[Computer-assisted planning and modeling for the surgical treatment of patients with fibrous dysplasia of cranial vault and base].

Abstract

Background: The probability of cranial lesions in fibrous dysplasia reaches 50%. A pre-operative computer-assisted planning provides opportunities for precise radical bone resection and customized xenograft manufacturing.

Objective: To evaluate postoperative outcomes in patients with fibrous dysplasia of the cranial vault and base, achived by means of preoperative computer-assisted planning and modeling.

Material and methods: There were 32 patients with fibrous dysplasia of skull cranioorbital and vault localisation in Moscow National Medical Research Center for Neurosurgery named after Academician N.N. Burdenko from 2008 to 2024. All patients underwent a virtual lesion resection, a surgical template and a customized implant or its mold modelling. Implants were mostly manufactured from polymethylmethacrylate either before or during the surgery. The peculiarities of surgeries were application of template to dysplastic bone, resection within appropriate contour and subsequent cranioplasty with customized cranial implant. After surgery, we performed CT and analyzed deviations between postoperative and virtual skull. Reconstruction quality was assessed evaluating cranial asymmetry by means of craniometric analysis.

Results: Craniometric measurements of asymmetry proved the effectiveness of surgical skull correction. The part comparison analysis of skull models after a computer-assisted planning and operations revealed convenience and predictability of the chosen approach.

Conclusion: The developed complex of preoperative computer-assisted planning and modeling significantly improved resection and cranioplasty quality.