Multimaterial and multicolor 3D-printed model in training of transnasal endoscopic surgery for pituitary adenoma

Zheng, Jianbao; Li, Chuzhong; Chen, Guoqiang

doi:10.3171/2019.6.focus19294

Cited by 15 publications

(9 citation statements)

References 26 publications

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“…In a previous study of patients with malignant brain tumors (glioma), a 3D printing approach was shown to improve patient understanding and support clinical decision making [ 28 ]. For patients with pituitary tumors 3D printed anatomical models have been proposed for enhancing surgical training [ 23 , 24 ]. A particular focus of these early models has been the visual appearance and aesthetics with respect to mimicking human tissue.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, it seems unlikely that this type of anatomical model would be readily adopted into routine clinical practice. Specifically, the lack of colors depicting the different structures was considered a significant limitation, and is something which has been highlighted by other workers [ 23 ].…”

Section: Discussionmentioning

confidence: 99%

“…Importantly, guidelines have been developed for the use of 3D printing in clinical practice, including for cardiac, hepatobiliary, gastrointestinal and other conditions where it may have a potential role in informing management [ 20 – 22 ]. However to our knowledge these guidelines do not make specific mention to the pituitary gland although a small number of studies have shown the feasibility of 3D printing of pituitary tumors [ 23 – 25 ].…”

Section: Introductionmentioning

confidence: 99%

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Methods of 3D printing models of pituitary tumors

et al. 2021

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Background Pituitary adenomas can give rise to a variety of clinical disorders and surgery is often the primary treatment option. However, preoperative magnetic resonance imaging (MRI) does not always reliably identify the site of an adenoma. In this setting molecular (functional) imaging (e.g. 11C-methionine PET/CT) may help with tumor localisation, although interpretation of these 2D images can be challenging. 3D printing of anatomicalal models for other indications has been shown to aid surgical planning and improve patient understanding of the planned procedure. Here, we explore the potential utility of four types of 3D printing using PET/CT and co-registered MRI for visualising pituitary adenomas. Methods A 3D patient-specific model based on a challenging clinical case was created by segmenting the pituitary gland, pituitary adenoma, carotid arteries and bone using contemporary PET/CT and MR images. The 3D anatomical models were printed using VP, MEX, MJ and PBF 3D printing methods. Different anatomicalal structures were printed in color with the exception of the PBF anatomical model where a single color was used. The anatomical models were compared against the computer model to assess printing accuracy. Three groups of clinicians (endocrinologists, neurosurgeons and ENT surgeons) assessed the anatomical models for their potential clinical utility. Results All of the printing techniques produced anatomical models which were spatially accurate, with the commercial printing techniques (MJ and PBF) and the consumer printing techniques (VP and MEX) demonstrating comparable findings (all techniques had mean spatial differences from the computer model of < 0.6 mm). The MJ, VP and MEX printing techniques yielded multicolored anatomical models, which the clinicians unanimously agreed would be preferable to use when talking to a patient; in contrast, 50%, 40% and 0% of endocrinologists, neurosurgeons and ENT surgeons respectively would consider using the PBF model. Conclusion 3D anatomical models of pituitary tumors were successfully created from PET/CT and MRI using four different 3D printing techniques. However, the expert reviewers unanimously preferred the multicolor prints. Importantly, the consumer printers performed comparably to the commercial MJ printing technique, opening the possibility that these methods can be adopted into routine clinical practice with only a modest investment.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Methods of 3D printing models of pituitary tumors

et al. 2021

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“…With advanced in 3D printing technology and manufacturing many 3D organ models have been developed for surgical training, including temporal bone (6)(7)(8), paranasal sinuses (9-12), skull base (9,(13)(14)(15)(16), kidney, renal pelvis, and ureter (17), mandibular (9), aorta (18), and heart (19). In addition, some models successfully reproduce the organs with pre-existing pathology such as cerebral aneurysms (20,21) and basilar invagination (22).…”

