“Black bone”: the new backbone in CAD/CAM-assisted craniosynostosis surgery?

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.

Geometric accuracy of magnetic resonance imaging–derived virtual 3‐dimensional bone surface models of the mandible in comparison to computed tomography and cone beam computed tomography: A porcine cadaver study

“…Specific clinical applications recently reported include guided dental implant surgery, 32,51,52 trauma surgery, 30 orthodontic treatment planning, 21 and craniosynostosis surgery. 53 Practical limitations to the use of MR imaging in dental and craniofacial applications include the presence of motion and susceptibility artifacts, some contraindications such as the presence of pacemakers or neurostimulators, and limitations in terms of extended cost and availability.…”

New Technologies to Improve Surgical Outcome during Open-Cranial Vault Remodeling

“…CT imaging is the standard technique used for the generation of 3D models of the cranium prior to surgery. However, a new MRI technique called "black bone" has already been validated as a reference for CAD/CAM craniosynostosis surgery [47]. Therefore, MRI could be used to avoid CT scans and the exposure of the infants to ionizing radiation.…”

The Evolution of the Role of Imaging in the Diagnosis of Craniosynostosis: A Narrative Review

“…The superior imaging quality of CT scans on cortical bones and the possibility of creating 3D reconstructions were one of the major limitations of wider applicability of MRI, but advancements in technologies are working hard to propose MRI as a no-radiation alternative in this field. New protocols, such as black-bone imaging, can provide high-quality 3D imaging of bones and sutures similar to those of CT, while giving, in the same session, details about structural anomalies and prognostic information [ 38 , 39 ]. Eley et al first reported the black-bone imaging technique in literature in 2012 [ 40 ]; thanks to short TE/TR and low flip angle, it makes it possible to minimize soft-tissue contrast to enhance the bone-soft tissue interface.…”

“…Patent sutures have a different signal intensity than prematurely fused ones [ 41 ]. Moreover, it is possible to provide 3D-reconstructed images and, also, to create 3D models using a 3D printing [ 39 , 41 ].…”