Search Results (95)

Cranial cruciate ligament (CrCL) rupture is a common orthopedic disorder in dogs, leading to stifle joint instability and progressive osteoarthritis. This study aimed to develop and biomechanically evaluate a novel intra-articular reconstruction system designed to mimic the natural ligament and restore joint stability following CrCL excision. The system consisted of a 3D-printed thermoplastic polyurethane (TPU) graft, cerclage wire, and H-button fixation. Fourteen pelvic limbs from mature mixed-breed cadaveric dogs were used. The inclination angle, dimensions, volume, tensile strength, and elongation of the native CrCL were measured. Seven CrCL-deficient stifles were reconstructed using the proposed system and tested biomechanically. The native CrCL showed a significantly higher tensile strength than the TPU graft; however, the TPU demonstrated a greater flexibility. The reconstruction system successfully stabilized the joint and provided repeatable fixation. Significant correlations were found between CrCL volume and both age and body weight. These findings support the mechanical suitability of the proposed system for ex vivo stifle stabilization and highlight the potential of 3D-printed TPU in ligament reconstruction. Further in vivo studies are recommended to assess long-term performance, including implant integration, tissue remodeling, and clinical outcomes. Full article

Background/Objectives: This case study presents the first documented use of a low-cost, simulated, patient-specific three-dimensional (3D) printed model to support presurgical planning for an infant with Apert syndrome in a resource-limited setting. The primary objectives are to (1) demonstrate the value of 3D printing as a simulation tool for preoperative planning in low-resource environments and (2) identify opportunities for future AI-enhanced simulation models in craniofacial surgical planning. Methods: High-resolution CT data were segmented using InVesalius 3, with mesh refinement performed in ANSYS SpaceClaim (version 2021). The cranial model was fabricated using fused deposition modeling (FDM) on a Creality Ender-3 printer with Acrylonitrile Butadiene Styrene (ABS) filament. Results: The resulting 3D-printed simulated model enabled the surgical team to assess cranial anatomy, simulate incision placement, and rehearse osteotomies. These steps contributed to a reduction in operative time and fewer complications during surgery. Conclusions: This case demonstrates the value of accessible 3D printing as a simulation tool in surgical planning within low-resource settings. Building on this success, the study highlights potential points for AI integration, such as automated image segmentation and model reconstruction, to increase efficiency and scalability in future 3D-printed simulation models. Full article

Background and Clinical Significance: Traumatic brain injury (TBI) represents a major public health concern due to its profound neurological, psychological, and socioeconomic consequences. Effective management is essential to optimize patient outcomes and reduce healthcare burden. In cases involving extensive bone loss or complex fractures, particularly when decompressive craniectomy (DC) is considered, secondary cranial reconstruction is typically required. However, DC is associated with prolonged hospitalization, multiple surgical interventions, an increased risk of complications, and higher costs. Case Presentation: We present the case of a 59-year-old male involved in a high-energy bicycle accident, sustaining severe craniofacial trauma with multiple midface fractures, a multifragmented left cranial fracture, and a left-sided epidural hematoma with brain compression. Hematoma evacuation and immediate primary reconstruction of the fractured skull using autologous bone were successfully performed, avoiding the need for DC. The patient recovered under intensive care and was transferred to a neurorehabilitation center. Conclusions: Primary reconstruction of large skull fractures using autologous bone should remain the goal, whenever possible, in order to avoid additional costs, risks, and complications. Full article

For the vast majority of spatial navigation research, experimental tasks are implemented in real-world environments. In recent decades, there has been an increasing trend toward virtual environments, which offer several benefits compared to their real-world counterparts while also having certain limitations. With these properties in mind, we have developed the Gallery of Memories (GA-ME), a customizable virtual-navigation task that is equipped for the assessment of both spatial navigation and memory within a highly controlled three-dimensional environment. The GA-ME provides a 3D position and head direction (pitch and yaw) sampling rate that is significantly higher compared to alternatives, enabling users to reconstruct a participant’s movement in the environment with remarkable spatiotemporal precision while its design, including nested spaces, makes it optimal for the study of place and grid cells in humans. These properties imbue the GA-ME with the potential to be widely utilized in both research and clinical settings for the in-depth study of spatial navigation and memory, with the possibility of conducting human intra- and extra-cranial electrophysiology, imaging, and eye-tracking measurements relevant to these faculties. Full article

