Clinical application of 3D virtual and printed models for cerebrovascular diseases

Jin Woo Bae,Da Yeong Lee,Chang Hwan Pang,Jeong Eun Kim,Chul-Kee Park,Doohee Lee,Sang Joon Park,Won-Sang Cho

doi:10.1016/j.clineuro.2021.106719

Jin Woo Bae, Da Yeong Lee + Show 6 more

Open Access

https://doi.org/10.1016/j.clineuro.2021.106719

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Abstract

ObjectiveThree-dimensional (3D) printing techniques are rapidly advancing in the medical industry and in clinical practice. We aimed to evaluate the usefulness of 3D virtual and printed models of 6 representative cerebrovascular diseases using the software we developed. MethodsSix cases consisted of 4 intracranial aneurysms (IAs) including complex ones with intrasaccular thrombosis, large size and a skull base location; 1 cavernous malformation in the pons; and 1 arteriovenous malformation in the parietal lobe. The 3D modeling process was performed retrospectively in 3 cases and prospectively in 1 IA. Segmentation of raw data and rendering and modification for 3D virtual models were processed mostly automatically. ResultsMost intracranial structures were satisfactorily made, including the skull, brain, vessels, thrombus, tentorium and major cranial nerves. Based on 3D modeling, surgical plan was changed in 1 prospective IA case. However, it was still difficult to discriminate small vessels and cranial nerves, to feel a realistic tactile sense and to directly perform presurgical simulations, such as dissection, removal, clipping and microanastomosis. ConclusionsThe 3D modeling was thought to be very helpful in experiencing the operative views from various directions in advance, in selecting an appropriate surgical approach, and in educating physicians and patients. With advancements in radiological resolution, processing techniques and material properties, 3D modeling is expected to simulate real brain tissues more closely.

Highlights

Since Charles Hull filed US patents for the world’s first 3-dimensional (3D) printer in 1984,1 3D printing techniques have rapidly expanded throughout different industries. 3D printing was first applied for dental implants in the 1990s, and thereafter it has been innovatively adopted in a few medical fields, such as anatomical models for surgery and education, devices and instruments for drug delivery and surgery, implants and prostheses, and bioprinting.[2]
It is standard to approach a target via the side of the dominant A1 for proximal control; the nondominant side was more advantageous to clip this case, which was imaged on the 3D virtual model (Figure 1a and b)
In Case 2, a 17.2 mm aneurysm at the right middle cerebral artery (MCA) bifurcation was clipped via the right MP approach

Summary

Introduction

Since Charles Hull filed US patents for the world’s first 3-dimensional (3D) printer in 1984,1 3D printing techniques have rapidly expanded throughout different industries. 3D printing was first applied for dental implants in the 1990s, and thereafter it has been innovatively adopted in a few medical fields, such as anatomical models for surgery and education, devices and instruments for drug delivery and surgery, implants and prostheses, and bioprinting.[2]. 3D printing was first applied for dental implants in the 1990s, and thereafter it has been innovatively adopted in a few medical fields, such as anatomical models for surgery and education, devices and instruments for drug delivery and surgery, implants and prostheses, and bioprinting.[2] Despite the advancement of neuroimaging, it is still not easy to recognize the intracranial structures and their 3D relationships because they are minute and complex and are found within a narrow space. There have been many attempts to apply 3D printing techniques to presurgical planning, education, and the development of devices and implants in a few neurosurgical fields, such as cerebrovascular diseases, brain tumors, spinal diseases, functional disorders, congenital anomalies and neurotrauma.[2,3] In the area of cerebrovascular diseases, studies have continued since the first report by D’Urso et al in 19994 that mainly dealt with intracranial aneurysms (IAs) and arteriovenous malformations (AVMs).[3,4,5,6,7,8,9,10,11,12,13,14,15] We evaluated the usefulness and limitations of 3D printing techniques by making 3D virtual and printed models of representative cerebrovascular diseases such as IA, AVM and cavernous malformations (CM) using our brand-new software for segmentation and rendering

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