UB surgeons use digital surgical planning to reduce head size in children with macrocephaly

University at Buffalo surgeons use CAD/CAM technology to treat macrocephaly in children

BUFFALO, N.Y.: Surgeons at the University at Buffalo are advancing the field of pediatric craniofacial surgery through the use of computer-aided design (CAD) and computer-aided manufacturing (CAM) to treat children with macrocephaly, a condition characterized by an abnormally large head.

Macrocephaly affects up to 5% of infants, often caused by hydrocephalus, a buildup of cerebrospinal fluid in the brain. While hydrocephalus is commonly treated with a shunt to relieve pressure, some children are left with significantly enlarged skulls that affect motor development, balance, and cognitive outcomes.

Computer-assisted surgery in reduction cranioplasty

In more severe cases, reduction cranioplasty—a highly complex surgery that reduces head circumference and reshapes the skull—is recommended. Traditionally considered risky, the procedure has now become more precise and predictable through digital planning tools.

Dr. Michael Markiewicz, DDS, MPH, MD, professor and chair of the Department of Oral and Maxillofacial Surgery at the University at Buffalo School of Dental Medicine, and Dr. Renee Reynolds, MD, clinical associate professor in neurosurgery at the Jacobs School of Medicine and Biomedical Sciences, have led several such cases using CAD/CAM systems at John R. Oishei Children’s Hospital.

Their recent publication in the Cleft Palate Craniofacial Journal details how digital guides, virtual surgical simulations, and custom fixation templates are transforming the outcomes of reduction cranioplasty.

“We plan the entire surgery virtually after a CT scan,” said Dr. Markiewicz. “We can take our time and design what will lead to the best outcomes for each patient.”

Benefits of using CAD/CAM in pediatric cranial surgery

• Shorter surgery duration
• Improved safety and reduced risks to critical brain structures
• Predictable aesthetic outcomes
• Faster recovery times, with most patients discharged within 4–5 days

Dr. Markiewicz emphasized that while the technology improves precision, real-time judgment during surgery remains essential.

“It’s still partially guided,” he said. “Surgeons must adjust intraoperatively when necessary, especially when working close to the brain, cerebrospinal fluid, and major blood vessels.”

Not one-size-fits-all

One of the biggest challenges, the surgeons note, is the design process itself. The virtual cranioplasty plan must be uniquely tailored to each child’s anatomy, requiring collaboration between surgeons and biomedical engineers. Despite a learning curve, the technique is proving to be a valuable innovation, especially as digital surgical planning becomes more accessible.

Dr. David Best, a co-author and former UB fellow, now at Boston Children’s Hospital, also contributed to the study. Their case series followed three children aged 2 to 6 who successfully underwent the procedure.

As macrocephaly and pediatric hydrocephalus remain pressing public health challenges, this approach may offer a safer, more effective treatment path for selected cases.

CLICK HERE TO FOLLOW Medical News Pakistan WhatsApp Channel for more life-changing, science-backed health updates.