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Zhang Y, Pei Y, Guo Y, Chen S, Zhou ZB, Xu T, Zha H. Adaptable cascaded registration for personalized maxilla completion and cleft defect volume estimation. Med Phys 2024; 51:4283-4296. [PMID: 38555877 DOI: 10.1002/mp.17046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 01/29/2024] [Accepted: 03/04/2024] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND Cone-beam computed tomography (CBCT) images provide high-resolution insights into the underlying craniofacial anomaly in patients with cleft lip and palate (CLP), requiring non-negligible annotation costs to measure the cleft defect for the guidance of the clinical secondary alveolar bone graft procedures. Considering the cumbersome volumetric image acquisition, there is a lack of paired CLP CBCTs and normal CBCTs for learning-based anatomical structure restoration models. Nowadays, the registration-based method relieves the annotation burden, though one-shot registration and the regular mask are limited to handling fine-grained shape variations and harmony between restored bony tissues and the defected maxilla. PURPOSE This study aimed to design and evaluate a novel method for deformable partial registration of the CLP CBCTs and normal CBCTs, enabling personalized maxilla completion and cleft defect volume prediction from CLP CBCTs. METHODS We proposed an adaptable deep registration framework for personalized maxilla completion and cleft defect volume prediction from CLP CBCTs. The key ingredient was a cascaded partial registration to exploit the maxillary morphology prior and attribute transfer. Cascaded registration with coarse-to-fine registration fields handled morphological variations of cleft defects and fine-grained maxillary restoration. We designed an adaptable cleft defect mask and volumetric Boolean operators for reliable voxel filling of the defected maxilla. A total of 36 clinically obtained CLP CBCTs were used to train and validate the proposed model, among which 22 CLP CBCTs were used to generate a training dataset with 440 synthetic CBCTs by B-spline deformation-based data augmentation and the remaining for testing. The proposed model was evaluated on maxilla completion and cleft defect volume prediction from clinically obtained unilateral and bilateral CLP CBCTs. RESULTS Extensive experiments demonstrated the effectiveness of the adaptable cleft defect mask and the cascaded partial registration on maxilla completion and cleft defect volume prediction. The proposed method achieved state-of-the-art performances with the Dice similarity coefficient of 0.90 ± $\pm$ 0.02 on the restored maxilla and 0.84 ± $\pm$ 0.04 on the estimated cleft defect, respectively. The average Hausdorff distance between the estimated cleft defect and the manually annotated ground truth was 0.30 ± $\pm$ 0.08 mm. The relative volume error of the cleft defect was0.09 ± $0.09\pm$ 0.08. The proposed model allowed for the prediction of cleft defect maps that were in line with the ground truth in the challenging unilateral and bilateral CLP CBCTs. CONCLUSIONS The results suggest that the proposed adaptable deep registration model enables patient-specific maxilla completion and automatic annotation of cleft defects, relieving tedious voxel-wise annotation and image acquisition burdens.
