Elsevier

World Neurosurgery

Volume 109, January 2018, Pages 356-361
World Neurosurgery

Doing More with Less
3D-Printed Craniosynostosis Model: New Simulation Surgical Tool

https://doi.org/10.1016/j.wneu.2017.10.025Get rights and content

Background

Craniosynostosis is a complex disease once it involves deep anatomic perception, and a minor mistake during surgery can be fatal. The objective of this report is to present novel 3-dimensional–printed polyamide craniosynostosis models that can improve the understanding and treatment complex pathologies.

Methods

The software InVesalius was used for segmentation of the anatomy image (from 3 patients between 6 and 9 months old). Afterward, the file was transferred to a 3-dimensional printing system and, with the use of an infrared laser, slices of powder PA 2200 were consecutively added to build a polyamide model of cranial bone.

Results

The 3 craniosynostosis models allowed fronto-orbital advancement, Pi procedure, and posterior distraction in the operating room environment. All aspects of the craniofacial anatomy could be shown on the models, as well as the most common craniosynostosis pathologic variations (sphenoid wing elevation, shallow orbits, jugular foramen stenosis). Another advantage of our model is its low cost, about 100 U.S. dollars or even less when several models are produced.

Conclusions

Simulation is becoming an essential part of medical education for surgical training and for improving surgical safety with adequate planning. This new polyamide craniosynostosis model allowed the surgeons to have realistic tactile feedback on manipulating a child's bone and permitted execution of the main procedures for anatomic correction. It is a low-cost model. Therefore our model is an excellent option for training purposes and is potentially a new important tool to improve the quality of the management of patients with craniosynostosis.

Introduction

Craniosynostosis is often a complex disease, generally involving orbital and facial bones together with the cranial deformity. Treatment is sometimes challenging, and surgical correction requires a multidisciplinary approach with association of neurosurgeon and plastic surgeon skills. Surgical expertise and meticulous techniques are required to achieve the best cosmetic and functional results and to improve patient safety.1

Training surgeons to perform craniofacial procedures is particularly challenging, as the majority of procedures carry a high risk and a minor mistake can be fatal. Considering that medical-legal issues preclude mistakes during the learning curve of young surgeons,2, 3 simulation-based training models can be useful to transpose these educational obstacles; however, as far as we know, a refined simulation model is still lacking.4, 5, 6

An ideal training model for craniosynostosis should provide all the complex anatomy of the cranial base, the most common pathologic variations, and tactile feedback of performing osteotomies. In this context, 3D-printed models may provide an accurate reproduction of bone anatomy and specific pathologic nuances. 3D-printed models can be used for surgical training and surgical planning, which may improve the safety of the procedure and understanding of each patient's craniosynostosis nuances.

The objective of this report is to present novel 3D-printed polyamide craniosynostosis models that can improve the understanding and treatment complex pathologies while promoting a cost-effective and trending form of education.

Section snippets

Data Acquisition

To obtain data for model manufacturing, we collected computed tomography (CT) images of our craniofacial clinic patients. We obtained CT scan images with a slice thickness of 1 mm, of patients 6–9 months of age, diagnosed with craniosynostosis (single suture or complex craniosynostosis). Most CT and magnetic resonance imaging units have the ability to export data in common medical file format—digital imaging and communication in medicine (DICOM).

After saving CT or magnetic resonance imaging

Results

We have produced 3 craniosynostosis models based on the image examinations of 3 patients: 1) simple sagittal stenosis, 2) bilateral coronal stenosis, and 3) complex multisutural stenosis with coronal and lambdoid stenosis. The models allowed adequate surgical planning (see Figure 2) and performing the 3 most common procedures in craniosynostosis treatment (see Figure 3): fronto-orbital advancement, Pi procedure, and posterior distraction.

All aspects of craniofacial anatomy could be shown on the

Discussion

Simulation provides a safe learning environment and has the ability to expose the trainee to problems of varying complexity levels.14 An excellent example of success using simulation is in the aviation industry, which was a pioneer of using flight simulation models. Simulation is already an important tool in medical and resident education in other areas of medicine15, 16, 17 and is gaining acceptance in neurosurgery as more validated tools and assessment methods are developed.18, 19, 20

Conclusions

Simulation is becoming an essential part of medical education for surgical training and for improving surgical safety with adequate planning. We propose a 3D-printed model used to create patient-specific geometries to replace bone structures. The biomodel geometries were designed on the basis of head CT scans of real craniosynostosis patients that allow the experience of dealing with such challenging pathologies. The ability to reproduce the unique complex bone abnormalities present in

References (22)

  • G. Coelho et al.

    Anatomical pediatric model for craniosynostosis surgical training

    Childs Nerv Syst

    (2014)
  • Cited by (33)

    • A Low-Cost Simulation Model for Endoscopic-Assisted Sagittal Craniosynostosis Repair

      2022, World Neurosurgery
      Citation Excerpt :

      Eastwood et al.23 reported that a base for the sagittal synostosis model costs 200 Canadian dollars, and the consumable cartridge for subsequent uses costs 50 Canadian dollars (160 and 40 USD, respectively). Ghizoni et al.24 described a craniosynostosis model of about 100 USD, with the possibility of further reduction of the cost with large-scale production. The model we introduce has an initial cost of 10 USD and 2 USD for successive uses.

    • Surgical training 2.0: A systematic approach reviewing the literature focusing on oral maxillofacial surgery – Part I

      2021, Journal of Stomatology, Oral and Maxillofacial Surgery
      Citation Excerpt :

      Learners must become more independent in the way they progress [49,50]. Cadaver models have been used for a long time, but they do not allow the various pathologies to be reproduced, they are expensive, they have medical restrictions due to prion disease and pose some ethical problems [45,50–58]. Certain pathologies are rare or cannot be sufficiently preserved at the time of prosection [56,59–62].

    View all citing articles on Scopus

    Conflict of interest statement: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. None of the authors has any conflict of interest to disclose.

    View full text