Volume 5, Issue 2, December 2019, Page: 37-44
Application of a Three-dimensional Printed Anatomical Model in Presurgical Planning of Surgical Treatment of Brain Aneurysms
Veranis Sotirios, Neurosurgical Department, 251 General Air Force and Reserve Hospital, Athens, Greece
Lagios Konstantinos, Neurointerventional Unit, 251 General Air Force and Reserve Hospital, Athens, Greece
Received: Nov. 24, 2019;       Accepted: Dec. 20, 2019;       Published: Dec. 30, 2019
DOI: 10.11648/j.ijcda.20190502.13      View  331      Downloads  63
Abstract
Three dimensional (3D) printed models represent innovative tools in anatomy teaching and surgical planning. The present study aimed at generating 3D skull models incorporating middle cerebral artery (MCA) aneurysms and in assessing their anatomical accuracy and utility as training and preoperative planning tools. Two aneurysm models were generated. Initially, a full skull (model A) and subsequently a half skull (model B) using white polyactic acid (PLA) filament incorporating two arterial networks with hard black PLA filament (in model A) and a softer semitransparent filament (in model B). The models were based on computed tomographic angiography (CTA) of a female patient suffering from bilateral unruptured middle cerebral aneurysms. Model A, a high contrast model, was designed for anatomical illustration purposes. Model B was designed to allow for clipping simulations. The anatomical accuracy of the two models compared to CTA was assessed by measuring their dimensions at the neck, proximal, distal branches and fundus, using an electronic micrometer. The utility of the models for the comprehension of the underlying anatomy, pathology and preoperative planning was evaluated by means of online questionnaires following clipping simulations conducted by neurosurgery residents and specialized neurosurgeons. Of the two 3D printed models generated, model B (clipping model) showed the highest degree of anatomical accuracy. The results of the online survey on the utility of the proposed models indicate that the majority of participants accepted the innovation with positive responses and approve the use of 3D printed aneurysm models for preoperative planning and resident training.
Keywords
Three-dimensional Printing, Presurgical Planning, Brain Aneurysm, Aneurysm Clip, Middle Cerebral Artery Aneurysms
To cite this article
Veranis Sotirios, Lagios Konstantinos, Application of a Three-dimensional Printed Anatomical Model in Presurgical Planning of Surgical Treatment of Brain Aneurysms, International Journal of Clinical and Developmental Anatomy. Vol. 5, No. 2, 2019, pp. 37-44. doi: 10.11648/j.ijcda.20190502.13
Copyright
Copyright © 2019 Authors retain the copyright of this article.
This article is an open access article distributed under the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Reference
[1]
Anderson J R, Thompson W L, Alkattan A K, Diaz O, Klucznik R, et al. 2016. Three-dimensional printing 
of anatomically accurate, patient specific intracranial aneurysm models 
 J. Neurointerv. Surg. 8: 517–20.
[2]
Kimura T, Morita A, Nishimura K, Aiyama H, Itoh H, Fukaya S, Sora S, Ochiai C. Simulation of and training for cerebral aneurysm clipping with 3-dimensional models. Neurosurgery. 2009 Oct; 65 (4): 719-25; discussion 725-6. doi: 10.1227/01.NEU.0000354350.88899.07.
[3]
Gabriele Wurm, MD, Michael Lehner, MD, Berndt Tomancok, MD, Raimund Kleiser, PhD, and Karin Nussbaumer, MD Cerebrovascular Biomodeling for Aneurysm Surgery: Simulation-Based Training by Means of Rapid Prototyping Technologies Surgical Innovation
18 (3) 294–306, 2011.
[4]
Chua, C. K; Leong, K. F.; Lim, C. S. (2003), Rapid Prototyping: Principles and Applications (2nd ed.), World Scientific Publishing Co, ISBN 981-238-117-1 Chapter 6, Rapid Prototyping Formats.
[5]
Kahn, Charles E.; Carrino, John A.; Flynn, Michael J.; Peck, Donald J.; Horii, Steven C. (September 2007). "DICOM and Radiology: Past, Present, and Future". Journal of the American College of Radiology. 4 (9): 652–657. doi: 10.1016/j.jacr.2007.06.004.
[6]
Aja-Fernandez, Santiago; de Luis Garcia, Rodrigo; Tao, Dacheng; Li, Xuelong (2009). Tensors in Image Processing and Computer Vision. Advances in Computer Vision and Pattern Recognition. Springer Science & Business Media. ISBN 9781848822993.
