Endoscopic endonasal cranial base surgery simulation using an artificial cranial base model created by selective laser sintering

Abstract

Mastery of the expanded endoscopic endonasal approach (EEA) requires anatomical knowledge and surgical skills; the learning curve for this technique is steep. To a great degree, these skills can be gained by cadaveric dissections; however, ethical, religious, and legal considerations may interfere with this paradigm in different regions of the world. We assessed an artificial cranial base model for the surgical simulation of EEA and compared its usefulness with that of cadaveric specimens. The model is made of both polyamide nylon and glass beads using a selective laser sintering (SLS) technique to reflect CT-DICOM data of the patient's head. It features several artificial cranial base structures such as the dura mater, venous sinuses, cavernous sinuses, internal carotid arteries, and cranial nerves. Under endoscopic view, the model was dissected through the nostrils using a high-speed drill and other endonasal surgical instruments. Anatomical structures around and inside the sphenoid sinus were accurately reconstructed in the model, and several important surgical landmarks, including the medial and lateral optico-carotid recesses and vidian canals, were observed. The bone was removed with a high-speed drill until it was eggshell thin and the dura mater was preserved, a technique very similar to that applied in patients during endonasal cranial base approaches. The model allowed simulation of almost all sagittal and coronal plane EEA modules. SLS modeling is a useful tool for acquiring the anatomical knowledge and surgical expertise for performing EEA while avoiding the ethical, religious, and infection-related problems inherent with use of cadaveric specimens.

Three-Dimensional Printing: Current Use in Rhinology and Endoscopic Skull Base Surgery

“…However, cadaveric models for training are far more expensive and harder to obtain than temporal bones and do not typically contain pathologic entities. 30 Access to simulation through 3D printed educational tools results in trainees with more advanced skills earlier in training, potentially improving patient safety. In institutions or countries where access cadaveric material for simulation and anatomic dissection is relatively limited, 3D printing can be a source of models for training and education.…”

“…ESBS simulation. Many 3D printed models for endoscopic skull base surgical simulation have been developed [29][30][31][32][33] ( Table 2). Educators have been attracted to the properties and unique characteristics that simulation with 3D models can offer.…”

“…This was reflected as a point of emphasis in some of the simulation models. 30,31,33 In particular, Lin et al created a 3D printed model for simulation of an endoscopic endonasal approach. A drilling insert was created using plaster composites followed by an epoxy coating to mimic bicortical bone and enhance strength.…”

“…Oyama et al utilized SLS polyamide with nylon and glass beads to create a model of ESBS. 30 To complete the model, SLS was followed by hand-painting layers of silicone to represent periorbita and dura. Using endoscopic instruments, 3 experienced neurosurgeons then performed dissections of various endoscopic approaches.…”

Surgical Anatomy for the Endoscopic Endonasal Approach to the Ventrolateral Skull Base

“…Laboratory hands-on training, using cadaver heads and/or training models, is an important and necessary step in the acquisition of anatomical knowledge and surgical skills for EEA. 28,29) …”