Three-dimensional printing in neurosurgical planning of skull base surgery

Objective To assess the value of three-dimensional (3D) printed models of skull base disease in neurosurgical planning and simulation surgery. Methods Nine patients with skull base diseases, including 6 with meningiomas, one with schwannoma, one with epidermoid cyst and one with multiple aneurysm, were enrolled in this study from March 2015 to December 2015. Preoperative computed tomography (CT) and magnetic resonance imaging (MRI) data of the skull were obtained; Mimics 17.0 Research software was used to three-dimensionally reconstruct the skull base disease models; with the 3D printer, the skull base disease models were printed out. The surgeries were simulated in the models and surgical procedures were developed based on the models. The clinical data and treatment efficacy of these patients were retrospectively analyzed. Results Surgeons completed the skull base disease models before surgery, which could clearly show the morphology of skull base space occupying lesions and their spatial relations with the adjacent vessels and skull. These models provided an important basis for designing surgery approaches and making surgical plans, as well as a chance of in vitro simulated surgery. Intra-operative guidance by 3D models for tumors resection or aneurysm clip obtained good results without severe complications and deaths: excepted for one with epidermoid cyst achieving subtotal excision of cyst wall and one with meningioma achieving subtotal excision, the other 6 patients achieved total excision. Conclusion The 3D printed skull base disease models are technically feasible, which can effectively assist the development of complex skull base disease surgery program and simulated surgery; therefore, they can help to improve the efficiency and safety of the surgery. Key words: Skull base surgery; Three-dimensional printing; Simulation surgery; Tumor model