| Chapter1 Application of Three-dimensional Printing in Neurosurgical Planning of Skull Base SurgeryObject To assess the value of three-dimensional(3D)printed models of skull base disease for neurosurgical planning and simulation surgery.Methods 9 cases of skull base disease patients were enrolled in this study from March 2015 to December 2015.To obtain the patients’preoperative data of Computed Tomography(CT)and Magnetic Resonance Imaging(MR)of skull,we use MIMICS 17.0 software to make three-dimensional reconstruction of skull base disease with the 3D printer to print out the skull base disease model for preoperative evaluation and design of surgical plans in the model.Results Surgeons completed the skull base disease model in the preoperative,which clearly showed the morphology of skull base space occupying lesion and their spatial relations with the adjacent vessels and skull.They provide an important basis for the design of surgery approach and making surgery plan,as well as vitro simulated surgery.Intraoperative guidance by the 3D models for tumors resection or aneurysm clip obtained good results without severe complications and deaths.Conclusion 3D printed skull base disease model is technically feasible,which can effectively assist the development of complex skull base disease surgery program and simulate surgery,improve the efficiency and safety of the surgery.Chapter 2 Using 3D Printing to Create Individualized Cranial Nerves for Skull Base Tumor SurgeryObject Using 3D printing to create individualized skull base tumor model,the optic chiasm and facial nerve visualization to help identify and protect the cranial nerve during surgery.Methods 23 cases of sellar tumors were excised via frontotemporal approach or Endoscopic transnasal approach(EEA),and 15 cases of tumors of the cerebellopontine angle were resected via retrosigmoid approach.Preoperative imaging information of patients with three-dimensional T1-weighted turbo field echo(3D T1-TFE)sequence and diffusion tensor imaging-based fiber tracking(DTI-FT)to visualize cranial nerves.The use of MIMICS 17.0 software for three-dimensional reconstruction of skull base tumors and print 3D solid model for the simulation of the basic,steps and intraoperative navigation.Results The surgical procedure of 38 cases of skull base tumor was basically consistent with the preoperative design.Postoperative neurological function was well preserved without serious complications.Individualized cranial nerve and skull base tumor of 3D printed solid models visualized the anatomical details of the sellar region and the cerebellopontine angle region.The optic chiasma was 21.74%(5/23)located in the anterior lower,65.22%(15/23)in the anterior upper of the saddle area tumors,and 8.70%(2/23)in the posterior superior,in addition,1 case was unknown before operation.The facial nerves are 6.67%(1/15)located in the dorsal side of the the cerebellopontine angle region tumors,6.67%(1/15)in the inferior pole,26.67%(4/15)in the inferior ventralside,13.33%(2/15)in the middle ventralside,33.33%(5/15)in the superior ventralside,and none in the superior pole,in addition,2 case was unknown before operation;all of which were confirmed accurately by intraoperative or imaging.Initial questionnaire assessment showed that neurosurgeons highly evaluated the accuracy and usefulness of skull base tumor models.Conclusion 3D printed skull base tumor model and related cranial nerves,the virtual three-dimensional model into a solid model simulation surgery can help preoperative design of surgical options,intraoperative real-time guidance of surgical operations to avoid mistaken injuring cranial nerve. |
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