**Acknowledgements**

*Spina Bifida and Craniosynostosis - New Perspectives and Clinical Applications*

realistic phantoms [59].

after surgical remodeling.

anesthesia is not required.

relapses after initial treatment.

cranial vault remodeling procedures.

**6. Conclusions**

field and has not been yet integrated into the standard of care. Navigation systems are characterized by their accuracy and robustness during surgical instrument tracking with respect to patient anatomy [58]. On the other hand, AR technology is still under development and future research is still required to achieve optimal performance and robustness. Intraoperative guidance could benefit from the mixed integration of both technologies in the operating room to combine real-time and accurate positioning feedback provided by navigation systems with valuable AR visualization within the surgical field. Although both technologies require specialized training of craniofacial surgeons, proficiency could be achieved by the trainees through simulation-based training using

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

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

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

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

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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Supported by projects PI18/01625 (Ministerio de Ciencia, Innovación y Universidades, Instituto de Salud Carlos III and European Regional Development Fund "Una manera de hacer Europa") and IND2018/TIC-9753 (Comunidad de Madrid).