[7]
Ghasemloonia A, Baxandall S, Zareinia K, Lui JT, Dort JC, Sutherland GR, Chan S. Evaluation of haptic interfaces for simulation of drill vibration in virtual temporal bone surgery. Comput Biol Med. 2016 Nov 1; 78: 9-17. doi: 10.1016/j.compbiomed.2016.09.005. Epub 2016 Sep 12. PubMed PMID: 27643462.
[8]
Lan Q, Chen A, Zhang T, Li G, Zhu Q, Fan X, Ma C, Xu T. Development of Three-Dimensional Printed Craniocerebral Models for Simulated Neurosurgery. World Neurosurg. 2016 Jul; 91: 434-42. doi: 10.1016/j.wneu.2016.04.069. Epub 2016 Apr 27. PubMed PMID: 27132180.
[9]
Shibata E, Takao H, Amemiya S, Ohtomo K. 3D-Printed Visceral Aneurysm Models Based on CT Data for Simulations of Endovascular Embolization: Evaluation of Size and Shape Accuracy. AJR Am J Roentgenol. 2017 Aug; 209 (2): 243-247. doi: 10.2214/AJR.16.17694.
[10]
Wang L, Ye X, Hao Q, Chen Y, Chen X, Wang H, Wang R, Zhao Y, Zhao J. Comparison of Two Three-Dimensional Printed Models of Complex Intracranial Aneurysms for Surgical Simulation. World Neurosurg. 2017 Jul; 103: 671-679. doi: 10.1016/j.wneu.2017.04.098. Epub 2017 Apr 24.
[11]
Ploch CC, Mansi CSSA, Jayamohan J, Kuhl E. Using 3D Printing to Create Personalized Brain Models for Neurosurgical Training and Preoperative Planning. World Neurosurg. 2016 Jun; 90: 668-674. doi: 10.1016/j.wneu.2016.02.081. Epub 2016 Feb 24. PubMed PMID: 26924117.
[12]
Michael W. Itagaki Using 3D printed models for planning and guidance during endovascular intervention: a technical advance Diagn Interv Radiol. 2015 Jul-Aug; 21 (4): 338–341. Published online 2015 May 29. doi: 10.5152/dir.2015.14469.
[13]
Mashiko T, Otani K, Kawano R, Konno T, Kaneko N, Ito Y, Watanabe E. Development of three-dimensional hollow elastic model for cerebral aneurysm clipping simulation enabling rapid and low cost prototyping World Neurosurg. 2015 Mar; 83 (3): 351-61. doi: 10.1016/j.wneu.2013.10.032. Epub 2013 Oct 16.
[14]
Lin J, Zhou Z, Guan J), Zhu Y), Liu Y, Yang Z, Lin B, JiangY, Quan X, Ke Y, Xu T. Using Three-Dimensional Printing to Create Individualized Cranial Nerve Models for Skull Base Tumor Surgery World Neurosurg. 2018 Dec; 120: e142-e152. doi: 10.1016/j.wneu.2018.07.236. Epub2018 Aug 16.
[15]
van de Belt TH, Nijmeijer H, Grim D, Engelen LJLPG, Vreeken R, van Gelder MMHJ, Ter Laan M. Patient-Specific Actual-Size Three-Dimensional Printed Models for Patient Education in Glioma Treatment: First Experiences. World Neurosurg. 2018 Sep; 117: e99-e105. doi: 10.1016/j.wneu.2018.05.190. Epub 2018 Jun 2. PubMed PMID: 29870846.
[16]
Elsharkawy A, Lehečka M, Niemelä M, Billon-Grand R, Lehto H, Kivisaari R, Hernesniemi J. A new, more accurate classification of middle cerebral artery aneurysms: computed tomography angiographic study of 1,009 consecutive cases with 1,309 middle cerebral artery aneurysms. Neurosurgery. 2013 Jul; 73 (1): 94-102; discussion 102. doi: 10.1227/01.neu.0000429842.61213.d5.
[17]
Todeschi J, Bund C, Cebula H, Chibbaro S, Lhermitte B, Pin Y, Lefebvre F, Izzie JN, Proust F. Diagnostic value of fusion of the metabolic and structural images for stereotactic biopsy of brain tumors without enhancement after contrast medium injection. Neurochirurgie. 2019 Sep 24. pii: S0028-3770 (19) 30218-8. doi: 10.1016/j.neuchi.2019.08.002. [Epub ahead of print] PubMed PMID: 31560911.
[18]
Khan IS, Kelly PD, Singer RJ. Prototyping of cerebral vasculature physical models. Surg Neurol Int. 2014 Jan 27; 5: 11. doi: 10.4103/2152-7806.125858. eCollection 2014. PubMed PMID: 24678427; PubMed Central PMCID: PMC3942610.
