3D Printing-Assisted Skull Base Tumor Surgeries: An Institutional Experience

AbstractThree-dimensional (3D) printing technology in neurosurgery has gained popularity nowadays. Skull base contains many major neurovascular structures in a confined space, along with anatomical variations making surgical approaches to this region challenging. 3D-printed model of skull base tumors consists of the patient's bony skull base, actual tumor dimensions, and surrounding major neurovascular structures. We included a total number of five patients with skull base tumors (one case of planum sphenoidale meningioma, two cases of sellar tumor with suprasellar extension, and two cases of cerebellopontine angle tumor) and 3D-printed tumor model of each of them. These models were used for preoperative simulation and served as very true to life training tool. These help in increasing the efficacy of the surgeon, improves surgical safety and ergonomics. They were also used for patient counselling, educating about the disease, the surgical procedure, and associated risks.

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3D Printing Technology-Assisted Endoscopy Surgery in the Treatment of Skull Base Tumors : A retrospective study

10.21203/rs.3.rs-80038/v1 ◽

2020 ◽

Author(s):

Peng Gao ◽

Angsi Liu ◽

Fuxing Zuo ◽

Jianxin Kong ◽

Xueji Li

Keyword(s):

3D Printing ◽

Skull Base ◽

Endoscopic Surgery ◽

Surgery Simulation ◽

Skull Base Tumors ◽

Printing Technology ◽

3D Printing Technology ◽

3D Printed ◽

The Mean ◽

Printing Time

Abstract Object 3D printing technology has becoming more and more popular in medicine, we aim to describe the application experiences of 3D printing technology in endoscopic surgery for skull base tumors, with the assessment of 3D-printed models in skull base endoscopic surgery simulation and anatomy learning.Method Five patients with 3D-printed models were enrolled in our institution from October 2015 to March 2019. 5 individual models, created by different 3D printing methods and printing materials, were used to design the optimal surgical approach before surgery. Besides, the 3D-printed models were applied in endoscopic surgery simulation and anatomy learning. Likert scale questionnaires (1 indicating strongly disagree; 2, disagree; 3, neutral; 4, agree; and 5, strongly agree) were administered to 9 neurosurgeons in our institution to evaluate the application of 3D printed models. Result We successfully printed 5 cases of complex skull base tumor 3D models and performed endoscopic surgery with the help of information of the 5 3D-printed models. Evaluation of the Likert scores showed that model 4 which was printed by the mixed photosensitive resin material was the most conducive in surgery simulation and anatomy learning. The mean (standard deviation) 3D printing time is 16.3 (4.96) hours, and the mean (SD) printing cost is 4,500 (1183.22) RMB.Conclusion 3D printing technology has a high value in the application of endoscopic surgery for skull base tumors. The fast 3D printing time can satisfy the requirement of tight preoperative inspection time. Besides, the average price is acceptable for patients and clinical anatomy learning. The combination of the technology of 3D printing and the techniques of skull base endoscopy shows many unique advantages.

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Full tractography for detecting the position of cranial nerves in preoperative planning for skull base surgery: technical note

Journal of Neurosurgery ◽

10.3171/2019.1.jns182638 ◽

2020 ◽

Vol 132 (5) ◽

pp. 1642-1652 ◽

Cited By ~ 2

Author(s):

Timothee Jacquesson ◽

Fang-Chang Yeh ◽

Sandip Panesar ◽

Jessica Barrios ◽

Arnaud Attyé ◽

...

Keyword(s):