Objectives: The aim of the present study was to examine the growth dynamics of the ossification centers of the lesser wings of the sphenoid bone in the human fetus based on linear, planar, and volumetric parameters. Methods: The examinations were carried out on 37 human fetuses of both sexes (16 males and 21 females) after 18–30 weeks of gestation. These were obtained from spontaneous miscarriages and preterm deliveries. Using computed tomography (CT), digital image analysis software, 3D reconstruction, and statistical methods, the size and growth patterns of the ossification centers of the lesser wings of the sphenoid bone were evaluated. Results: All morphometric parameters—length, width, projected surface area, and volume—of the ossification centers of the lesser wings of the sphenoid bone increased proportionally with gestational age. No significant sex-related or lateral differences were observed. Conclusions: The numerical data obtained from CT-based analysis and the observed growth trends of the ossification centers of the lesser wings of the sphenoid bone may serve as age-specific normative references. These findings may support clinicians—including anatomists, radiologists, obstetricians, pediatricians, and craniofacial surgeons—in the assessment of normal fetal cranial development and the early diagnosis of congenital craniofacial anomalies. Full article

Over the last decade, the quality of neurosurgical procedures dramatically improved, also thanks to the development and increased accessibility of several technological recourses (e.g., imaging, neuronavigation, neurophysiology, microscopy), allowing to plan increasingly complex approaches, while reducing the risk of postoperative complications. Among these resources, three-dimensional rendering and simulation systems, such as virtual and augmented reality, provide a high-quality visual reconstruction of brain structures and interaction with advanced anatomical models. Although the usefulness of these systems is now widely recognized, the additional availability of proprioceptive (haptic) feedback might help to further enhance the realism of surgical simulation. A systematic literature review on the application of haptic technology in simulation of cranial neurosurgical procedures was made. Inclusion criteria were the usage of simulators with haptic feedback for specific neurosurgical procedures whereas the studies that did not include an evaluation of the surgical simulation system by a surgeon were excluded. According to inclusion and exclusion criteria, 10 studies were selected. Simulation in neurosurgery still lacks a system capable of rehearsing the entire procedure—from skin incision to skin closure—while providing both visual and proprioceptive feedback. Consequently, further advancements in this area are necessary. Full article

In this article, an analysis of the problem of treating bone defects using cranial bone disorders as an example is presented. The study was performed in the context of the development of various implant biomaterials used to fill bone defects. An analysis of the requirements for modern materials is undertaken, indicating the need for their further development. The article focuses particular attention on these biomaterial properties, which have an influence on bioresorbability and promote osteointegration and bone growth. The analysis showed the need for further development of biomaterials, the characteristics of which may be multifunctionality. Multifunctional scaffolds are those that simultaneously fill and stabilize the defect and contribute to the proper process of regeneration and reconstruction of cranial bones. Due to the complex structure of the skull and special protective functions, there is a need to develop innovative implants. Implants with complex geometries can be successfully manufactured using additive technologies. Full article

Background/Objectives: Cranial reconstruction (cranioplasty) is a surgical procedure performed to restore skull function and aesthetics following trauma, oncological conditions, or congenital defects. Magnetic resonance imaging (MRI) is commonly used for the postoperative monitoring and diagnosis of patients with cranial implants. However, MRI artifacts caused by these implants can compromise imaging accuracy and diagnostic precision. This study aims to evaluate the extent of MRI artifacts caused by titanium and polyether ether ketone (PEEK) cranial implants and to identify optimal imaging sequences to minimize these artifacts. Methods: Phantom skull models with cranial defects of varying sizes (one-quarter, one-third, and one-half of the skull) were used to simulate real-world clinical conditions. The defects were filled with a water-based medium containing simulated brain tissue and tumor models. Custom 3D-printed titanium and PEEK cranial implants were fixed onto the phantom skulls and scanned using 1.5 T and 3 T MRI scanners. Various imaging sequences were tested, with a focus on optimizing parameters to reduce artifact formation. Turbo Spin Echo (TSE) sequences with fat saturation were implemented to assess their effectiveness in artifact reduction. Results: The study found that MRI artifacts varied based on the implant material, defect size, and magnetic field strength. A higher field strength (3 T) resulted in more pronounced artifacts. However, the use of TSE sequences with fat saturation significantly reduced artifacts and improved lesion visualization, enhancing diagnostic accuracy. Conclusions: This research highlights the importance of optimized MRI protocols when imaging patients with cranial implants. Proper selection of imaging sequences, particularly TSE with fat saturation, can mitigate artifacts and improve diagnostic precision, ultimately benefiting patient outcomes in clinical radiology. Full article