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Affiliation(s)
- Yungeng Zhang
- Key Laboratory of Machine Perception (MOE), Department of Machine Intelligence, School of Intelligence Science and Technology, Peking University, Beijing, China
- China Telecom Research Institute, Beijing, China
| | - Yuru Pei
- Key Laboratory of Machine Perception (MOE), Department of Machine Intelligence, School of Intelligence Science and Technology, Peking University, Beijing, China
| | - Yixiao Guo
- Key Laboratory of Machine Perception (MOE), Department of Machine Intelligence, School of Intelligence Science and Technology, Peking University, Beijing, China
| | - Si Chen
- School of Stomatology, Stomatology Hospital, Peking University, Beijing, China
| | - Zhi-Bo Zhou
- School of Stomatology, Stomatology Hospital, Peking University, Beijing, China
| | - Tianmin Xu
- School of Stomatology, Stomatology Hospital, Peking University, Beijing, China
| | - Hongbin Zha
- Key Laboratory of Machine Perception (MOE), Department of Machine Intelligence, School of Intelligence Science and Technology, Peking University, Beijing, China
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Kim CNT, Binh CX, Dung VT, Toan TV. Design and mechanical evaluation of a large cranial implant and fixation parts. INTERDISCIPLINARY NEUROSURGERY 2023. [DOI: 10.1016/j.inat.2022.101676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Tantisatirapong S, Khunakornpattanakarn S, Suesatsakul T, Boonpratatong A, Benjamin I, Tongmeesee S, Kangkorn T, Chanwimalueang T. The simplified tailor-made workflows for a 3D slicer-based craniofacial implant design. Sci Rep 2023; 13:2850. [PMID: 36801943 PMCID: PMC9938178 DOI: 10.1038/s41598-023-30117-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 02/15/2023] [Indexed: 02/19/2023] Open
Abstract
A specific design of craniofacial implant model is vital and urgent for patients with traumatic head injury. The mirror technique is commonly used for modeling these implants, but it requires the presence of a healthy skull region opposite to the defect. To address this limitation, we propose three processing workflows for modeling craniofacial implants: the mirror method, the baffle planner, and the baffle-based mirror guideline. These workflows are based on extension modules on the 3D Slicer platform and were developed to simplify the modeling process for a variety of craniofacial scenarios. To evaluate the effectiveness of these proposed workflows, we investigated craniofacial CT datasets collected from four accidental cases. The designed implant models were created using the three proposed workflows and compared to reference models created by an experienced neurosurgeon. The spatial properties of the models were evaluated using performance metrics. Our results show that the mirror method is suitable for cases where a healthy skull region can be completely reflected to the defect region. The baffle planner module offers a flexible prototype model that can be fit independently to any defect location, but it requires customized refinement of contour and thickness to fill the missing region seamlessly and relies on the user's experience and expertise. The proposed baffle-based mirror guideline method strengthens the baffle planner method by tracing the mirrored surface. Overall, our study suggests that the three proposed workflows for craniofacial implant modeling simplify the process and can be practically applied to a variety of craniofacial scenarios. These findings have the potential to improve the care of patients with traumatic head injuries and could be used by neurosurgeons and other medical professionals.
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Affiliation(s)
- Suchada Tantisatirapong
- grid.412739.a0000 0000 9006 7188Department of Biomedical Engineering, Faculty of Engineering, Srinakharinwirot University, Nakhon Nayok, 26120 Thailand
| | - Sarunyapong Khunakornpattanakarn
- grid.412739.a0000 0000 9006 7188Department of Biomedical Engineering, Faculty of Engineering, Srinakharinwirot University, Nakhon Nayok, 26120 Thailand
| | - Thanyakarn Suesatsakul
- grid.412739.a0000 0000 9006 7188Department of Biomedical Engineering, Faculty of Engineering, Srinakharinwirot University, Nakhon Nayok, 26120 Thailand
| | - Amaraporn Boonpratatong
- grid.412739.a0000 0000 9006 7188Department of Biomedical Engineering, Faculty of Engineering, Srinakharinwirot University, Nakhon Nayok, 26120 Thailand
| | - Itsara Benjamin
- grid.414283.80000 0001 0580 0910Division of Plastic and Reconstructive Surgery, Department of Surgery, Chonburi Hospital, Chonburi, 20000 Thailand
| | - Somprasong Tongmeesee
- grid.414283.80000 0001 0580 0910Division of Plastic and Reconstructive Surgery, Department of Surgery, Chonburi Hospital, Chonburi, 20000 Thailand
| | - Tanasit Kangkorn
- grid.414283.80000 0001 0580 0910Division of Plastic and Reconstructive Surgery, Department of Surgery, Chonburi Hospital, Chonburi, 20000 Thailand
| | - Theerasak Chanwimalueang
- Department of Biomedical Engineering, Faculty of Engineering, Srinakharinwirot University, Nakhon Nayok, 26120, Thailand.
