The Application Value Of 3D Printing Technology In Surgery Of Nasal Skull Base Tumor

OBJECTIVES: Through three-dimensional reconstruction of the nasal skull base tumor and its surrounding structures,a personalized three-dimensional model was constructed and printed to study the role and value of 3D printing technology in the surgery of nose-skull base tumor.To obtain anatomical parameters of nasal skull base tumor and its surrounding structures,and to provide anatomical basis and technical support for the application of 3D printing technology to improve surgical planning,and combine 3D printing technology with the use of nasal endoscopic surgery operating system to evaluate surgical risks and formulate reasonable and effective personalized surgical plans.METHODS: Clinical data of patients with complex nasal skull base tumor(limited to meningioma,pituitary tumor,craniopharyngioma and hemangioma)admitted to tianjin Huan Hu hospital from 2018 to 2019 were collected,and gender,age,clinical symptoms and disease types(pathology)were sorted out and summarized.Inclusion criteria:1.CT and magnetic resonance imaging(MRI)confirmed the occupation of the nasal skull base;2.all preoperative imaging examinations and post operative imaging data were completed.Exclusion criteria:recurrent space-occupying lesion sorprevious chemo radio therapy.According to the original data of patients’ images(3D reconstruction,MRI plainscan,enhanced MRI and CTA),"MINICS" soft ware was used to read the original imaging images of patients,and the nasal skull base structure was divided into do main values and image segmentation,and then the 3D model was reconstructed.The 3D model of the anatomy of the nasal skull base was converted into STL format and sent to 3D printer to print the resin model of the nasal skull base.According to the original data obtained from imaging scans,3D printing soft ware and 3D reconstruction technology were used to print the resin model based on the results of patients’ nasal skull base,and the resin model was used to simulate the surgical plan of endoscopic resection of nasal skull base tumor and individualized design of nasal skull base tumor.To print and prefabricate the reconstruction material on the model according to the scope of the simulated operation.RESULTS: 3D models of nasal skull base tumors and their surrounding structures were successfully established and 3D printed in 15 patients.The model can clearly show the complex anatomical structure of the nasal skull base and the position relationship between the tumor and the surrounding vascular tissue.All 15 patients successfully completed surgical resection of the tumor,including 12 patients who received total resection,2 patients who received subtotal resection,and 1 patient who received majority resection.The intraoperative resection scope was consistent with the preoperative operation scope simulated on the 3D printing model.The patient had a good cranial and facial appearance,no defect,no diplopia or enophthalmia,unobstructed nasal cavity,good sphenoid sinus,good recovery of alveolar process and palatal shape,clear voice,normal eating,no obvious cough or reflux,etc.During the follow-up period of 12-36 months,14 patients recovered well after the operation,and no tumor recurrence or serious postoperative complications were found after clinical and MRI examinations.One patient(squamous cell carcinoma)with major resection had recurrence after the operation and radiotherapy,and the patient got better after comprehensive treatment.The invasion range of tumor,the destruction range of skull base and the relationship with blood vessels can be clearly and stereo identified,which can provide help for accurate formulation of surgical plan by using the 3D printing model.CONCLUSIONS: 3D reconstruction of the nose-skull base tumorby CT,MRI and other imaging raw data showed good results,which could clearly image the complex anatomical structure of the nasal skull base and the relationship between the tumor and the surrounding vascular tissue.Becouse of the structure of the base of the skull is complex,it is the key to choose the optimal surgical route and repair and reconstruct the skull base.The 3D personalized model of nasal skull base tumor printed by 3D technology can be used to design and plan the resection and postoperative repair and reconstruction of nasal skull base tumor,which is of great significance for guiding the clinical thorough resection of tumor tissue,protecting adjacent nerves and blood vessels,and repairing defects after surgery.The construction of 3D printing model is helpful to communicate with patients and their families before surgery,effectively shorten the operation time,reduce postoperative complications,and contribute to the preservation and recovery of the physiological function of nasal skull base tissue structure.