[19]
Qiu K, Haghiashtiani G, McAlpine MC. 3D Printed Organ Models for Surgical Applications. Annu Rev Anal Chem (Palo Alto Calif). 2018 Jun 12; 11 (1): 287-306. doi: 10.1146/annurev-anchem-061417-125935. Epub 2018 Mar 28. Review. PubMed PMID: 29589961; PubMed Central PMCID: PMC6082023.
[20]
Brown C, Robinson D, Egan R, Hopkins L, Abdelrahman T, Powell A, Pollitt MJ, Lewis WG. Prospective Cohort Study of Haptic Virtual Reality Laparoscopic Appendicectomy Learning Curve Trajectory. J Laparoendosc Adv Surg Tech A. 2019 Sep; 29 (9): 1128-1134. doi: 10.1089/lap.2019.0332. Epub 2019 Jul 30. PubMed PMID: 31361560.
[21]
Xu Y, Tian W, Wei Z, Li Y, Gao X, Li W, Dong B. Microcatheter shaping using three-dimensional printed models for intracranial aneurysm coiling. J Neurointerv Surg. 2019 Sep 28. pii: neurintsurg-2019-015346. doi: 10.1136/neurintsurg-2019-015346. [Epub ahead of print] PubMed PMID: 31563890.
[22]
Nagassa RG, McMenamin PG, Adams JW, Quayle MR, Rosenfeld JV. Advanced 3D printed model of middle cerebral artery aneurysms for neurosurgery simulation. 3D Print Med. 2019 Aug 1; 5 (1): 11. doi: 10.1186/s41205-019-0048-9. PubMed PMID: 31372773; PubMed Central PMCID: PMC6743137.
[23]
Kim PS, Choi CH, Han IH, Lee JH, Choi HJ, Lee JI. Obtaining Informed Consent Using Patient Specific 3D Printing Cerebral Aneurysm Model. J Korean Neurosurg Soc. 2019 Jul; 62 (4): 398-404. doi: 10.3340/jkns.2019.0092. Epub 2019 Jul 1. PubMed PMID: 31290295; PubMed Central PMCID: PMC6616983.
[24]
Levitt MR, Mandrycky C, Abel A, Kelly CM, Levy S, Chivukula VK, Zheng Y, Aliseda A, Kim LJ. Genetic correlates of wall shear stress in a patient-specific 3D-printed cerebral aneurysm model. J Neurointerv Surg. 2019 Oct; 11 (10): 999-1003. doi: 10.1136/neurintsurg-2018-014669. Epub 2019 Apr 12. PubMed PMID: 30979845; PubMed Central PMCID: PMC6744304.
[25]
Bairamian D, Liu S, Eftekhar B. Virtual Reality Angiogram vs 3-Dimensional Printed Angiogram as an Educational tool-A Comparative Study. Neurosurgery. 2019 Aug 1; 85 (2): E343-E349. doi: 10.1093/neuros/nyz003. PubMed PMID: 30715444.
[26]
Sullivan S, Aguilar-Salinas P, Santos R, Beier AD, Hanel RA. Three-dimensional printing and neuroendovascular simulation for the treatment of a pediatric intracranial aneurysm: case report. J Neurosurg Pediatr. 2018 Dec 1; 22 (6): 672-677. doi: 10.3171/2018.6. PEDS17696. PubMed PMID: 30215588.
[27]
Ruedinger KL, Rutkowski DR, Schafer S, Roldán-Alzate A, Oberstar EL, Strother C. Impact of image reconstruction parameters when using 3D DSA reconstructions to measure intracranial aneurysms. J Neurointerv Surg. 2018 Mar; 10 (3): 285-289. doi: 10.1136/neurintsurg-2017-013080. Epub 2017 Apr 6. PubMed PMID: 28385725.
[28]
Benet A, Plata-Bello J, Abla AA, Acevedo-Bolton G, Saloner D, Lawton MT. Implantation of 3D-Printed Patient-Specific Aneurysm Models into Cadaveric Specimens: A New Training Paradigm to Allow for Improvements in Cerebrovascular Surgery and Research. Biomed Res Int. 2015; 2015: 939387. doi: 10.1155/2015/939387. Epub 2015 Oct 11. PubMed PMID: 26539542; PubMed Central PMCID: PMC4619899.
[29]
Michael T. Lawton, MD, and Michael J. Lang, MD. The future of open vascular neurosurgery, perspectives on cavernous malformations, AVMs, and bypasses for complex aneurysms. JNSPG 7th Anniversary Invited Review Article.
Browse journals by subject