Skull Base ◽

Preoperative Planning ◽

Skull Base Surgery ◽

Cranial Nerves ◽

Patient Specific ◽

Small Scale ◽

Skull Base Tumor ◽

Skull Base Tumors ◽

Brain White Matter ◽

Human Connectome Project

OBJECTIVEDiffusion imaging tractography has allowed the in vivo description of brain white matter. One of its applications is preoperative planning for brain tumor resection. Due to a limited spatial and angular resolution, it is difficult for fiber tracking to delineate fiber crossing areas and small-scale structures, in particular brainstem tracts and cranial nerves. New methods are being developed but these involve extensive multistep tractography pipelines including the patient-specific design of multiple regions of interest (ROIs). The authors propose a new practical full tractography method that could be implemented in routine presurgical planning for skull base surgery.METHODSA Philips MRI machine provided diffusion-weighted and anatomical sequences for 2 healthy volunteers and 2 skull base tumor patients. Tractography of the full brainstem, the cerebellum, and cranial nerves was performed using the software DSI Studio, generalized-q-sampling reconstruction, orientation distribution function (ODF) of fibers, and a quantitative anisotropy–based generalized deterministic algorithm. No ROI or extensive manual filtering of spurious fibers was used. Tractography rendering was displayed in a tridimensional space with directional color code. This approach was also tested on diffusion data from the Human Connectome Project (HCP) database.RESULTSThe brainstem, the cerebellum, and the cisternal segments of most cranial nerves were depicted in all participants. In cases of skull base tumors, the tridimensional rendering permitted the visualization of the whole anatomical environment and cranial nerve displacement, thus helping the surgical strategy.CONCLUSIONSAs opposed to classical ROI-based methods, this novel full tractography approach could enable routine enhanced surgical planning or brain imaging for skull base tumors.

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Skull Base Trauma: Clinical Considerations in Evaluation and Diagnosis and Review of Management Techniques and Surgical Approaches

Seminars in Plastic Surgery ◽

10.1055/s-0037-1607275 ◽

2017 ◽

Vol 31 (04) ◽

pp. 177-188 ◽

Cited By ~ 7

Author(s):

Soroush Farnoosh ◽

Robert Kellman ◽

Sherard Tatum ◽

Jacob Feldman

Keyword(s):

Skull Base ◽

Surgical Approaches ◽

Trauma Patients ◽

Traumatic Injuries ◽

Surgical Access ◽

Radiographic Testing ◽

Cranial Nerve Injury ◽

Cranial Fossa ◽

Skull Base Anatomy ◽

Neurovascular Structures

AbstractTraumatic injuries to the skull base can involve critical neurovascular structures and present with symptoms and signs that must be recognized by physicians tasked with management of trauma patients. This article provides a review of skull base anatomy and outlines demographic features in skull base trauma. The manifestations of various skull base injuries, including CSF leaks, facial paralysis, anosmia, and cranial nerve injury, are discussed, as are appropriate diagnostic and radiographic testing in patients with such injuries. While conservative management is sometimes appropriate in skull base trauma, surgical access to the skull base for reconstruction of traumatic injuries may be required. A variety of specific surgical approaches to the anterior cranial fossa are discussed, including the classic anterior craniofacial approach as well as less invasive and newer endoscope-assisted approaches to the traumatized skull base.

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Clinical Applications of Patient-Specific 3D Printed Models in Cardiovascular Disease: Current Status and Future Directions

Biomolecules ◽

10.3390/biom10111577 ◽

2020 ◽

Vol 10 (11) ◽

pp. 1577

Author(s):

Zhonghua Sun

Keyword(s):

Cardiovascular Disease ◽

3D Printing ◽

Current Status ◽

Patient Specific ◽

Future Research ◽

Junior Doctors ◽

Imaging Data ◽

Training Tool ◽

Complex Anatomy ◽

3D Printed

Three-dimensional (3D) printing has been increasingly used in medicine with applications in many different fields ranging from orthopaedics and tumours to cardiovascular disease. Realistic 3D models can be printed with different materials to replicate anatomical structures and pathologies with high accuracy. 3D printed models generated from medical imaging data acquired with computed tomography, magnetic resonance imaging or ultrasound augment the understanding of complex anatomy and pathology, assist preoperative planning and simulate surgical or interventional procedures to achieve precision medicine for improvement of treatment outcomes, train young or junior doctors to gain their confidence in patient management and provide medical education to medical students or healthcare professionals as an effective training tool. This article provides an overview of patient-specific 3D printed models with a focus on the applications in cardiovascular disease including: 3D printed models in congenital heart disease, coronary artery disease, pulmonary embolism, aortic aneurysm and aortic dissection, and aortic valvular disease. Clinical value of the patient-specific 3D printed models in these areas is presented based on the current literature, while limitations and future research in 3D printing including bioprinting of cardiovascular disease are highlighted.

