**6. Conclusions**

Multiple technological developments have demonstrated a positive impact on the management of craniosynostosis, from the diagnosis to the postoperative patient follow-up. Cranial shape analysis based on statistical shape models contributes to a more objective and precise diagnosis of craniosynostosis that will lead to earlier detection and surgical correction. Furthermore, statistical shape models can improve preoperative planning by determining the most optimal cranial shapes to target during surgical interventions and facilitating the automatic virtual arrangement of bone fragments. This target cranial shape enables to evaluate the stability of the surgical outcome during postoperative cranial development and to identify possible relapses. In that manner, it will be possible to assess the need for overcorrection to compensate for cranial underdevelopment after surgical remodeling.

Also, the use of CAD/CAM tools, intraoperative navigation, and augmented reality will enable the accurate translation of the preoperative plan into the operating room to ensure optimal surgical outcomes. All these technologies can be integrated into the surgical workflow to increase reproducibility, to reduce operative time, to streamline the methodology, and to reduce intersurgeon variability in open cranial vault remodeling procedures.

In addition, it has been demonstrated that 3D photography presents a valuable alternative to CT imaging. This non-invasive scanning technology can be easily used for diagnosis, intraoperative surgical outcome evaluation, and patient follow-up of craniosynostosis patients avoiding the exposure of the infants to harmful ionizing radiation. Besides, 3D photographs can be acquired instantly, and sedation or anesthesia is not required.

Most of the technological developments presented in this chapter have been tested and validated in non-syndromic single-suture synostosis. However, these approaches could also be applied to syndromic multi-suture synostosis. In these complex cases, most anatomical references in the cranium are altered and optimal surgical correction is challenging. Therefore, these cases will highly benefit from computer-assisted diagnosis, planning, and intraoperative guidance to achieve optimal surgical outcomes. Furthermore, these techniques could also be applied to secondary surgical interventions performed to correct possible complications or relapses after initial treatment.

Although all technologies mentioned can greatly benefit the management of craniosynostosis, there are some limitations to bear in mind. First of all, most of these technologies are costly, and this factor may restrict their integration into clinical practice in some centers with limited budgets. However, many of the previously mentioned technological developments are based on free and open-source software

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*New Technologies to Improve Surgical Outcome during Open-Cranial Vault Remodeling*

platforms [12, 53], which could reduce the costs associated with its integration on the surgical workflow. Also, CAD/CAM guides and templates can be designed and manufactured in-hospital to reduce cost and production time [60, 61]. These technologies could also be shared among different hospital departments, improving

Apart from the economic perspective, some indirect costs must also be considered. The addition of advanced cranial shape analysis, automatic planning algorithms, and design and manufacturing of CAD/CAM tools may increase the duration of the planning phase and will also require the collaboration of engineers. However, patient-specific planning of craniosynostosis surgeries is essential to improve surgical treatment. Advanced algorithms can provide valuable objective metrics to determine the best remodeling approach for each patient. Therefore, the benefits of these technological advancements may outweigh the increased duration

In addition, most of the technologies developed for image-guided craniosynostosis surgeries require specialized training for craniofacial surgeons and some of them present a steep learning curve. However, surgeries can be simulated preoperatively using patient-specific phantoms to provide the trainees with realistic tactile feedback of the patient's anatomy. Simulation offers a safe environment where surgery can be replicated step-by-step leading to the acquisition of technical skills which can be translated into better performance during the surgical task [59]. To conclude, multiple technologies are currently available to improve the surgical management of craniosynostosis. The integration of these developments on the surgical workflow of craniosynostosis will have a positive impact on the surgical outcomes, increasing the reproducibility and efficiency of these procedures. Multidisciplinary collaborations between scientific and clinical personnel are essential to improve patient care. Further studies must evaluate the costeffectiveness of these technologies to determine how to integrate them optimally

Supported by projects PI18/01625 (Ministerio de Ciencia, Innovación y

The authors declare that they have no conflicts of interest.

Universidades, Instituto de Salud Carlos III and European Regional Development Fund "Una manera de hacer Europa") and IND2018/TIC-9753 (Comunidad de Madrid).

*DOI: http://dx.doi.org/10.5772/intechopen.94536*

their impact at a lower cost.

of the preoperative planning phase.

into clinical practice.

**Acknowledgements**

**Conflict of interest**

#### *New Technologies to Improve Surgical Outcome during Open-Cranial Vault Remodeling DOI: http://dx.doi.org/10.5772/intechopen.94536*

platforms [12, 53], which could reduce the costs associated with its integration on the surgical workflow. Also, CAD/CAM guides and templates can be designed and manufactured in-hospital to reduce cost and production time [60, 61]. These technologies could also be shared among different hospital departments, improving their impact at a lower cost.

Apart from the economic perspective, some indirect costs must also be considered. The addition of advanced cranial shape analysis, automatic planning algorithms, and design and manufacturing of CAD/CAM tools may increase the duration of the planning phase and will also require the collaboration of engineers. However, patient-specific planning of craniosynostosis surgeries is essential to improve surgical treatment. Advanced algorithms can provide valuable objective metrics to determine the best remodeling approach for each patient. Therefore, the benefits of these technological advancements may outweigh the increased duration of the preoperative planning phase.

In addition, most of the technologies developed for image-guided craniosynostosis surgeries require specialized training for craniofacial surgeons and some of them present a steep learning curve. However, surgeries can be simulated preoperatively using patient-specific phantoms to provide the trainees with realistic tactile feedback of the patient's anatomy. Simulation offers a safe environment where surgery can be replicated step-by-step leading to the acquisition of technical skills which can be translated into better performance during the surgical task [59].

To conclude, multiple technologies are currently available to improve the surgical management of craniosynostosis. The integration of these developments on the surgical workflow of craniosynostosis will have a positive impact on the surgical outcomes, increasing the reproducibility and efficiency of these procedures. Multidisciplinary collaborations between scientific and clinical personnel are essential to improve patient care. Further studies must evaluate the costeffectiveness of these technologies to determine how to integrate them optimally into clinical practice.
