Smart cranioplasty in cleidocranial dysplasia - bridging robotics and neurotechnology for precision reconstruction - Letter to the Editor

Sep 29, 2026

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Letter to the Editor discussing cleidocranial dysplasia (CCD) as a congenital skeletal disorder with RUNX2-related impaired ossification and multiple associated spinal abnormalities. It argues for delayed-cranioplasty consequences and highlights single-stage cranioplasty using a patient-specific prefabricated cranial implant, supported by robotic systems for CT-guided precision, optimized resizing, and surgical automation. It further links neurotechnology and “smart” implants to improved outcomes, summarizes evidence on timing and complication patterns, and identifies a research gap for CCD-specific, genetics-aware, long-term and pediatric considerations.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages2

Reading Time5 min

AccessFree to download

Cleidocranial dysplasia background

Genetics, skeletal features, and associated abnormalities

Rationale for single-stage cranioplasty

Robotic system for patient-specific implant modification

Neurotechnology integration and smart implant concept

Evidence on timing, complications, and outcomes

Review findings and comparative infection risks

CCD-specific evidence gaps and pediatric considerations

Letter to the Editor Smart cranioplastyin cleidocranial dysplasia:bridging roboticsand neurotechnology forprecision reconstruction Duaa Seengar, MBBSa , Hamza Ali, MBBSb , Muhammad Talha, MBBSc , Mahnoor Fatima, MBBSd,*,Ubaid Ur Rehman, MBBSc To the Editor, Cleidocranial dysplasia (CCD) is a congenital skeletal dysplasiacharacterized by hypoplasia or agenesis of the clavicle, brachyce -phalic skull, midfacial hypoplasia, prolonged patency of the fonta -nelles, and mild to moderate growth retardation. CCD is anautosomal dominant disorder with a prevalence of about 1/1 000 000 globally. RUNX2 (runt-related transcription factor 2gene) is a key regulator of osteogenesis, situated on chromosome 6(6p21) . The mutation in the RUNX2 leads to cleidocranial dysto -sis. Because of impaired bone ossification of the contours of theembryonic vertebral arch, spinal abnormalities include spina bifida,scoliosis, kyphosis/kyphoscoliosis, spondylolysis, spondylolisth -esis, and hemivertebra[1] . Surgical correction may be undertakenfor cleidocranial hypoplasia, while calcium and vitaminD supplementation are recommended for reduced bone density[2] .This is inline with the TITAN Guidelines on the need fortranspar -ency in AI use in healthcare[3] . Delayed cranioplasty causes major consequences. Therefore,single-stage cranioplasty, which primarily restores the skull defectwith a patient-specific prefabricated cranial implant CCI, is morewidely adopted. The robotic system offers precise CCI modificationfor single-stage cranioplasty and enhanced clinical implementationby addressing challenges inpatients’ CT, optimizing CCI resizingalgorithms, and advancing surgical automation. Furthermore, therobotic system provides quicker and more accurate CCImodifications[4] . Neurotechnology plays a pivotal role in integrat -ing brain–machine interfaces, biosensors, and adaptive neural mon -itoring systems within these cranial constructs, bridging surgerywith digital neuroscience[5] . Moreover, CCI integrates implanted aDepartment of Medicine, Jinnah Sindh Medical University, Karachi, Pakistan,bDepartment of Medicine, Karachi medical and Dental college, Karachi, Pakistan,cDepartment of Medicine, King Edward Medical University, Lahore, Pakistan anddDepartment of Medicine, Shaheed Ziaur Rahman Medical College, RajshahiMedical University, Bogura, Bangladesh Sponsorships or competing interests that maybe relevant to content are disclosedatthe end of this article. *Corresponding author. Address: Shaheed Ziaur Rahman Medical College,Rajshahi Medical University, Ladies Hostel, Bogura 5800, Bangladesh. Tel.: +8801972635581 E-mail: mahnoorzahid786@gmail.com (M. Fatima).Copyright © 2025 The Author(s). Published by Wolters Kluwer Health, Inc. This is anopen access article distributed under the Creative Commons Attribution License 4.0(CCBY), which permits unrestricted use, distribution, and reproduction in any med-ium, provided the original work is properly cited. Annals of Medicine & Surgery (2026) 88:1009–1010Received 3 November 2025; Accepted 5 November 2025Published online 14 November 2025http://dx.doi.org/10.1097/MS9.0000000000004359 neurotechnology, such as ventriculostomy shunts, intracranial pres -sure monitoring devices, and drug delivery systems, transformingfrom“basic”implants into“smart”implants with advanced func -tionality. These smart implants optimize the patients’ outcomes byutilizing the cranial space to build advanced technology[6] . Recent studies suggest that cranioplasty results depend ontiming and patient factors. A review of 754 cases showed verylow mortality but a notable complication rate that highlightsitspotential applications. Early surgeries were linked to higherinfection and hydrocephalus risks. Operations done between 15 and 30 days had fewer bone resorption issues, and olderpatients showed better outcomes with lower resorption [7] .While another study reported a relatively low complicationrate of 15.6% consistent wit

FAQs

What causes cleidocranial dysplasia and what key skeletal features define it?

CCD is described as a congenital skeletal dysplasia involving clavicle hypoplasia or agenesis, brachycephalic skull features, midfacial hypoplasia, delayed fontanel closure, and mild to moderate growth retardation. RUNX2 mutation is presented as a key regulator of osteogenesis, with impaired ossification contributing to the condition.

Why is single-stage cranioplasty emphasized over delayed cranioplasty?

Delayed cranioplasty is stated to cause major consequences. Single-stage cranioplasty is presented as restoring the skull defect using patient-specific prefabricated cranial implants, and it is said to be more widely adopted.

How do robotic and neurotechnology approaches improve cranioplasty outcomes?

The robotic system is described as enabling precise CT-guided modification and optimization of implant resizing, supporting quicker and more accurate adjustments and enhanced surgical automation. Neurotechnology is described as integrating brain–machine interfaces, biosensors, and adaptive neural monitoring systems within the cranial constructs.

Sep 29, 2026

Uploaded by Dipper