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Pediatric Skull Base Tumors

10.5772/intechopen.95605 ◽

2021 ◽

Author(s):

Usman A. Khan ◽

Jillian H. Plonsker ◽

Robert C. Rennert ◽

Michael L. Levy

Keyword(s):

Quality Of Life ◽

Skull Base ◽

Neurofibromatosis Type ◽

Surgical Anatomy ◽

Surgical Approaches ◽

Skull Base Tumors ◽

Tumor Pathology ◽

Neuro Imaging ◽

Individualized Management

Management of pediatric skull base tumors requires a multi-disciplinary team that integrates advances in neuro-imaging, radiation, medical and surgical treatments, and allied therapies. Tumors of the skull base harbor complex genetic and molecular signatures that have major implications on prognosis and quality of life. Individualized management requires a strong inter-disciplinary alliance amongst practitioners, as well as a strong therapeutic alliance with the patient and family to navigate the complex decision-making process of treatments. In this chapter, we present our experience managing surgical lesions of the pediatric skull base. General considerations to tumor pathology genetics and radiobiology, diagnostic imaging, rehabilitation of cranial neuropathies and cognitive function, surgical anatomy and reconstructive options, and quality of life should be applied to each case. We also present location- and tumor-specific considerations in the anterior, middle, and posterior fossa skull base with a focus on surgical approaches and complication avoidance. Special consideration is given to syndromic tumors, particularly those from neurofibromatosis type 2 (NF-2). Tumors can exist in multiple cranial compartments and as such some redundancy in concepts is unavoidable. Nevertheless, each patient presents with a unique clinical picture and tumor behavior. Knowledge and proficiency in skull base approaches is a necessary tool in every pediatric neurosurgeon’s armamentarium.

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Bone Conduction Implants for Hearing Rehabilitation in Skull Base Tumor Patients

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0039-1677690 ◽

2019 ◽

Vol 80 (02) ◽

pp. 139-148

Author(s):

Lauren Placke ◽

Eric Appelbaum ◽

Akash Patel ◽

Alex Sweeney

Keyword(s):

Skull Base ◽

Skull Base Surgery ◽

Bone Conduction ◽

Skull Base Tumor ◽

Skull Base Tumors ◽

Tumor Patients ◽

Hearing Rehabilitation ◽

Bone Conduction Hearing ◽

Direct Vibration ◽

Over Time

AbstractBone conduction implants transfer sound to the inner ear through direct vibration of the skull. In patients with skull base tumors and infections, these devices can bypass a dysfunctional ear canal and/or middle ear. Though not all skull base surgery patients opt for bone conduction hearing rehabilitation, a variety of these devices have been developed and marketed over time. This article reviews the evolution and existing state of bone conduction technology.

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The Orbitozygomatic Craniotomy and Its Judicious Use

Operative Neurosurgery ◽

10.1093/ons/opz246 ◽

2019 ◽

Vol 18 (5) ◽

pp. 559-569 ◽

Cited By ~ 2

Author(s):

Aaron Cohen-Gadol

Keyword(s):

Skull Base ◽

Large Firm ◽

The Other ◽

Skull Base Tumors ◽

Bone Removal ◽

Neurovascular Structures

Abstract The concept of maximizing bone removal along the skull base has been advocated to expand the operative space for large, firm, and encasing ventral and ventrolateral skull base tumors. However, indications for the use of such osteotomies have not been well defined. The improved maneuverability and enhanced extent of expansion of the operative corridor via the skull base approaches compared to those of standard craniotomies have been based on cadaveric studies that might not simulate the operative environment realistically. Bony removal alone is not adequate to protect neurovascular structures, and strategic use of dynamic retraction and innovative operative routes are some of the other factors that contribute to successful microsurgery. In this analysis, the more discriminate indications and modified techniques for orbitozygomatic osteotomy are discussed.

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Slower growth of skull base meningiomas compared with non–skull base meningiomas based on volumetric and biological studies

Journal of Neurosurgery ◽

10.3171/2011.11.jns11999 ◽

2012 ◽

Vol 116 (3) ◽

pp. 574-580 ◽

Cited By ~ 57

Author(s):

Naoya Hashimoto ◽

Carter S. Rabo ◽

Yoshiko Okita ◽

Manabu Kinoshita ◽

Naoki Kagawa ◽

...