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Fuessinger MA, Metzger MC, Rothweiler R, Brandenburg LS, Schlager S. Cranial reconstruction evaluation - comparison of European statistical shape model performance on Chinese dataset. Bone Rep 2022; 17:101611. [PMID: 36120645 PMCID: PMC9478677 DOI: 10.1016/j.bonr.2022.101611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 08/10/2022] [Accepted: 08/12/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose Morphological variability of the skull is an important consideration for cranioplasty and implant design. Differences in morphology of the skull based on the ethnicity are known. In a previous study we could show the accuracy and benefits of virtual reconstructions based on a statistical shape model (SSM) for neurocranial defects. As the SSM is trained on European data, the question arises how well this model fares when dealing with patients with a different ethnic background. In this study we aim to evaluate the accuracy and applicability of our proposed method when deploying a cranial SSM generated from European data to estimate missing parts of the neurocranium in a Chinese population. Methods We used the same data and methods as in our previous study and compared the outcomes when applied to Chinese individuals. A large unilateral defect on the right side and a bilateral defect were created. The outer surface of the cranial table was reconstructed from CT scans, meshed with triangular elements, and registered to a template. Principal component analysis together with Thin Plate Spines (TPS) deformation was applied to quantify modes of variation. The mesh to mesh distances between the original defects´ surfaces and the reconstructed surface were computed. Results Comparing the Chinese test group with the European control group, regarding the entire defect the analysis shows no significant difference for unilateral defects (test vs. control group/0.46 mm ± vs. 0.44 mm). Reconstruction of bilateral defects exhibited only in slightly higher prediction errors than those of unilateral defects (0.49 mm ± vs. 0.45 mm). Conclusion The proposed method shows a high accuracy that seems to be ethnical independent - with low error margins for virtual skull reconstruction and implant design. Clinical relevance: Metallic objects may severely impact image quality in several CBCT devices. Statistical shape modelling enables automatic skull reconstruction for computer assisted surgery Despite a Caucasian database, the statistical shape model can provide accurate results for other ethnic groups. The results facilitate the development of reconstruction algorithms, as the data basis can be kept smaller
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Affiliation(s)
- Marc Anton Fuessinger
- Department of Oral and Maxillofacial Surgery, Albert-Ludwigs University Freiburg, Hugstetterstr. 55, 79106 Freiburg, Germany
| | - Marc Christian Metzger
- Department of Oral and Maxillofacial Surgery, Albert-Ludwigs University Freiburg, Hugstetterstr. 55, 79106 Freiburg, Germany
| | - Rene Rothweiler
- Department of Oral and Maxillofacial Surgery, Albert-Ludwigs University Freiburg, Hugstetterstr. 55, 79106 Freiburg, Germany
| | - Leonard Simon Brandenburg
- Department of Oral and Maxillofacial Surgery, Albert-Ludwigs University Freiburg, Hugstetterstr. 55, 79106 Freiburg, Germany
| | - Stefan Schlager
- Department of Physical Anthropology, Albert-Ludwigs University Freiburg, Hebelstr. 29, 79104 Freiburg, Germany
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Wodzinski M, Daniol M, Socha M, Hemmerling D, Stanuch M, Skalski A. Deep learning-based framework for automatic cranial defect reconstruction and implant modeling. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2022; 226:107173. [PMID: 36257198 DOI: 10.1016/j.cmpb.2022.107173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 08/19/2022] [Accepted: 10/02/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND AND OBJECTIVE This article presents a robust, fast, and fully automatic method for personalized cranial defect reconstruction and implant modeling. METHODS We propose a two-step deep learning-based method using a modified U-Net architecture to perform the defect reconstruction, and a dedicated iterative procedure to improve the implant geometry, followed by an automatic generation of models ready for 3-D printing. We propose a cross-case augmentation based on imperfect image registration combining cases from different datasets. Additional ablation studies compare different augmentation strategies and other state-of-the-art methods. RESULTS We evaluate the method on three datasets introduced during the AutoImplant 2021 challenge, organized jointly with the MICCAI conference. We perform the quantitative evaluation using the Dice and boundary Dice coefficients, and the Hausdorff distance. The Dice coefficient, boundary Dice coefficient, and the 95th percentile of Hausdorff distance averaged across all test sets, are 0.91, 0.94, and 1.53 mm respectively. We perform an additional qualitative evaluation by 3-D printing and visualization in mixed reality to confirm the implant's usefulness. CONCLUSION The article proposes a complete pipeline that enables one to create the cranial implant model ready for 3-D printing. The described method is a greatly extended version of the method that scored 1st place in all AutoImplant 2021 challenge tasks. We freely release the source code, which together with the open datasets, makes the results fully reproducible. The automatic reconstruction of cranial defects may enable manufacturing personalized implants in a significantly shorter time, possibly allowing one to perform the 3-D printing process directly during a given intervention. Moreover, we show the usability of the defect reconstruction in a mixed reality that may further reduce the surgery time.
