S. Patent No. 11504241). U.S. Patent and Trademark Office. 2022 . Accessed April 17, 2024 at: https://patents.google.com/patent/US11504241B2/en?oq=11504241
  • 30 Friesen O, Daskopoulou E, Akhtar F. , et al Method and System for Wireless Charging of Implantable Medical Devices (U.S. Patent Publication No. 2023/0109327A1). Alexandria, VA: U.S. Patent and Trademark Office; 2023
  • 31 Ashayeri K, MJackson E, Huang J, Brem H, Gordon CR. Syndrome of the trephined: a systematic review. Neurosurgery 2016; 79 (04) 525-534
  • 32 Gordon CR. Patient-specific craniofacial implants (US Patent No. 10,639,158). U.S. Patent and Trademark Office. 2020 . Accessed April 17, 2024 at: https://portal.unifiedpatents.com/patents/patent/US-10639158-B2
  • 33 Vannier MW, Marsh JL, Warren JO. Three dimensional CT reconstruction images for craniofacial surgical planning and evaluation. Radiology 1984; 150 (01) 179-184
  • 34 Marsh JL, Vannier MW. The “third” dimension in craniofacial surgery. Plast Reconstr Surg 1983; 71 (06) 759-767
  • 35 Marsh JL, Vannier MW, Stevens WG, Warren JO, Gayou D, Dye DM. Computerized imaging for soft tissue and osseous reconstruction in the head and neck. Clin Plast Surg 1985; 12 (02) 279-291
  • 36 Hull CW, Arcadia C. Apparatus for production of three-dimensional objects by stereolithography. US Patent 4575330A. March 11, 1986
  • 37 Xia J, Samman N, Yeung RW. et al. Three-dimensional virtual reality surgical planning and simulation workbench for orthognathic surgery. Int J Adult Orthodon Orthognath Surg 2000; 15 (04) 265-282
  • 38 Xia JJ, Gateno J, Teichgraeber JF. Three-dimensional computer-aided surgical simulation for maxillofacial surgery. Atlas Oral Maxillofac Surg Clin North Am 2005; 13 (01) 25-39
  • 39 Belzberg M, Shalom NB, Wolff A, Huang J, Gordon C. Bilateral versus unilateral cranialization in the management of a breached frontal sinus. J Craniofac Surg 2020; 31 (01) 261-264
  • 40 Kirloskar KM, Saikaly K, Episalla NC, Baker SB. A novel approach to preventing temporal hollowing using virtual surgical planning and suture suspension of the temporalis muscle. J Craniofac Surg 2023; 34 (03) e331-e333
  • 41 Moellmann HL, Mehr VN, Karnatz N, Wilkat M, Riedel E, Rana M. Evaluation of the fitting accuracy of CAD/CAM-manufactured patient-specific implants for the reconstruction of cranial defects—a retrospective study. J Clin Med 2022; 11 (07) 1-21
  • 42 Tel A, Tuniz F, Fabbro S, Sembronio S, Costa F, Robiony M. Computer-guided in-house cranioplasty: establishing a novel standard for cranial reconstruction and proposal of an updated protocol. J Oral Maxillofac Surg 2020; 78 (12) 2297.e1-2297.e16