Background: Organ transplant recipients are at a significantly higher risk of developing skin cancer compared to the general population, particularly cutaneous squamous cell carcinoma. Approximately 3–8% of these carcinomas are located on the scalp. Scalp reconstruction is particularly challenging, especially for large excisions, due to the thickness of the scalp, the inelastic aponeurosis of the galea, and the integrity of the hair-bearing scalp. Additionally, in organ transplant recipients, the presence of numerous comorbidities and the increased risk of infection due to immunosuppressive therapy make management more complex. Based on our experience and the existing literature, we aim to describe possible reconstruction methods and discuss the combined management of medical and immunosuppressive therapy. Method: We present our experience with seven kidney transplant patients who underwent excision of cutaneous squamous cell carcinoma with a diameter larger than 3 cm. The crane technique involves three key steps. First, the tumor is excised with wide margins of disease-free tissue. Next, a pericranial flap is rotated and positioned to cover the exposed cranial bone. Finally, a bilayer dermal substitute is applied to create a microenvironment that supports skin graft implantation. Results: The crane technique was used for six patients. In one case, an O-Z rotation flap was used. All patients modified their immunosuppressive therapy, with those receiving antiproliferative therapy switching everolimus after surgery. Conclusions: When combined with a post-operative modification of the immunosuppressive regimen, the crane technique could be considered a feasible, safe, and effective approach to managing large cSCC of the scalp in fragile patients. Full article

Callobruchus maculatus is a major quarantine pest of stored legumes in China. As a holometabolous insect, it lives inside the bean it burrows into in both its larval and pupal stages. This study utilized micro-CT and 3D reconstruction to document thoracic morphological transformation during larval and pupal stages. The multi-peak fitting of cranial width was applied to determine larval instars. The results indicate that the first-instar larvae bore into beans using prothoracic muscles and those connecting the head to the mesothorax. The second-instar larva possessed the highest number of thoracic muscles, likely correlating with peak boring activity. The prepupa and the initial pupa exhibited minimal musculature, suggesting larval muscle degradation prior to pupation. Muscles unique to prepupae might homologize with indirect flight muscles in pupae, implying that adult flight capability is determined in the final larval stage. The muscles of both larvae and pupae undergo changes in attachment site, shape and curvature throughout development. At the same time, changes also occur in the larval cuticle and pupal endoskeleton. During the larval stage, muscle growth and degradation occur simultaneously, influencing muscle volume. In the pupal stage, the progressive increase in both absolute and relative thoracic muscle volumes prepare the weevil for movement after emergence. Meanwhile, the other thoracic organs, including the gut, air sacs and nerves, also change during development. Full article

Cranioplasty enables the restoration of cranial defects caused by traumatic injuries, brain tumour excisions, or decompressive craniectomies. Conventional methods rely on Computer-Aided Design (CAD) for implant design, which requires significant resources and expertise. Recent advancements in Artificial Intelligence (AI) have improved Computer-Aided Diagnostic systems for accurate and faster cranial reconstruction and implant generation procedures. However, these face inherent limitations, including the limited availability of diverse datasets covering different defect shapes spanning various locations, absence of a comprehensive pipeline integrating the preprocessing of medical images, cranial reconstruction, and implant generation, along with mechanical testing and validation. The proposed framework incorporates a robust preprocessing pipeline for easier processing of Computed Tomography (CT) images through data conversion, denoising, Connected Component Analysis (CCA), and image alignment. At its core is CRIGNet (Cranial Reconstruction and Implant Generation Network), a novel deep learning model rigorously trained on a diverse dataset of 2160 images, which was prepared by simulating cylindrical, cubical, spherical, and triangular prism-shaped defects across five skull regions, ensuring robustness in diagnosing a wide variety of defect patterns. CRIGNet achieved an exceptional reconstruction accuracy with a Dice Similarity Coefficient (DSC) of 0.99, Jaccard Similarity Coefficient (JSC) of 0.98, and Hausdorff distance (HD) of 4.63 mm. The generated implants showed superior geometric accuracy, load-bearing capacity, and gap-free fitment in the defected skull compared to CAD-generated implants. Also, this framework reduced the implant generation processing time from 40–45 min (CAD) to 25–30 s, suggesting its application for a faster turnaround time, enabling decisive clinical support systems. Full article

Reconstruction of cranio-maxillofacial defects following ablative surgeries requires a comprehensive approach that balances functional restoration with aesthetic outcomes. Advances in computer-aided design and manufacturing (CAD/CAM) technology have revolutionized this field, enabling precise preoperative planning, including 3D modeling, segmentation, and virtual resection planning. These methods allow for the production of patient-specific implants and surgical templates while facilitating the evaluation of treatment outcomes. CAD/CAM technology offers numerous benefits, such as enhanced surgical accuracy, improved aesthetic results, reduced operative times, and the possibility of single-stage resection and reconstruction. However, limitations exist, including high costs, the need for specialized expertise, and dependency on accurate imaging data. This paper provides a surgeon-centric evaluation of the advantages and limitations of CAD/CAM in cranio-maxillofacial reconstruction. The discussion encompasses the technological workflow, clinical applications, and recommendations for optimizing outcomes. Future perspectives highlight ongoing developments, such as integrating non-ionizing imaging techniques and expanding the applicability of virtual and augmented reality. By synthesizing technical advancements and clinical expertise, this review aims to establish practical guidelines for implementing CAD/CAM technology in routine surgical practice. Full article

