University of Twente Student Theses
An automated workflow for virtual surgical planning of orbital advancements in open cranial vault reconstruction surgery in trigonocephaly patients : a proof of principle
Kaaij, F.A. van der (2023) An automated workflow for virtual surgical planning of orbital advancements in open cranial vault reconstruction surgery in trigonocephaly patients : a proof of principle.
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| Abstract: | Background: Craniosynostosis is a congenital disorder in which one or more cranial sutures are closed prematurely. Patients after the age of six months are subjected to open cranial vault reconstruction surgery (OCVRS). In the Radboudumc, preoperative virtual surgical planning (VSP) is implemented to aim for improvement of clinical outcome and reduction of the risk of complications. Nevertheless, the current manual planning workflow is subjective due to the lack of a superior cranial reconstruction technique, the non-use of craniofacial measurements, inaccurate placement of the osteotomy planes and incorrect alignment with the healthy reference skull. Additionally, the planning workflow is time consuming and difficult to deploy on a large scale. Objectives: The research presented in this thesis focuses on the technical feasibility of development of an automated planning workflow for virtual surgical planning of the orbital advancement. This is evaluated based on three correction methods: 1) Correction toward landmarks of a healthy reference skull, 2) Correction toward the interorbital angle of the reference skull and 3) Correction toward a range of interorbital angles. Methods: The patient's skull was translated and rotated into sella turcica - nasion orientation based on annotated landmarks for alignment with the age-specific reference skull. A set of osteotomy planes was defined and placed based on the annotated landmarks. After execution of the osteotomy, the resulting osseous panels of the orbital bar were repositioned by 1) outward rotation of the orbits based on the three correction methods and 2) inward rotation of the temporal fragments based on defined vectors and the vector angle formula. The resulting VSPs were compared to the reference skull and the manual VSPs my means of distance maps and three craniofacial measurements: the lateral orbital distance (LOD), the interorbital angle (IOA) and the amount of orbital advancement (OA). The width of the orbits was analyzed based on the annotated landmarks to verify the patient's ability to reach a certain LOD. Results: 11 patients with single-suture trigonocephaly were included in the study. The LOD and IOA obtained using the first and second correction method were generally lower than those of the reference skull and manual VSP. Based on comparison to the reference LOD, the third correction method showed the best fitting interorbital angle (IOA) with values of either 125 or 145 degrees in three patients (27%). In comparison to the reference skull based on a distance map, the best fitting IOA was 130 degrees for 4 out of 11 patients (36%). The width of the orbits was insufficient for correction to a healthy LOD in 8 out of 11 patients (72%). Conclusion: The research presented in this thesis demonstrated that development of an automated planning workflow for VSP of the orbital advancement in OCVRS is technically feasible. The third correction method has the greatest potential for an automated planning workflow for OCVRS in trigonocephaly patients. However, further improvements of the proposed methods are required prior to clinical implementation. Keywords: Virtual surgical planning, open cranial vault reconstruction surgery, orbital advancement, trigonocephaly, craniosynostosis |
| Item Type: | Essay (Master) |
| Clients: | RadboudUMC, Nijmegen, The Netherlands |
| Faculty: | TNW: Science and Technology |
| Subject: | 44 medicine |
| Programme: | Technical Medicine MSc (60033) |
| Link to this item: | https://purl.utwente.nl/essays/94849 |
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