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Affiliation(s)
- Marek Wodzinski
- Department of Measurement and Electronics, AGH University of Science and Technology, Krakow, Poland; MedApp S.A., Krakow, Poland; Information Systems Institute, University of Applied Sciences Western Switzerland, Sierre, Switzerland.
| | - Mateusz Daniol
- Department of Measurement and Electronics, AGH University of Science and Technology, Krakow, Poland; MedApp S.A., Krakow, Poland
| | - Miroslaw Socha
- Department of Measurement and Electronics, AGH University of Science and Technology, Krakow, Poland
| | - Daria Hemmerling
- Department of Measurement and Electronics, AGH University of Science and Technology, Krakow, Poland
| | - Maciej Stanuch
- Department of Measurement and Electronics, AGH University of Science and Technology, Krakow, Poland; MedApp S.A., Krakow, Poland
| | - Andrzej Skalski
- Department of Measurement and Electronics, AGH University of Science and Technology, Krakow, Poland; MedApp S.A., Krakow, Poland
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Kodym O, Španěl M, Herout A. Deep learning for cranioplasty in clinical practice: Going from synthetic to real patient data. Comput Biol Med 2021; 137:104766. [PMID: 34425418 DOI: 10.1016/j.compbiomed.2021.104766] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 08/10/2021] [Accepted: 08/10/2021] [Indexed: 11/17/2022]
Abstract
Correct virtual reconstruction of a defective skull is a prerequisite for successful cranioplasty and its automatization has the potential for accelerating and standardizing the clinical workflow. This work provides a deep learning-based method for the reconstruction of a skull shape and cranial implant design on clinical data of patients indicated for cranioplasty. The method is based on a cascade of multi-branch volumetric CNNs that enables simultaneous training on two different types of cranioplasty ground-truth data: the skull patch, which represents the exact shape of the missing part of the original skull, and which can be easily created artificially from healthy skulls, and expert-designed cranial implant shapes that are much harder to acquire. The proposed method reaches an average surface distance of the reconstructed skull patches of 0.67 mm on a clinical test set of 75 defective skulls. It also achieves a 12% reduction of a newly proposed defect border Gaussian curvature error metric, compared to a baseline model trained on synthetic data only. Additionally, it produces directly 3D printable cranial implant shapes with a Dice coefficient 0.88 and a surface error of 0.65 mm. The outputs of the proposed skull reconstruction method reach good quality and can be considered for use in semi- or fully automatic clinical cranial implant design workflows.
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Affiliation(s)
- Oldřich Kodym
- Department of Computer Graphics and Multimedia, Brno University of Technology, Božetěchova 2, 612 66, Brno, Czech Republic.
