Virtual surgical planning and 3D printing in repeat calvarial vault reconstruction for craniosynostosis: technical note

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Repeat surgery for restenosis after initial nonsyndromic craniosynostosis intervention is sometimes needed. Calvarial vault reconstruction through a healed surgical bed adds a level of intraoperative complexity and may benefit from preoperative and intraoperative definitions of biometric and aesthetic norms. Computer-assisted design and manufacturing using 3D imaging allows the precise formulation of operative plans in anticipation of surgical intervention. 3D printing turns virtual plans into anatomical replicas, templates, or customized implants by using a variety of materials. The authors present a technical note illustrating the use of this technology: a repeat calvarial vault reconstruction that was planned and executed using computer-assisted design and 3D printed intraoperative guides.

ABBREVIATIONSCAD/CAM = computer-assisted design and manufacturing; CVR = calvarial vault reconstruction; VSP = virtual surgical planning.

Article Information

INCLUDE WHEN CITING Published online February 3, 2017; DOI: 10.3171/2016.10.PEDS16301.

Correspondence Sandi Lam, Department of Neurosurgery, Texas Children's Hospital, 6701 Fannin St., CCC 1230.01, Houston, TX 77030. email:

© AANS, except where prohibited by US copyright law.



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    Preoperative VSP. Upper: 3D head CT scans with virtually planned osteotomies. Lower: Planned expansion to the dimensions of a normative 2-year-old female cranium (superimposed in red). Note lateral (left), where anterior is facing down, and superior (center) distractions with overall outward expansion (right). Figure is available in color online only.

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    Use of a sterile cutting guide to mark the location of preoperatively planned osteotomies (patient in prone position). Figure is available in color online only.

  • View in gallery

    Left: Alignment of cut bone segments within the expansion guidelines of the normative cranial mold and fastening with absorbable plates and screws. Right: Final expanded calvarial construct (middle and posterior calvarial vault). Figure is available in color online only.

  • View in gallery

    Placement of expanded calvaria onto the skull with lateral attachments to native bone (patient in prone position). Figure is available in color online only.



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