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Cuba M, Vanluchene H, Murek M, Goldberg J, Müller MD, Montalbetti M, Janosovits K, Rhomberg T, Zhang D, Raabe A, Joseph FJ, Bervini D. Training Performance Assessment for Intracranial Aneurysm Clipping Surgery Using a Patient-Specific Mixed-Reality Simulator: A Learning Curve Study. Oper Neurosurg (Hagerstown) 2024; 26:01787389-990000000-01028. [PMID: 38251883 PMCID: PMC11086963 DOI: 10.1227/ons.0000000000001041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 11/10/2023] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND AND OBJECTIVES The value of simulation-based training in medicine and surgery has been widely demonstrated. This study investigates the introduction and use of a new mixed-reality neurosurgical simulator in aneurysm clipping surgery, focusing on the learning curve and performance improvement. METHODS Five true-scale craniotomy head models replicating patient-specific neuroanatomy, along with a mixed-reality simulator, a neurosurgical microscope, and a set of microsurgical instruments and clips, were used in the operation theater to simulate aneurysm microsurgery. Six neurosurgical residents participated in five video-recorded simulation sessions over 4 months. Complementary learning modalities were implemented between sessions. Thereafter, three blinded analysts reported on residents' use of the microscope, quality of manipulation, aneurysm occlusion, clipping techniques, and aneurysm rupture. Data were also captured regarding training time and clipping attempts. RESULTS Over the course of training, clipping time and number of clipping attempts decreased significantly (P = .018, P = .032) and the microscopic skills improved (P = .027). Quality of manipulation and aneurysm occlusion scoring improved initially although the trend was interrupted because the spacing between sessions increased. Significant differences in clipping time and attempts were observed between the most and least challenging patient models (P = .005, P = .0125). The least challenging models presented higher rates of occlusion based on indocyanine green angiography evaluation from the simulator. CONCLUSION The intracranial aneurysm clipping learning curve can be improved by implementing a new mixed-reality simulator in dedicated training programs. The simulator and the models enable comprehensive training under the guidance of a mentor.
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Affiliation(s)
- Miguel Cuba
- Image Guided Therapy, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Hanne Vanluchene
- Image Guided Therapy, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Michael Murek
- Department of Neurosurgery, Inselspital Bern University Hospital, University of Bern, Bern, Switzerland
| | - Johannes Goldberg
- Department of Neurosurgery, Inselspital Bern University Hospital, University of Bern, Bern, Switzerland
| | - Mandy D. Müller
- Department of Neurosurgery, Inselspital Bern University Hospital, University of Bern, Bern, Switzerland
| | - Matteo Montalbetti
- Department of Neurosurgery, Inselspital Bern University Hospital, University of Bern, Bern, Switzerland
| | - Katharina Janosovits
- Department of Neurosurgery, Inselspital Bern University Hospital, University of Bern, Bern, Switzerland
| | - Thomas Rhomberg
- Department of Neurosurgery, Inselspital Bern University Hospital, University of Bern, Bern, Switzerland
| | - David Zhang
- Department of Neurosurgery, Inselspital Bern University Hospital, University of Bern, Bern, Switzerland
| | - Andreas Raabe
- Department of Neurosurgery, Inselspital Bern University Hospital, University of Bern, Bern, Switzerland
| | - Fredrick J. Joseph
- Image Guided Therapy, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - David Bervini
- Department of Neurosurgery, Inselspital Bern University Hospital, University of Bern, Bern, Switzerland
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Ali A, Morris JM, Decker SJ, Huang YH, Wake N, Rybicki FJ, Ballard DH. Clinical situations for which 3D printing is considered an appropriate representation or extension of data contained in a medical imaging examination: neurosurgical and otolaryngologic conditions. 3D Print Med 2023; 9:33. [PMID: 38008795 PMCID: PMC10680204 DOI: 10.1186/s41205-023-00192-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 10/03/2023] [Indexed: 11/28/2023] Open
Abstract
BACKGROUND Medical three dimensional (3D) printing is performed for neurosurgical and otolaryngologic conditions, but without evidence-based guidance on clinical appropriateness. A writing group composed of the Radiological Society of North America (RSNA) Special Interest Group on 3D Printing (SIG) provides appropriateness recommendations for neurologic 3D printing conditions. METHODS A structured literature search was conducted to identify all relevant articles using 3D printing technology associated with neurologic and otolaryngologic conditions. Each study was vetted by the authors and strength of evidence was assessed according to published guidelines. RESULTS Evidence-based recommendations for when 3D printing is appropriate are provided for diseases of the calvaria and skull base, brain tumors and cerebrovascular disease. Recommendations are provided in accordance with strength of evidence of publications corresponding to each neurologic condition combined with expert opinion from members of the 3D printing SIG. CONCLUSIONS This consensus guidance document, created by the members of the 3D printing SIG, provides a reference for clinical standards of 3D printing for neurologic conditions.