| | - Michal Španěl
- Department of Computer Graphics and Multimedia, Brno University of Technology, Božetěchova 2, 612 66, Brno, Czech Republic
| | - Adam Herout
- Department of Computer Graphics and Multimedia, Brno University of Technology, Božetěchova 2, 612 66, Brno, Czech Republic
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Wittner C, Borowski M, Pirl L, Kastner J, Schrempf A, Schäfer U, Trieb K, Senck S. Thickness accuracy of virtually designed patient-specific implants for large neurocranial defects. J Anat 2021; 239:755-770. [PMID: 34086982 PMCID: PMC8450480 DOI: 10.1111/joa.13465] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 04/27/2021] [Accepted: 05/12/2021] [Indexed: 12/15/2022] Open
Abstract
The combination of computer‐aided design (CAD) techniques based on computed tomography (CT) data to generate patient‐specific implants is in use for decades. However, persisting disadvantages are complicated design procedures and rigid reconstruction protocols, for example, for tailored implants mimicking the patient‐specific thickness distribution of missing cranial bone. In this study we used two different approaches, CAD‐ versus thin‐plate spline (TPS)‐based implants, to reconstruct extensive unilateral and bilateral cranial defects in three clinical cases. We used CT data of three complete human crania that were virtually damaged according to the missing regions in the clinical cases. In total, we carried out 132 virtual reconstructions and quantified accuracy from the original to the generated implant and deviations in the resulting implant thickness as root‐mean‐square error (RMSE). Reconstructions using TPS showed an RMSE of 0.08–0.18 mm in relation to geometric accuracy. CAD‐based implants showed an RMSE of 0.50–1.25 mm. RMSE in relation to implant thickness was between 0.63 and 0.70 mm (TPS) while values for CAD‐based implants were significantly higher (0.63–1.67 mm). While both approaches provide implants showing a high accuracy, the TPS‐based approach additionally provides implants that accurately reproduce the patient‐specific thickness distribution of the affected cranial region.
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Affiliation(s)
- Claudia Wittner
- Research Group Computed Tomography, University of Applied Sciences Upper Austria, Wels, Austria
| | - Markus Borowski
- Institut für Röntgendiagnostik und Nuklearmedizin, Städtisches Klinikum Braunschweig GmbH, Braunschweig, Germany
| | - Lukas Pirl
- Institut für Röntgendiagnostik und Nuklearmedizin, Städtisches Klinikum Braunschweig GmbH, Braunschweig, Germany
| | - Johann Kastner
- Research Group Computed Tomography, University of Applied Sciences Upper Austria, Wels, Austria
| | - Andreas Schrempf
- Research Group for Surgical Simulators Linz, University of Applied Sciences Upper Austria, Linz, Austria
| | - Ute Schäfer
- Forschungseinheit Experimentelle Neurotraumatologie, Medizinische Universität Graz, Graz, Austria
| | - Klemens Trieb
- Research Group Computed Tomography, University of Applied Sciences Upper Austria, Wels, Austria.,Department of Orthopedic and Trauma Surgery, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Sascha Senck
- Research Group Computed Tomography, University of Applied Sciences Upper Austria, Wels, Austria
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Morais A, Egger J, Alves V. Automated Computer-aided Design of Cranial Implants Using a Deep Volumetric Convolutional Denoising Autoencoder. ADVANCES IN INTELLIGENT SYSTEMS AND COMPUTING 2019. [DOI: 10.1007/978-3-030-16187-3_15] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Volpe Y, Furferi R, Governi L, Uccheddu F, Carfagni M, Mussa F, Scagnet M, Genitori L. Surgery of complex craniofacial defects: A single-step AM-based methodology. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2018; 165:225-233. [PMID: 30337077 DOI: 10.1016/j.cmpb.2018.09.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 08/17/2018] [Accepted: 09/03/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND AND OBJECTIVE The purpose of the present paper is to pave the road to the systematic optimization of complex craniofacial surgical intervention and to validate a design methodology for the virtual surgery and the fabrication of cranium vault custom plates. Recent advances in the field of medical imaging, image processing and additive manufacturing (AM) have led to new insights in several medical applications. The engineered combination of medical actions and 3D processing steps, foster the optimization of the intervention in terms of operative time and number of sessions needed. Complex craniofacial surgical intervention, such as for instance severe hypertelorism accompanied by skull holes, traditionally requires a first surgery to correctly "resize" the patient cranium and a second surgical session to implant a customized 3D printed prosthesis. Between the two surgical interventions, medical imaging needs to be carried out to aid the design the skull plate. Instead, this paper proposes a CAD/AM-based one-in-all design methodology allowing the surgeons to perform, in a single surgical intervention, both skull correction and implantation. METHODS A strategy envisaging a virtual/mock surgery on a CAD/AM model of the patient cranium so as to plan the surgery and to design the final shape of the cranium plaque is proposed. The procedure relies on patient imaging, 3D geometry reconstruction of the defective skull, virtual planning and mock surgery to determine the hypothetical anatomic 3D model and, finally, to skull plate design and 3D printing. RESULTS The methodology has been tested on a complex case study. Results demonstrate the feasibility of the proposed approach and a consistent reduction of time and overall cost of the surgery, not to mention the huge benefits on the patient that is subjected to a single surgical operation. CONCLUSIONS Despite a number of AM-based methodologies have been proposed for designing cranial implants or to correct orbital hypertelorism, to the best of the authors' knowledge, the present work is the first to simultaneously treat osteotomy and titanium cranium plaque.
