Computer supported pre-operative planning of craniosynostosis surgery : a mimics-integrated approach

In order to correct functional and aesthetical aspects of malformations as caused by craniosynostosis, skull reconstruction is required. Because of the complexity of the surgery, pre- operative planning is unavoidable. Current and previously developed planning environments allow an iterative sequence of osteotomies and repositioning trials in order to search for the optimal reconstruction plan. Nevertheless, they often lack the opportunity to simulate neonatus cranial bone bending (1) as well as to transfer the simulated surgery to the operation room on a cheap but accurate and easy to handle basis (2). This study combines existing planning utilities in the commercial Mimics® environment with newly developed tools, implemented in Matlab®. Skull reconstruction planning is done on an outer bone surface model - generated partly in Mimics®, partly in Matlab® - by the use of Mimics® MedCAD, measurement and simulation tools. For each resected/osteotomized bone part, the presented Matlab® procedures provide virtual bone bending based on reference data and finally generate surface based bone cutting guides, also denoted templates. The clinical feasibility of using templates in combination with Mimics® planning screenshots is validated by three successful clinical cases which result in considerable surgery time reduction and optimal results.