Reverse Engineering Techniques for Virtual Reconstruction of Defective Skulls: an Overview of Existing Approaches

The surgical process adopted to repair cranial defects using an implant, typically called Cranioplasty, has seen an abrupt increase in recent years due to the introduction of Reverse Engineering (RE) and Additive Manufacturing (AM) techniques. By adopting these techniques, CT/MRI data can be used to reconstruct, in a pre-operative stage, the 3D anatomy of the defective skull in order to design a patient-specific digital model of the prosthesis. The so-designed cranial plate can be then fabricated via AM, in a suitable metal alloy, and implanted. This allows for a perfect fit of the implant during the actual surgery, reducing the risks for the patient and increasing the efficacy of the treatment. This paper reviews existing approaches for the virtual reconstruction of defective skulls, and a basic classification, proposing four different classes of strategies (Mirroring, Surface Interpolation, Template-Based and Slice-based techniques) is provided. The findings of the study suggest that the reconstruction of skull defects is still an open problem, due to the complexities imposed by surface that needs to be retrieved (i.e. the human anatomy). All the presented approaches share weaknesses and limits, which are discussed in the article. Finally, possible directions to improve the existing techniques are briefly presented.