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Affiliation(s)
- Yary Volpe
- Department of Industrial Engineering of Florence, University of Florence (Italy), via di Santa Marta 3, 50139 Firenze, Italy
| | - Rocco Furferi
- Department of Industrial Engineering of Florence, University of Florence (Italy), via di Santa Marta 3, 50139 Firenze, Italy.
| | - Lapo Governi
- Department of Industrial Engineering of Florence, University of Florence (Italy), via di Santa Marta 3, 50139 Firenze, Italy
| | - Francesca Uccheddu
- Department of Industrial Engineering of Florence, University of Florence (Italy), via di Santa Marta 3, 50139 Firenze, Italy
| | - Monica Carfagni
- Department of Industrial Engineering of Florence, University of Florence (Italy), via di Santa Marta 3, 50139 Firenze, Italy
| | - Federico Mussa
- Department of Pediatric Surgery, Meyer Children's Hospital, Viale Pieraccini 24, 50141 Florence, Italy
| | - Mirko Scagnet
- Department of Pediatric Surgery, Meyer Children's Hospital, Viale Pieraccini 24, 50141 Florence, Italy
| | - Lorenzo Genitori
- Department of Pediatric Surgery, Meyer Children's Hospital, Viale Pieraccini 24, 50141 Florence, Italy
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Xie S, Leow WK, Lee H, Lim TC. Flip‐avoiding interpolating surface registration for skull reconstruction. Int J Med Robot 2018; 14:e1906. [DOI: 10.1002/rcs.1906] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 02/02/2018] [Accepted: 02/02/2018] [Indexed: 11/12/2022]
Affiliation(s)
- Shudong Xie
- Department of Computer Science National University of Singapore
| | - Wee Kheng Leow
- Department of Computer Science National University of Singapore
| | - Hanjing Lee
- Division of Plastic, Reconstruction and Aesthetic Surgery National University Hospital Singapore
| | - Thiam Chye Lim
- Division of Plastic, Reconstruction and Aesthetic Surgery National University Hospital Singapore
- Department of Surgery National University of Singapore
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Planning of skull reconstruction based on a statistical shape model combined with geometric morphometrics. Int J Comput Assist Radiol Surg 2017; 13:519-529. [DOI: 10.1007/s11548-017-1674-6] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Accepted: 10/01/2017] [Indexed: 01/08/2023]
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12
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Rodriguez-Florez N, Bruse JL, Borghi A, Vercruysse H, Ong J, James G, Pennec X, Dunaway DJ, Jeelani NUO, Schievano S. Statistical shape modelling to aid surgical planning: associations between surgical parameters and head shapes following spring-assisted cranioplasty. Int J Comput Assist Radiol Surg 2017; 12:1739-1749. [PMID: 28550406 PMCID: PMC5608871 DOI: 10.1007/s11548-017-1614-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 05/16/2017] [Indexed: 12/04/2022]
Abstract
PURPOSE Spring-assisted cranioplasty is performed to correct the long and narrow head shape of children with sagittal synostosis. Such corrective surgery involves osteotomies and the placement of spring-like distractors, which gradually expand to widen the skull until removal about 4 months later. Due to its dynamic nature, associations between surgical parameters and post-operative 3D head shape features are difficult to comprehend. The current study aimed at applying population-based statistical shape modelling to gain insight into how the choice of surgical parameters such as craniotomy size and spring positioning affects post-surgical head shape. METHODS Twenty consecutive patients with sagittal synostosis who underwent spring-assisted cranioplasty at Great Ormond Street Hospital for Children (London, UK) were prospectively recruited. Using a nonparametric statistical modelling technique based on mathematical currents, a 3D head shape template was computed from surface head scans of sagittal patients after spring removal. Partial least squares (PLS) regression was employed to quantify and visualise trends of localised head shape changes associated with the surgical parameters recorded during spring insertion: anterior-posterior and lateral craniotomy dimensions, anterior spring position and distance between anterior and posterior springs. RESULTS Bivariate correlations