Surgery of complex craniofacial defects: A single-step AM-based methodology

Abstract

Background and objectiveThe purpose of the present paper is to pave the road to the systematic optimization of complex craniofacial surgical intervention and to validate a design methodology for the virtual surgery and the fabrication of cranium vault custom plates. Recent advances in the field of medical imaging, image processing and additive manufacturing (AM) have led to new insights in several medical applications. The engineered combination of medical actions and 3D processing steps, foster the optimization of the intervention in terms of operative time and number of sessions needed. Complex craniofacial surgical intervention, such as for instance severe hypertelorism accompanied by skull holes, traditionally requires a first surgery to correctly "resize" the patient cranium and a second surgical session to implant a customized 3D printed prosthesis. Between the two surgical interventions, medical imaging needs to be carried out to aid the design the skull plate. Instead, this paper proposes a CAD/AM-based one-in-all design methodology allowing the surgeons to perform, in a single surgical intervention, both skull correction and implantation. MethodsA strategy envisaging a virtual/mock surgery on a CAD/AM model of the patient cranium so as to plan the surgery and to design the final shape of the cranium plaque is proposed. The procedure relies on patient imaging, 3D geometry reconstruction of the defective skull, virtual planning and mock surgery to determine the hypothetical anatomic 3D model and, finally, to skull plate design and 3D printing. ResultsThe methodology has been tested on a complex case study. Results demonstrate the feasibility of the proposed approach and a consistent reduction of time and overall cost of the surgery, not to mention the huge benefits on the patient that is subjected to a single surgical operation. ConclusionsDespite a number of AM-based methodologies have been proposed for designing cranial implants or to correct orbital hypertelorism, to the best of the authors' knowledge, the present work is the first to simultaneously treat osteotomy and titanium cranium plaque.

Comparison of STL skull models produced using open-source software versus commercial software

“…Most of the published articles used commercial software (Volpe et al , 2018; Yu et al , 2018; Zeng et al , 2019; Zhang et al , 2018) for processing of DICOM data, where the raw medical data were segmented, processed and saved into STL format, which can be sent to three-dimensional printer for printing physical models. One of the most commonly used software is MIMICS (Ghai et al , 2018).…”

Current Practice in Preoperative Virtual and Physical Simulation in Neurosurgery

“…A deep knowledge of the anatomical geometry of the patient is necessary to plan the best surgical strategy and to reduce the risk of surgical errors. Within this context, it is clear how important it is to use surgical simulators that allow the physician to simulate the operation before entering the surgical room, improving self-confidence and reducing stress during actual surgery [34]. Specifically, during this phase, the surgeon can test multiple surgical strategies in order to identify the best one in terms of results and timing.…”

Ear Reconstruction Simulation: From Handcrafting to 3D Printing

“…On the other hand, 3D scanning enables the direct acquisition of three-dimensional data of the outer anatomical surface without the use of ionizing radiation, non-invasively, and at low cost [38]. In the medical field, several scientific studies report the use of 3D scanners to acquire anatomical data for the construction of orthoses [39] or medical devices [40], but also for diagnostic purposes [41] or maxillofacial reconstruction planning [41,42,43,44].…”