title: A novel application of computer-aided design and manufacturing for reduction cranioplasty.
abstract: Macrocephaly is a rare presentation of untreated hydrocephalus. In cases where medical management has failed, macrocephaly can be managed with reduction cranioplasty. Traditionally, reduction cranioplasty is highly dependent on intraoperative tailoring of bone segments to obtain the best possible result and involves high risks of associated severe blood loss and mortality. In this clinical report, we describe a patient with hydrocephalus macrocephaly treated with reduction cranioplasty with the innovative use of computer-aided design and manufacturing to reduce intraoperative risks and improve efficiency. We used computer-aided design to plan osteotomy sites and the final positioning of bone segments. We also utilized computer-aided manufacturing to produce cutting guides, positioning guides, and models to increase precision and improve the final positioning of the cranium. Computer-aided design and manufacturing technology has enabled a shift of the planning burden of complicated craniofacial reconstructions from the intraoperative to the preoperative phase. With a completed plan and premade guides and models, it is possible to minimize the risks, improve efficiency, and obtain a precise, aesthetic result.
authors.affiliation: From the *Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; †Division of Plastic Surgery, Université de Montréal, Montréal, Québec, Canada; and ‡Department of Radiology and §Division of Pediatric Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Amir
authors.initials: A
authors.lastname: Dorafshar
authors.forename: Mark
authors.initials: M
authors.lastname: Fisher
authors.forename: Daniel
authors.initials: D
authors.lastname: Borsuk
authors.forename: Elliot
authors.initials: E
authors.lastname: Fishman
authors.forename: Edward
authors.initials: E
authors.lastname: Ahn
mesh_terms: D002648:Child; D003198:Computer Simulation; D017076:Computer-Aided Design; D004954:Esthetics; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000000981:diagnostic imaging / Q000601:surgery*; D021621:Imaging, Three-Dimensional; D008297:Male; D058627:Megalencephaly / Q000000981:diagnostic imaging / Q000601:surgery*; D010027:Osteotomy / Q000379:methods; D010347:Patient Care Planning; D019651:Plastic Surgery Procedures / Q000379:methods*; D012886:Skull / Q000000981:diagnostic imaging / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D014584:User-Computer Interface