Section: Discussionmentioning

confidence: 99%

Remote Training of Functional Endoscopic Sinus Surgery With Advanced Manufactured 3D Sinus Models and a Telemedicine System

et al. 2021

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Objective: Traditionally, cadaveric courses have been an important tool in surgical education for Functional Endoscopic Sinus Surgery (FESS). The recent COVID-19 pandemic, however, has had a significant global impact on such courses due to its travel restrictions, social distancing regulations, and infection risk. Here, we report the world-first remote (Functional Endoscopic Sinus Surgery) FESS training course between Japan and Australia, utilizing novel 3D-printed sinus models. We examined the feasibility and educational effect of the course conducted entirely remotely with encrypted telemedicine software.Methods: Three otolaryngologists in Hokkaido, Japan, were trained to perform frontal sinus dissections on novel 3D sinus models of increasing difficulty, by two rhinologists located in Adelaide, South Australia. The advanced manufactured sinus models were 3D printed from the Computed tomography (CT) scans of patients with chronic rhinosinusitis. Using Zoom and the Quintree telemedicine platform, the surgeons in Adelaide first lectured the Japanese surgeons on the Building Block Concept for a three Dimensional understanding of the frontal recess. They in real time directly supervised the surgeons as they planned and then performed the frontal sinus dissections. The Japanese surgeons were asked to complete a questionnaire pertaining to their experience and the time taken to perform the frontal dissection was recorded. The course was streamed to over 200 otolaryngologists worldwide.Results: All dissectors completed five frontal sinusotomies. The time to identify the frontal sinus drainage pathway (FSDP) significantly reduced from 1,292 ± 672 to 321 ± 267 s (p = 0.02), despite an increase in the difficulty of the frontal recess anatomy. Image analysis revealed the volume of FSDP was improved (2.36 ± 0.00 to 9.70 ± 1.49 ml, p = 0.014). Questionnaires showed the course's general benefit was 95.47 ± 5.13 in dissectors and 89.24 ± 15.75 in audiences.Conclusion: The combination of telemedicine software, web-conferencing technology, standardized 3D sinus models, and expert supervision, provides excellent training outcomes for surgeons in circumstances when classical surgical workshops cannot be realized.

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“…17,18 The design and fabrication of cerebral vascular phantoms using additive manufacturing for neurosurgery have already been reported in the literature. 13,[19][20][21][22] The most representative examples are mainly related to surgical aid applications (e.g., aneurysm clipping 20,23 ) as well as to diagnosis, 24,25 blood circulation analysis, 26,27 and patients' information purposes. 12 The manufacturing strategies explored included material extrusion of thermoplastic polymers (e.g., fused filament fabrication [FFF] 20,28 ), VAT photopolymerization, 29,30 PolyJet printing, 31,32 and sacrificial approaches combining FFF of acrylonitrile butadiene styrene (ABS) templates and casting of silicone-based materials.…”

Section: Introductionmentioning

confidence: 99%

Additive Fabrication of a Vascular 3D Phantom for Stereotactic Radiosurgery of Arteriovenous Malformations

Legnani

Gallo

Pezzotta

et al. 2021

3D Printing and Additive Manufacturing

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In this study, an efficient methodology for manufacturing a realistic three-dimensional (3D) cerebrovascular phantom resembling a brain arteriovenous malformation (AVM) for applications in stereotactic radiosurgery is presented. The AVM vascular structure was 3D reconstructed from brain computed tomography (CT) data acquired from a patient. For the phantom fabrication, stereolithography was used to produce the AVM model and combined with silicone casting to mimic the brain parenchyma surrounding the vascular structure. This model was made with tissues-equivalent materials for radiology. The hollow vascular system of the phantom was filled with a contrast agent usually employed on patients for CT scans. The radiological response of the phantom was tested and compared with the one of the clinical case. The constructed model demonstrated to be a very accurate physical representation of the AVM and its vasculature and good morphological consistency was observed between the model and the patient-specific source anatomy. These results suggest that the proposed method has potential to be used to fabricate patient-specific phantoms for neurovascular radiosurgery applications and medical research.

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Multimaterial and multicolor 3D-printed model in training of transnasal endoscopic surgery for pituitary adenoma

Cited by 15 publications

References 26 publications

Methods of 3D printing models of pituitary tumors

Methods of 3D printing models of pituitary tumors

Remote Training of Functional Endoscopic Sinus Surgery With Advanced Manufactured 3D Sinus Models and a Telemedicine System

Additive Fabrication of a Vascular 3D Phantom for Stereotactic Radiosurgery of Arteriovenous Malformations

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