Fibrous dysplasia is an uncommon bone disorder affecting various parts of the skeleton, often affecting facial and cranial bones. In this case, a 10-year-old patient was diagnosed with fibrous dysplasia of the ethmoid sinus at an early age. The patient has experienced nasal congestion, snores, and worsening nasal patency since 2019. A CT scan revealed an expansive proliferative lesion, likely from the frontal or ethmoid bone, protruding into the nasal cavity, ethmoid sinus, and right orbit. The tumor causes bone defects in the area of the nasal bone, leading to fluid retention in the peripheral parts of the right maxillary sinus. The patient’s parents decided not to undergo surgery to remove the diseased tissue and reconstruct the area, as it would be very extensive, risky, and disfiguring. The patient is being treated conservatively with an MRI, with a contrast performed approximately every six months and infusions of bisphosphonates. Despite the lesion’s size, the patient does not experience pain characteristic of dysplasia, and functions typically. Fibrous dysplasia of bone is a rare condition that presents with the most visually apparent manifestations, often mistaken for other bone conditions. Advanced diagnostic tools, like CT and MRI, are used to identify conditions affecting the ethmoid sinus more frequently. However, diagnostic errors often occur in imaging studies, leading to confusion. The most common period for clinical manifestations and diagnosis is around 10 years of age. The preferred approach in managing fibrous dysplasia involves symptomatic treatment, which can alleviate airway obstruction, restore normal globe position and visual function, and address physical deformities. Surgical intervention is recommended only for patients with severe functional impairment, progressive deformities, or malignant transformation. Full article

Background and Objectives: The temporoparietal fascia flap (TPFF) has recently emerged as an option for skull base reconstruction in endoscopic transnasal surgery when vascularized nasal flaps are not available. This study provides a systematic literature review of its use in skull base surgery and describes a novel cohort of patients. Methods: PRISMA guidelines were used for the review. Patients undergoing skull base reconstruction with TPFF in our center from May 2022 to April 2024 were retrospectively included. Data were collected on pre- and post-operative clinical and radiological features, histology, surgical procedures, and complications. Results: Sixteen articles were selected, comprising 42 patients who underwent TPFF reconstruction for treatment of complex skull base pathologies. In total, 5 of 358 patients (0.9%) who underwent tumor resection via endoscopic transanal surgery in the study period in our institution required TPFF. All had been previously treated with surgery and radiation therapy for different pathologies (three chordomas, one giant pituitary neuroendocrine tumor (PitNET), and one sarcoma). Post-operative complications included CSF leak, which resolved after flap revision, and an internal carotid artery pseudoaneurysm requiring endovascular embolization. Conclusions: TPFF is an effective option for skull base reconstruction in complex cases and should be part of the armamentarium of the skull base surgeon. Full article

Open total cranial vault reconstruction (CVR) is the common procedure in managing craniosynostosis, yet more techniques have been introduced as alternatives, namely endoscopic suturectomy (ES), endoscopy-assisted craniectomy (EC), spring-assisted surgery (SAS), strip craniectomy with helmet (SC), Pi craniectomy (PiC), Pi plasty (PiP), and Renier’s “H” technique (RH). The aim of this study was to compare the effectiveness of craniosynostosis surgeries in improving the cephalic index of the patients. Studies published until 7 March 2024 reporting CVR, ES, SAS, SC, RH, and PiP as definitive craniosynostosis management with the cephalic index as the outcome were included. Bayesian network meta-analysis and pair-wise meta-analysis were performed using a random-effects model based on standardized mean difference (SMD) and 95% confidence interval (CI). Nine studies published in 2008–2024 recruiting a total of 464 craniosynostosis patients (age: 18–61 months) were included in this meta-analysis. EC (SMD = 0.23 [95%CI: −5.47 to 5.63]; p = 0.935), PiP (SMD = −0.07 [95%CI: −9.27 to 8.79]; p = 0.988), ES (SMD = −0.59 [95%CI: −6.07 to 4.94]; p = 0.834), PiC (SMD = −1.16 [95%CI: −8.89 to 6.35]; p = 0.765), RH (SMD = −0.96 [95%CI: −6.62 to 4.53]; p = 0.736), SAS (SMD = −0.86 [95%CI: −8.25 to 6.18]; p = 0.815), and SC (SMD = −1.79 [95%CI: −9.05 to 5.28]; p = 0.624) were found to be as effective as CVR in improving the cephalic index. Network meta-analysis suggests that PiP is the most effective among these techniques (rank 1 probability = 0.273). According to the rank probabilities of our model the order of techniques from the most to the least effective is as follows: EC > CVR > PiP > ES > SAS > RH > PiC > SC. Full article