Use of electromagnetic Medtronic neuronavigation in monobloc frontofacial advancement for syndromic craniofacial synostoses: A preliminary case series

Monobloc frontofacial advancement (MFFA) is a key procedure for treating functional and morphological complications of syndromic craniofacial synostoses. Critical osteotomies -particularly the frontonasal cut and the pterygomaxillary disjunction - are technically demanding and often performed under limited visibility. Conventional intra-operative fluoroscopy improves accuracy but prolongs surgery and exposes both patient and staff to radiation. We report our initial experience using an electromagnetic (EM) neuronavigation system (Medtronic StealthStation EM) in three pediatric patients undergoing MFFA with distraction. Pre-operative CT-based trajectory planning guided the frontonasal osteotomy, distraction vector orientation, and safe placement of distractors. Intra-operatively, a handheld EM-tracked stylet provided real-time guidance of deep osteotomies and confirmed the completeness of pterygomaxillary disjunction without the need for intra-operative fluoroscopy. It enabled precise orientation of distraction vectors, verification of pterygomaxillary separation, and real-time adjustment of the frontonasal osteotomy. Morphological improvement was achieved in all patients: all three showed correction of pseudo-exorbitism, and one was weaned from tracheostomy. Obstructive sleep apnea syndrome improved in two patients, though one continues to require non-invasive ventilation. Electromagnetic neuronavigation proved to be safe, radiation-free, and particularly valuable for guiding complex osteotomies in MFFA. It may reduce operative time, improve vector-oriented distraction, and facilitate teaching of intricate surgical steps.