A 3-Dimensional Printed Patient-Specific Surgical Guide to Facilitate Transsphenoidal Hypophysectomy in Dogs

Abstract

ObjectiveHypophysectomy in dogs is a difficult surgery that requires specific learning and training. We aimed to evaluate the accuracy of a 3-dimensional printed patient-specific surgical guide to facilitate choosing the entry point in the basisphenoid bone before approaching the sella turcica during transsphenoidal hypophysectomy in dogs.MethodsTwo canine cadavers and 8 dogs undergoing transsphenoidal hypophysectomy for Cushing's disease treatment, involving design and fabrication of a 3-dimensional printed guide. The ideal entry point in the basisphenoid bone outer cortical layer was determined in each dog pre-operatively; its anatomical location was described with a set of measurements then compared to post-operative computed tomography measures describing the location of the outer cortical window created in the basisphenoid bone.ResultsSeveral guide designs were proposed, and a consensus reached based on surgeons' experience performing hypophysectomy. The device chosen could be applied to the size and shape of skulls encountered in this case series. The pre-planned measurements were comparable to post-operative measurement (there was also no statistical difference), with median of differences <0.1 mm, which we judged as clinically acceptable.Clinical SignificanceHypophysectomy in dogs is a challenging procedure that has a learning curve and needs to be performed by specialist neurosurgeons. We propose that a low-profile 3-dimensional printed surgical guide can aid the specialist neurosurgeon to locate the burring site of the outer cortical layer of the basisphenoid bone at a pre-defined location and with good accuracy. It does not alleviate the need to understand the anatomy of the region and to know how to create a slot within the basisphenoid bone, which remains essential to enter the sella turcica. This device could help specialist veterinary neurosurgeons wishing to be trained to perform hypophysectomy.

Endoscopy-assisted resection of a sphenoid-wing meningioma using a 3D-printed patient-specific pointer in a dog: A case report

“…Third, we have included the findings of only one dog, although the feasibility of 3D-PSP-aided complete resection of sphenoid-wing meningioma has been demonstrated. Fourth, we could not evaluate the location or size of the surgical window, as previous studies have done, because post-operative CT was not performed ( 20 , 21 ). Although the 3D-printed pointer can be modified to fit the patient, further research is necessary to compare the accuracy and utility of this method with current best practices.…”

“…Surgical planning, including confirmation of the location, size, and shape of the 3D-PSP and identification of the exact location of the tumor, was performed using computer-aided 3D design software (3-DS Max; Autodesk, San Francisco, CA, USA) applied to the MRI and CT images ( 20 , 21 ). This was necessary because a PSP used in brain surgery can differ in detail from patient-specific guides used on the spine.…”

“…This was necessary because a PSP used in brain surgery can differ in detail from patient-specific guides used on the spine. Detailed guide concepts and methods have been described previously ( 20 , 21 ).…”

Contribution of three‐dimensional printed models to neurosurgery: Description of a feline intracranial meningioma treated by rostrotentorial craniectomy

“…[26][27][28][29][30][31] In small animal intracranial neurosurgery, to date, only 3D-printed patient-specific brain biopsy guides and transsphenoidal guide for hypophysectomy have been investigated in dogs. [32][33][34][35][36] To the authors' knowledge, this report is the first description of the manufacturing process and intraoperative use of a 3D-printed resin model for intracranial tumour resection in feline species.…”

3D printed guide pituitary surgery in dogs with Cushing's disease

“…The team at the CVS referral practice developed and assessed a 3D printed guide to enable safer brain surgery for a challenging procedure in dogs with Cushing's disease. Their study was published in the journal Frontiers in Veterinary Science 1 …”