SynthesisNeurosurgical review2025
The impact of virtual surgical planning on surgical outcomes in craniosynostosis surgery: a systematic review and meta-analysis.
Synthesis in Neurosurgical review, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Virtual surgical planning (VSP) is an increasingly adopted surgical tool in craniomaxillofacial surgery. It involves the creation of a patient-specific, modifiable digital model of the patient's skull, allowing for personalized preoperative rehearsal and the design of intraoperative surgical guides. Its role in craniosynostosis surgery is being increasingly explored; however, its efficacy compared to conventional planning approaches remains unclear. This systematic review and meta-analysis aims to evaluate whether VSP offers superior surgical and patient outcomes in craniosynostosis. A systematic search was conducted following PRISMA guidelines. Studies comparing outcomes between VSP-assisted and conventional craniosynostosis surgeries were included. Outcomes including operative times, hospital length of stay, intraoperative blood loss, complication and revision rates, and aesthetic results were extracted and stratified by craniosynostosis subtype where possible. Statistical analyses were conducted using random-effects models where applicable. A total of 11 studies (9 retrospective and 2 prospective), encompassing 762 patients-260 undergoing VSP-assisted surgery and 502 undergoing traditional approaches-were included. Overall, the literature revealed significant heterogeneity in performance across outcomes. Pooled analysis showed a marginal, though non-significant, reduction in operative time with VSP (-0.41 hours; p = 0.096). However, leave-one-out sensitivity analysis indicated a statistically significant reduction (-0.61 hours; p = 0.0008), and subgroup analysis limited to sagittal synostosis similarly showed a significant decrease in operative time (-0.93 hours; p < 0.0001). No significant differences were observed in hospital stay duration, intraoperative blood loss, or complication rates. Other outcomes, including aesthetic results, revision rates, and objective surgical quality measures, were inconsistently reported and varied across studies. These findings do not offer strong evidence for a significant improvement in surgical outcomes with VSP compared to traditional surgical approaches. However, the existing literature remains limited by poor methodological quality, with no randomized controlled trials to date and substantial heterogeneity in both intervention protocols and outcome reporting. As such, high-quality prospective randomized controlled studies are needed to validate these preliminary trends and better define the comparative efficacy of VSP in craniosynostosis surgery.
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