Narainsai Reddy

Introduction: Craniosynostosis involves the premature fusion of cranial sutures at birth.¹ It follows Virchow’s law which states that growth is restricted to the perpendicular plane of the affected suture, and compensatory skull growth occurs parallel to affected sutures.² Surgical intervention is usually indicated and might include cranial vault remodeling, calvarial expansion, and foramen magnum decompression. Given the uniqueness of the presentation for each patient, each surgery will be unique and require attention to the unique anatomy of the infant.² Applying a standard procedure is not feasible and becomes difficult to plan for as each case will be different.³ Trying to understand the unique anatomy in surgical planning and figuring out the best surgical plan becomes a laborious process for each case. Hence, the purpose of this review is to assess the efficacy and feasibility of 3D planning and printing applied to craniosynostosis surgerie. Methods: A literature review was conducted on the background of craniosynostosis and emerging 3D printing applications within surgery. Specifically, we discuss the considerations and benefits of 3D printing, applications within craniosynostosis, patient outcomes, and surgeon outcomes.  Results: 3D printing when used intraoperatively requires the materials to be sterilizable and contain biocompatible resins for models.⁴ This enables printing templates for bone cuts and remodeling patient anatomy. An important consideration is the cost of 3D printing, which can be an issue for accessibility particularly in low resource settings. Partnering is key and finding ways to fund or reduce these costs will be critical to making it more widespread ³ Recontouring cranial bones which is vital to almost every craniosynostosis procedure is vital to allow normal bony contouring and growth.⁴ Use of 3D printed cutting guides have shown to result in orbital indices and volume that are nearly equal to the unaffected side of the skull.^5,6 Additionally, the confidence in surgeons is higher when utilizing 3D models for planning and intraoperative guides, which is important when dealing with complex pediatric cases.^3,6 Conclusions: Craniosynostosis requires complex surgeries with a unique approach to patients depending on their anatomy. A lack of true standardization in surgical approach makes planning each patient a thoughtful process. The opportunity for 3D printing within craniosynostosis is large and has already shown to improve outcomes and efficiency. Further research can help better integrate 3D planning and printing into the care continuum.

1. Soldozy S, Yağmurlu K, Akyeampong DK, et al. Three-dimensional printing and craniosynostosis surgery. Childs Nerv Syst. 2021;37(8):2487-2495. doi:10.1007/s00381-021-05133-8
2. García-Mato D, Ochandiano S, García-Sevilla M, et al. Craniosynostosis surgery: workflow based on virtual surgical planning, intraoperative navigation and 3D printed patient-specific guides and templates. Sci Rep. 2019;9(1):17691. doi:10.1038/s41598-019-54148-4
3. Kobets AJ, Ammar A, Nakhla J, et al. Virtual modeling, stereolithography, and intraoperative CT guidance for the optimization of sagittal synostosis reconstruction: a technical note. Childs Nerv Syst. 2018;34(5):965-970. doi:10.1007/s00381-018-3746-5
4. Bowen L, Benech R, Shafi A, et al. Custom-Made Three-Dimensional Models for Craniosynostosis. J Craniofac Surg. 2020;31(1):292-293. doi:10.1097/SCS.0000000000005927
5. Alshomer F, AlFaqeeh F, Alariefy M, Altweijri I, Alhumsi T. Low-Cost Desktop-Based Three-Dimensional-Printed Patient-Specific Craniofacial Models in Surgical Counseling, Consent Taking, and Education of Parent of Craniosynostosis Patients: A Comparison With Conventional Visual Explanation Modalities. J Craniofac Surg. 2019;30(6):1652-1656. doi:10.1097/SCS.0000000000005401