Doctors and engineers of the Gregorio Marañón General University Hospital and the Carlos III University of Madrid (UC3M) have developed the world’s first surgical navigation system for the personalized treatment of craniosynostosis, a congenital defect that affects one in 2,000 children and that it can impede the proper growth and development of the brain.
This novel surgical navigation technology, which has already been used in seven patients, allows greater precision and repeatability in correction surgeries of malformation in children under one year of age and ensures optimal results. In addition, the dependence on the experience and subjective assessment of surgeons during the procedure will be reduced.
“This research is an interesting and novel contribution that improves results in surgery for this disease. We believe that we have transformed something subjective into something more scientific, with safe, accurate results that can be reproduced even in hospitals with less technological structure “, explained at a press conference Dr. Santiago Ochandiano, maxillofacial surgeon at Hospital Gregorio Marañón.
The development and validation of the precision of this procedure has been published in the scientific journal ‘Scientific Reports’.
Premature fusion of the skull
Craniosynostosis consists of the premature fusion of one or more sutures of the skull, generating cranial malformations and asymmetry of the baby’s face. These malformations can cause an increase in intracranial pressure, preventing the proper growth and development of the brain. In these cases, surgical intervention is necessary to be able to normalize the cranial morphology and the orbital region of the patients, avoiding problems during subsequent growth. According to the figures provided by Ochandiano, this disease could affect some 100 children a year in Spain.
Surgery for the treatment of craniosynostosis consists of cutting the affected bone tissue, reshape it to the most appropriate shape and reposition it in the patient in the appropriate position so that the cranial morphology is the desired one. Precision in remodeling and bone placement is very important, since small variations can negatively affect the functional and aesthetic result of the patient.
Until now, this procedure was based on the subjective assessment of surgeons taking into account their previous experience. After years of working on this project, these researchers have managed to develop a workflow based on virtual preoperative planning tailored to each patient and surgical navigation technology to target the surgical procedure.
Millimeter precision in the operating room
By being equipped with a triple guidance system, which combines the surgical navigation, three-dimensional photography and augmented reality, this technology is used to know the position of bone fragments with millimeter precision at any time during surgical reconstruction. With three-dimensional photography, the baby’s skull is reconstructed and any variation can be seen before, during and after the intervention.
During the operation, a high-resolution screen positioned close to the surgical field allows medical personnel to view a three-dimensional model representation of the actual position of the bone fragments relative to the planned final position prior to surgery.
Thus, surgeons can check at all times that they are meeting the objectives defined during the surgical planning phase and can make corrections to ensure optimal outcome.
In addition, it integrates visualization with augmented reality, which enables overlay virtual image of planning in the surgical field for surgeons to check the position of bone fragments thanks to surgical navigation. With it, it makes it easier for the team of professionals to ensure good aesthetic and functional results for patients.
Ochandiano has ensured that the technique has “a precision with errors below the millimeter”. “It is an absolutely exact system”, he has detailed. One year after the treatment, in less than 40 seconds they obtain a three-dimensional image of the baby’s head. “With these graphs we can compare how the morphology is per year. The result is that it is stable and is maintained with growth,” he said.
To achieve these best results, Hospital Gregorio Marañón is working with the Children’s National Hospital of the University of Washington DC (United States) to obtain, according to the characteristics of the baby, the most appropriate standards for their age, bone structure and future development.
“Children’s National sends us the ideal image of the baby’s morphology if it were not affected by the disease. We apply virtual planning, the preoperative 3D image and remodel that bone. Once we have achieved that, it is a matter of entering the operating room for treatment with virtual reality “, has wielded.
Likewise, with a view to the future, these Spanish researchers are collaborating with this American center to introduce new advances in the planning and treatment of craniosynostosis.