Surgical planning is the preoperative method of pre-visualising a surgical intervention, in order to predefine the surgical steps and furthermore the

bone segment navigation Bone segment navigation is a surgical method used to find the anatomical position of displaced bone fragments in fractures, or to position surgically created fragments in craniofacial surgery. Such fragments are later fixed in position by osteosynt ...

in the context of

computer-assisted surgery Computer-assisted surgery (CAS) represents a surgical concept and set of methods, that use computer technology for surgical planning, and for guiding or performing surgical interventions. CAS is also known as computer-aided surgery, computer-assist ...

. The surgical planning is most important in

neurosurgery Neurosurgery or neurological surgery, known in common parlance as brain surgery, is the medical specialty concerned with the surgical treatment of disorders which affect any portion of the nervous system including the brain, spinal cord and peri ...

and oral and maxillofacial surgery. The transfer of the surgical planning to the patient is generally made using a medical navigation system. __TOC__

Principles of surgical planning

The imagistic

dataset A data set (or dataset) is a collection of data. In the case of tabular data, a data set corresponds to one or more database tables, where every column of a table represents a particular variable, and each row corresponds to a given record of the ...

used for surgical planning is mainly based on a CT or

MRI Magnetic resonance imaging (MRI) is a medical imaging technique used in radiology to form pictures of the anatomy and the physiological processes of the body. MRI scanners use strong magnetic fields, magnetic field gradients, and radio waves ...

. In oral and maxillofacial surgery, a different, more "traditional" surgical planning can be used for orthognatic surgery, based on cast models fixed into an

articulator An articulator is a mechanical hinged device used in dentistry to which plaster casts of the maxillary (upper) and mandibular (lower) jaw are fixed, reproducing some or all the movements of the mandible in relation to the maxilla The maxil ...

History of the concept

In order to make a surgical planning, one would need a 3D image of the patient. The starting point was made by G. Hounsfield in the 1970s, by using CT in order to record data about the anatomical situation of the patients. In the 1980s, advances were made by the radiologist M. Vannier and his team, by creating the first computed three-dimensional reconstruction from a CT dataset. In the early 1990s, the surgical planning was performed by using stereolithographic models. During the late 1990s, the first full computer-based virtual surgical planning was made for osteotomies, and then transferred to the operating theatre by a

navigation system A navigation system is a computing system that aids in navigation. Navigation systems may be entirely on board the vehicle or vessel that the system is controlling (for example, on the ship's bridge) or located elsewhere, making use of radio or othe ...

. Currently 3D Printed models are also used to plan a procedure and improve patient outcomes. The first commercially available neurosurgical planning systems appeared in the 1990s (the StealthStation by

Medtronic Medtronic plc is an American medical device company. The company's operational and executive headquarters are in Minneapolis, Minnesota, and its legal headquarters are in Ireland due to its acquisition of Irish-based Covidien in 2015. While it ...

, the VectorVision by

Brainlab Brainlab is a privately held German medical technology company headquartered in Munich, Bavaria. Brainlab develops software and hardware for radiotherapy and radiosurgery, and the surgical fields of neurosurgery, ENT and craniomaxillofacial, spin ...

). As newer imaging modalities emerged providing increasing anatomical and functional detail for the patient in the 2000s, these surgical planning systems started to incorporate

virtual reality Virtual reality (VR) is a simulated experience that employs pose tracking and 3D near-eye displays to give the user an immersive feel of a virtual world. Applications of virtual reality include entertainment (particularly video games), educ ...

technology to facilitate the visualisation and manipulation of the 3D data. One example of such systems is the

Dextroscope The Dextroscope is a medical equipment system that creates a virtual reality (VR) environment in which surgeons can plan neurosurgical and other surgical procedures. The Dextroscope is designed to show a patient's 3D anatomical relationships an ...

, manufactured by

Volume Interactions Pte Ltd Volume Interactions Pte Ltd was a company that pioneered in the 1990s the use Virtual Reality technology in surgery planning. The company created and marketed the Dextroscope, the first commercial surgical planning system that used virtual realit ...

. The Dextroscope is mostly used in the planning of complex neurosurgical procedures.{{cite journal , author = Robison R. A., Liu C. Y., Apuzzo M. L. J. , year = 2011 , title = Man, Mind, and Machine: The Past and Future of Virtual Reality Simulation in Neurologic Surgery , journal = World Neurosurgery , volume = 76 , issue = 5, pages = 419–30 , doi=10.1016/j.wneu.2011.07.008 , pmid=22152571

References

Oral and maxillofacial surgery Health informatics Radiology Tomography Computer-assisted surgery