Keyword(s):

Natural History ◽

Skull Base ◽

Biological Behavior ◽

Skull Base Tumor ◽

Skull Base Tumors ◽

Biological Studies ◽

History Of ◽

Skull Base Meningiomas ◽

Mib 1

Object The precise natural history of incidentally discovered meningiomas (IDMs) remains unknown. It has been reported that for symptomatic meningiomas, tumor location can be used to predict growth. As to whether the same is true for IDMs has not been reported. This study aims to answer this question and provide biological evidence for this assumption by extending the study to involve symptomatic cases. Methods A total of 113 IDMs were analyzed by fine volumetry. A comparison of growth rates and patterns between skull base and non–skull base IDMs was made. Subsequently, materials obtained from 210 patients with symptomatic meningiomas who were treated in the authors' hospital during the same period were included for a biological comparison between skull base and non–skull base tumors using the MIB-1 index. Results The 110 patients with IDMs included 93 females and 17 males, with a mean follow-up period of 46.9 months. There were 38 skull base (34%) and 75 non–skull base (66%) meningiomas. Forty-two (37%) did not exhibit growth of more than 15% of the volume, whereas 71 (63%) showed growth. Only 15 (39.5%) of 38 skull base meningiomas showed growth, whereas 56 (74.7%) of 75 non–skull base meningiomas showed growth (p = 0.0004). In the 71 IDMs (15 skull base and 56 non–skull base), there was no statistical difference between the 2 groups in terms of mean age, sex, follow-up period, or initial tumor volume. However, the percentage of growth (p = 0.002) was significantly lower and the doubling time (p = 0.008) was significantly higher in the skull base than in the non–skull base tumor group. In subsequently analyzed materials from 94 skull base and 116 non–skull base symptomatic meningiomas, the mean MIB-1 index for skull base tumors was markedly low (2.09%), compared with that for non–skull base tumors (2.74%; p = 0.013). Conclusions Skull base IDMs tend not to grow, which is different from non–skull base tumors. Even when IDMs grow, the rate of growth is significantly lower than that of non–skull base tumors. The same conclusion with regard to biological behavior was confirmed in symptomatic cases based on MIB-1 index analyses. The authors' findings may impact the understanding of the natural history of IDMs, as well as strategies for management and treatment of IDMs and symptomatic meningiomas.

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A neurosurgical simulation of skull base tumors using a 3D printed rapid prototyping model containing mesh structures

Acta Neurochirurgica ◽

10.1007/s00701-016-2781-9 ◽

2016 ◽

Vol 158 (6) ◽

pp. 1213-1219 ◽

Cited By ~ 19

Author(s):

Kosuke Kondo ◽

Naoyuki Harada ◽

Hiroyuki Masuda ◽

Nobuo Sugo ◽

Sayaka Terazono ◽

...

Keyword(s):

Rapid Prototyping ◽

Skull Base ◽

Skull Base Tumors ◽

3D Printed ◽

Rapid Prototyping Model ◽

Mesh Structures

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3D printing in neurosurgery education: a review

3D Printing in Medicine ◽

10.1186/s41205-021-00099-4 ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Grace M. Thiong’o ◽

Mark Bernstein ◽

James M. Drake

Keyword(s):

3D Printing ◽

Skull Base ◽

Surgical Simulation ◽

Simulation Modelling ◽

Full Potential ◽

Skull Defects ◽

3D Printed ◽

Dissection Techniques ◽

Surgery Education ◽

Neurosurgical Education

Abstract Objectives The objectives of this manuscript were to review the literature concerning 3D printing of brain and cranial vault pathology and use these data to define the gaps in global utilization of 3D printing technology for neurosurgical education. Methods Using specified criteria, literature searching was conducted to identify publications describing engineered neurosurgical simulators. Included in the study were manuscripts highlighting designs validated for neurosurgical skill transfer. Purely anatomical designs, lacking aspects of surgical simulation, were excluded. Eligible manuscripts were analyzed. Data on the types of simulators, representing the various modelled neurosurgical pathologies, were recorded. Authors’ countries of affiliation were also recorded. Results A total of thirty-six articles, representing ten countries in five continents were identified. Geographically, Africa as a continent was not represented in any of the publications. The simulation-modelling encompassed a variety of neurosurgical subspecialties including: vascular, skull base, ventriculoscopy / ventriculostomy, craniosynostosis, skull lesions / skull defects, intrinsic brain tumor and other. Finally, the vascular and skull base categories together accounted for over half (52.8 %) of the 3D printed simulated neurosurgical pathology. Conclusions Despite the growing body of literature supporting 3D printing in neurosurgical education, its full potential has not been maximized. Unexplored areas of 3D printing for neurosurgical simulation include models simulating the resection of intrinsic brain tumors or of epilepsy surgery lesions, as these require complex models to accurately simulate fine dissection techniques. 3D printed surgical phantoms offer an avenue for the advancement of global-surgery education initiatives.

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