Application of 3D-Printed Craniocerebral Model in Simulated Surgery for Complex Intracranial Lesions

Abstract

To demonstrate the use of 3-dimensional (3D)-printed intracranial lesion models for complex neurosurgery to increase the success rate of clinical surgeries via practice in simulated surgeries. We collected computed tomographic, magnetic resonance (MR), and computed tomographic images from patients with intracranial tumor or aneurysm, conducted multimodal image reconstruction, and then constructed a 3D-printed model with the skull base, cerebral arteries, and brain tumor or aneurysm. Forty-nine simulated surgeries were carried out on the model under a microscope, and actual surgery was carried out after validation and accumulation of experience. The 3D-printed brain tumor models were used to design the surgical route, to simulate piecemeal resection of tumors through keyhole approach, and to verify the extent of tumor resection. A drill was used for bone flap removal and milling of bony structures such as the anterior clinoid process, tuberculum sellae, petrous apex, and internal acoustic meatus. The tumors were removed by laser knife and cavitron ultrasonic aspiration. The 3D-printed aneurysm models were used to assess the feasibility of different keyhole approaches and to select the aneurysm clip. Actual surgery was based on the results of the simulated surgery. Postoperative MR image review showed that 84% (21/25) of patients had total tumor resection and 16% (4/25) subtotal resection. Digital subtraction angiography confirmed complete clipping of all aneurysms (24 cases/39 aneurysms). 3D-printed craniocerebral models provide effective simulated surgery conditions for keyhole surgeries of complex brain tumors or aneurysms and aid in preoperative surgical design, accumulation of surgical experience, and validation of surgical outcomes.