between surgical parameters and corresponding PLS shape vectors demonstrated that anterior-posterior (Pearson's [Formula: see text]) and lateral craniotomy dimensions (Spearman's [Formula: see text]), as well as the position of the anterior spring ([Formula: see text]) and the distance between both springs ([Formula: see text]) on average had significant effects on head shapes at the time of spring removal. Such effects were visualised on 3D models. CONCLUSIONS Population-based analysis of 3D post-operative medical images via computational statistical modelling tools allowed for detection of novel associations between surgical parameters and head shape features achieved following spring-assisted cranioplasty. The techniques described here could be extended to other cranio-maxillofacial procedures in order to assess post-operative outcomes and ultimately facilitate surgical decision making.
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Affiliation(s)
- Naiara Rodriguez-Florez
- UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK.
- Craniofacial Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.
| | - Jan L Bruse
- Craniofacial Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, London, UK
| | - Alessandro Borghi
- UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
- Craniofacial Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Herman Vercruysse
- Craniofacial Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Juling Ong
- Craniofacial Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Greg James
- UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
- Craniofacial Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | | | - David J Dunaway
- UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
- Craniofacial Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - N U Owase Jeelani
- UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
- Craniofacial Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Silvia Schievano
- UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
- Craniofacial Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, London, UK
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Unterhofer C, Wipplinger C, Verius M, Recheis W, Thomé C, Ortler M. Reconstruction of large cranial defects with poly-methyl-methacrylate (PMMA) using a rapid prototyping model and a new technique for intraoperative implant modeling. Neurol Neurochir Pol 2017; 51:214-220. [DOI: 10.1016/j.pjnns.2017.02.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2016] [Revised: 02/06/2017] [Accepted: 02/23/2017] [Indexed: 10/20/2022]
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Interactive reconstructions of cranial 3D implants under MeVisLab as an alternative to commercial planning software. PLoS One 2017; 12:e0172694. [PMID: 28264062 PMCID: PMC5338774 DOI: 10.1371/journal.pone.0172694] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 02/08/2017] [Indexed: 11/19/2022] Open
Abstract
In this publication, the interactive planning and reconstruction of cranial 3D Implants under the medical prototyping platform MeVisLab as alternative to commercial planning software is introduced. In doing so, a MeVisLab prototype consisting of a customized data-flow network and an own C++ module was set up. As a result, the Computer-Aided Design (CAD) software prototype guides a user through the whole workflow to generate an implant. Therefore, the workflow begins with loading and mirroring the patients head for an initial curvature of the implant. Then, the user can perform an additional Laplacian smoothing, followed by a Delaunay triangulation. The result is an aesthetic looking and well-fitting 3D implant, which can be stored in a CAD file format, e.g. STereoLithography (STL), for 3D printing. The 3D printed implant can finally be used for an in-depth pre-surgical evaluation or even as a real implant for the patient. In a nutshell, our research and development shows that a customized MeVisLab software prototype can be used as an alternative to complex commercial planning software, which may also not be available in every clinic. Finally, not to conform ourselves directly to available commercial software and look for other options that might improve the workflow.
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