Improving Surgical Outcomes via CAD/CAM, VSP, VR, and CNC Machining in the OR for Craniosynostosis Repair

Craniosynostosis is the fusion of two or more bones of the skull when one or more cranial sutures of the infant fuses prematurely. Total Cranial Vault Remodeling is a surgical procedure to treat this condition by cutting, drilling, and reshaping the cranial bones, thus imparting a normative head shape for a child's brain to grow. This study automates a component of total cranial vault remodeling surgery to enhance surgical and patient outcomes, offering a fresh alternative to the craniomaxillofacial surgical community. An effective workflow that improved the surgery's efficiency and precision was created using surgical planning, 3D printing, computer-aided design and manufacture, virtual reality, and CNC milling. Lean and Six Sigma concepts, together with expertise of quality control, were also used to enhance the reliability of the workflow. An ideal model that closely matched the mechanical characteristics of the calvarium bone of a human newborn was selected after mechanical testing on four different types of cadaver bones. By doing arbitrary tests on cadaver bone, a team of craniofacial surgeons further validated the mechanical testing results. Using a CNC machine, linear osteotomies were made in the selected bone while cutting parameters were optimized to reduce heat produced where the bone contacted the cutting tool. Complex osteotomies were machined using the kerfing technique after the optimal machining settings had been established in order to make the bone pliable. By using the workflow, instruments, and techniques created during this research, infants undergoing craniosynostosis correction will experience shorter surgical and anesthesia durations, more anatomically accurate and precise head shape correction, and less reliance on the experience of the operating surgeon. The research may also have broader applicability in other bone repair surgical specialties.