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

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**109**

**Chapter 6**

**Abstract**

outcome evaluation

**1. Introduction**

New Technologies to Improve

Open-Cranial Vault Remodeling

*David García-Mato, Javier Pascau and Santiago Ochandiano*

Current approaches for the surgical correction of craniosynostosis are highly dependent on surgeon experience. Therefore, outcomes are often inadequate, causing suboptimal esthetic results. Novel methods for cranial shape analysis based on statistical shape models enable accurate and objective diagnosis from preoperative 3D photographs or computed tomography scans. Moreover, advanced algorithms are now available to calculate a reference cranial shape for each patient from a multi-atlas of healthy cases, and to determine the most optimal approach to restore normal calvarial shape. During surgery, multiple technologies are available to ensure accurate translation of the preoperative virtual plan into the operating room. Patient-specific cutting guides and templates can be designed and manufactured to assist during osteotomy and remodeling. Then, intraoperative navigation and augmented reality visualization can provide real-time guidance during the placement and fixation of the remodeled bone. Finally, 3D photography enables intraoperative surgical outcome evaluation and postoperative patient follow-up. This chapter summarizes recent literature on all these technologies, showing how their integration into the surgical workflow could increase reproducibility and reduce inter-surgeon

**Keywords:** craniosynostosis, surgery, shape analysis, computer-assisted planning,

Craniosynostosis is a birth defect defined as the premature closure of one or more cranial sutures [1]. Compensatory growth of the brain along the non-fused sutures produces morphological abnormalities, including dysmorphic cranial vault and facial asymmetry, which can lead to severe conditions such as increased intracranial pressure and impaired brain growth [2]. Prevalence studies indicate that craniosynostosis affects 1 of every 2000–2500 live births worldwide [3, 4]. Although the management of craniosynostosis has significantly improved, surgical correction is the preferred approach for treatment in most cases. The objective of surgical correction is to release the fused suture and to normalize calvarial shape. Minimally invasive techniques (endoscopic, linear craniectomy) have been proposed as an alternative to open surgery [5]. These procedures are usually followed by postoperative helmet-molding therapy to facilitate appropriate changes in the

Surgical Outcome during

variability in open cranial vault remodeling procedures.
