A systematic review of the latest technologies in Cranial Vault Remodeling and its outcomes for correction of craniosynostosis

Plastic surgeons often come across the dilemma of keeping operative time under check and achieving the "perfect" shape while still compassing the desired functional and aesthetic outcomes on the patient. This leads to a tradeoff between speed and accuracy in the operating room. Craniosynostosis (CS) is a congenital disability that is caused when one or more sutures of an infant's skull fuses too early before the brain is fully formed. This premature fusion of cranial sutures leads to abnormal head skull shape, increased intracranial pressure (ICP), and neurodevelopmental impairment for the child in later stages of life. Total Cranial Vault Remodeling (CVR) is a surgical procedure to treat this condition by reshaping the cranial bones, thus imparting a normative head shape for a child's brain to grow. These surgeries are usually lengthy and require the patient to be under prolonged anesthetic exposure and blood transfusion. Moreover, CVR is highly dependent on the surgeon's experience and lacks repeatability even though each case is specific and may require volatile manipulations that can often last hours. Based on our research question, we deployed the PRISMA protocol, exhausting databases to find relevant literature on this topic. The search strategy yielded a total of 399 research papers and after carefully reviewing each study, 12 papers were included in the systematic review to better understand the current engineering technologies being used effectively to improve the surgical outcomes for the correction of CS. Computer-aided design and manufacturing (CAD/CAM), Virtual Surgery Planning (VSP), three-dimensional (3D) printing/CNC milling, resorbable plating system, 3D photogrammetry, 3D simulation, and intraoperative navigation are several technologies that can result in improving surgical outcomes for CVR surgery. Thus, there is a need to develop a workflow for the surgical treatment of CS using the latest technology that can potentially help surgeons achieve predictable and reproducible results in the operating room and be considered a standard across the craniofacial surgicalcommunity. A standardized workflow may also result in improving the speed (operative time) by moving part of the surgery to a more controlled pre-surgical planning environment and accuracy (precision) by achieving intricate and precise cuts on the calvarial bone, resulting in fewer errors during the surgery.