The use of virtual surgical planning and navigation in the treatment of orbital trauma

Virtual surgical planning （VSP） has recently been introduced in craniomaxillofacial surgery with the goal of improving efficiency and precision for complex surgical operations. Among many indications, VSP can also be applied for the treatment of congenital and acquired craniofacial defects, including orbital fractures. VSP permits the surgeon to visualize the complex anatomy of craniofacial region, showing the relationship between bone and neurovascular structures. It can be used to design and print using three- dimensional （3D） printing technology and customized surgical models. Additionally, intraoperative navigation may be useful as an aid in performing the surgery. Navigation is useful for both the surgical dissection as well as to confirm the placement of the implant. Navigation has been found to be especially useful for orbit and sinus surgery. The present paper reports a case describing the use of VSP and computerized navigation for the reconstruction of a large orbital floor defect with a custom implant.

Virtual surgical planning is a useful tool in the surgical management of mandibular condylar fractures

Purpose:The aim of this study is to evaluate the application value of virtual surgical planning in the management of mandibular condylar fractures and to provide a reliable reference.Methods:This was a prospective randomized controlled study and recruited 50 patients requiring surgical treatment for their mandibular condylar fractures.The inclusion criteria were patients(1)diagnosed with a condylar fracture by two clinically experienced doctors and required surgical treatment;(2)have given consent for the surgical treatment;and(3)had no contraindications to the surgery.Patients were excluded from this study if:(1)they were diagnosed with a non-dislocated or only slightly dislocated condylar fracture;(2)the comminuted condylar fracture was too severe to be treated with internal reduction and fixation;or(3)patients could not complete follow-up for 3 months.There were 33 male and 17 female patients with 33 unilateral condylar fractures and 17 bilateral condylar fractures included.The 50 patients were randomly(random number)divided into control group(25 patients with 35 sides of condylar fractures)and experimental group(25 patients with 32 sides of condylar fractures).Virtual surgical planning was used in the experimental group,but only clinical experience was used in the control group.The patients were followed up for 1,3,6 and 12 months after operation.Variables including the rate of perfect reduction by radiological analysis,the average distance of deviation between preoperative and postoperative CT measurements using Geomagic software and postoperative clinical examinations(e.g.,mouth opening,occlusion)were investigated for outcome measurement.SPSS 19 was adopted for data analysis.Results:The average operation time was 180.60 min in the experimental group and 223.2 min in the control group.One week postoperatively,CT images showed that the anatomic reduction rate was 90.63%(29/32)in the experimental group and 68.57%(24/35)in the control group,revealing significant difference(X^(2)=4.919,p=0.027).Geomagic comparative analysis revealed that the average distance of deviation was also much smaller in the experimental group than that in the control group(0.639 mm vs.0.995 mm;t=3.824,p<0.001).Conclusion:These findings suggest that virtual surgical planning can assist surgeons in surgical procedures,reduce operative time,and improve the anatomic reduction rate&accuracy,and thus of value in the diagnosis and treatment of condylar fractures.

Virtual reality system for diagnosis and therapeutic planning of cerebral aneurysms

Background The virtual reality （VR） system can provide the neurosurgeon to intuitively interact with and manipulate the three dimensional （3-D） image similarly to manipulate a real object.it was seldom reported that the system was used in diagnosis and treatment of cerebral aneurysms.This study aimed to investigate the application of VR system in diagnosis and therapeutic planning of cerebral aneurysms.Methods A total of 24 cases of cerebral aneurysms were enrolled in this study from 2006 to 2008, which diagnosed by 3-D digital subtraction angiography （3D-DSA） or VR-based computed tomography angiographies （CTA）.The VR system and 3D-DSA system were used to observe and measure aneurysms and the adjacent vessels.The data of observation and measurements were compared between VR image and 3D-DSA image.All the patients underwent surgical plan and simulated neurosurgical procedures in the VR system.Results There were 28 aneurysms detected in VR system and 3D-DSA system.The VR system generated clear and vivid 3-D virtual images which clearly displayed the location and size of the aneurysms and their precise anatomical spatial relations to the parent arteries and skull.The location, size and shape of the aneurysms and their anatomical relationship with the adjacent vessels were similar between 3-D virtual image and 3D-DSA, but the spatial relationship between aneurysms and skull only been displayed by VR system.This VR system also could simulate simple surgical procedures and surgical environments.Conclusions The VR system can provide a highly effective way to provide precise imaging details as same as 3D-DSA system and assist the diagnosis of cerebral aneurysms with virtual 3-D data based on CTA.It significantly enhances the chosen therapeutic strategy of cerebral aneurysms.

Innovations with the scapula and subscapular system for head and neck microvascular reconstruction

Microvascular free flap reconstruction based on the subscapular system is an established and versatile method of reconstructing complex head and neck defects.Since the first published description in the mid-1980s,advances have been made to the harvest technique,positioning,use of virtual surgical planning,and endosseous implants.Here,the most recent literature is reviewed for innovations related to the subscapular system.Microvascular head and neck surgeon preferences related to the subscapular system are surveyed and discussed.The concordance between virtual surgical plans using scapula cutting guides and pre-contoured plates with the postoperative result is assessed,and novel applications of the scapula free flap are presented.Subscapular system free flaps are an established and essential component of the reconstructive armamentarium for head and neck defects with minimal limitations and low donor site morbidity.

Simulation training in endoscopic skull base surgery: A scoping review

Objective:Proficiency in endoscopic endonasal skull base surgery requires both substantial baseline training and progressive lifelong learning.Endoscopic simulation models continue to evolve in an effort to optimize trainee education and preoperative preparation and improve surgical outcomes.The current scoping review systematically reviews all available literature and synthesizes the current paradigms of simulation models for endoscopic skull base surgery training and skill enhancement.Methods:In accordance with Preferred Reporting Items for Systemic Review and Meta-Analyses guidelines,we systematically searched PubMed,Embase,CINAHL,and Cochrane databases.Studies were categorized according to the type of simulation models investigated.Results:We identified 238 unique references,with 55 studies ultimately meeting inclusion criteria.Of these,19 studies described cadaveric dissection models,17 discussed three-dimensional(3D)printed models,14 examined virtual surgical planning and augmented reality-based models,and five 5 articles described task trainers.Conclusions:There are a wide variety of simulation models for endoscopic skull base surgery,including high-fidelity cadaveric,virtual reality,and 3D-printed models.These models are an asset for trainee development and preoperative surgical preparation.