Cheng-Hsien WU
Management of lesions involving the cranioorbital region is challenging. The operation may cross both the cranial cavity and the orbital cavity. Therefore, surgical treatment on this junctional zone is a topic which lies between different specialties, especially the neurosurgeons and ophthalmologists. The complex nature of the neurovascular structures challenges the surgeon’s knowledge to anatomy, experience, and the perception toward surgical outcome. Meanwhile, it also possesses a high risk for both neural and ophthalmic complications. The goal of these surgeries is not only a maximum resection to relieves the associated symptoms, but the reconstruction should also be aim on the restoration of patient’s function and esthetics. As maxillofacial surgeons, our training background provides better understanding on the craniomaxillofacial structures, which is a new avenue to deal with the cranioorbital diseases. With the rapid development of digital technologies and computational algorithm, modeling/navigation techniques profoundly change the surgical practice in craniomaxillofacial surgeries. Volume rendering from different image sources allows the surgeon to analyze the patient in three-dimensional format and to manipulate deformed or missing facial structures by computational algorism such as mirroring, segmentation, or insertion of unaltered or ideal skeletal constructs. The execution of the virtual planning is then accomplished by using stereolithographic models (SLMs), implants, cutting guides, or through image-guided surgery in the form of intraoperative navigation. Precision and reduced operation time are the main benefits from using computer assisted approaches. When combing endoscope and remote surgical approaches, tumor resection and customized reconstruction could be done with minimal visible scar. In this presentation, I will share the Taipei Veterans General Hospital experience of practicing computer-assisted approach on cranioorbital diseases.