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Affiliation(s)
- Arafat Ali
- Department of Radiology, Henry Ford Health, Detroit, MI, USA
| | | | - Summer J Decker
- Division of Imaging Research and Applied Anatomy, Department of Radiology, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Yu-Hui Huang
- Department of Radiology, University of Minnesota, Minneapolis, MN, USA
| | - Nicole Wake
- Department of Research and Scientific Affairs, GE HealthCare, New York, NY, USA
- Center for Advanced Imaging Innovation and Research, Department of Radiology, NYU Langone Health, New York, NY, USA
| | - Frank J Rybicki
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - David H Ballard
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, Saint Louis, MO, USA.
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Murphy AR, Allenby MC. In vitro microvascular engineering approaches and strategies for interstitial tissue integration. Acta Biomater 2023; 171:114-130. [PMID: 37717711 DOI: 10.1016/j.actbio.2023.09.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 09/10/2023] [Accepted: 09/12/2023] [Indexed: 09/19/2023]
Abstract
The increasing gap between clinical demand for tissue or organ transplants and the availability of donated tissue highlights the emerging opportunities for lab-grown or synthetically engineered tissue. While the field of tissue engineering has existed for nearly half a century, its clinical translation remains unrealised, in part, due to a limited ability to engineer sufficient vascular supply into fabricated tissue, which is necessary to enable nutrient and waste exchange, prevent cellular necrosis, and support tissue proliferation. Techniques to develop anatomically relevant, functional vascular networks in vitro have made significant progress in the last decade, however, the challenge now remains as to how best incorporate these throughout dense parenchymal tissue-like structures to address diffusion-limited development and allow for the fabrication of large-scale vascularised tissue. This review explores advances made in the laboratory engineering of vasculature structures and summarises recent attempts to integrate vascular networks together with sophisticated in vitro avascular tissue and organ-like structures. STATEMENT OF SIGNIFICANCE: The ability to grow full scale, functional tissue and organs in vitro is primarily limited by an inability to adequately diffuse oxygen and nutrients throughout developing cellularised structures, which generally results from the absence of perfusable vessel networks. Techniques to engineering both perfusable vascular networks and avascular miniaturised organ-like structures have recently increased in complexity, sophistication, and physiological relevance. However, integrating these two essential elements into a single functioning vascularised tissue structure represents a significant spatial and temporal engineering challenge which is yet to be surmounted. Here, we explore a range of vessel morphogenic phenomena essential for tissue-vascular co-development, as well as evaluate a range of recent noteworthy approaches for generating vascularised tissue products in vitro.
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Affiliation(s)
- A R Murphy
- School of Chemical Engineering, Faculty of Engineering, Architecture and Information Technology, The University of Queensland, St Lucia, QLD 4100, Australia
| | - M C Allenby
- School of Chemical Engineering, Faculty of Engineering, Architecture and Information Technology, The University of Queensland, St Lucia, QLD 4100, Australia; Centre for Biomedical Technologies, School of Medical, Mechanical and Process Engineering, Faculty of Engineering, Queensland University of Technology, Kelvin Grove, QLD 4059, Australia.
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Williams SC, Ahmed R, Davids JD, Funnell JP, Hanrahan JG, Layard Horsfall H, Muirhead W, Nicolosi F, Thorne L, Marcus HJ, Grover P. Benchtop simulation of the retrosigmoid approach: Validation of a surgical simulator and development of a task-specific outcome measure score. World Neurosurg X 2023; 20:100230. [PMID: 37456690 PMCID: PMC10344945 DOI: 10.1016/j.wnsx.2023.100230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 05/11/2023] [Accepted: 06/12/2023] [Indexed: 07/18/2023] Open
Abstract
Background Neurosurgical training is changing globally. Reduced working hours and training opportunities, increased patient safety expectations, and the impact of COVID-19 have reduced operative exposure. Benchtop simulators enable trainees to develop surgical skills in a controlled environment. We aim to validate a high-fidelity simulator model (RetrosigmoidBox, UpSurgeOn) for the retrosigmoid approach to the cerebellopontine angle (CPA). Methods Novice and expert Neurosurgeons and Ear, Nose, and Throat surgeons performed a surgical task using the model - identification of the trigeminal nerve. Experts completed a post-task questionnaire examining face and content validity. Construct validity was assessed through scoring of operative videos employing Objective Structured Assessment of Technical Skills (OSATS) and a novel Task-Specific Outcome Measure score. Results Fifteen novice and five expert participants were recruited. Forty percent of experts agreed or strongly agreed that the brain tissue looked real. Experts unanimously agreed that the RetrosigmoidBox was appropriate for teaching. Statistically significant differences were noted in task performance between novices and experts, demonstrating construct validity. Median total OSATS score was 14/25 (IQR 10-19) for novices and 22/25 (IQR 20-22) for experts (p < 0.05). Median Task-Specific Outcome Measure score was 10/20 (IQR 7-17) for novices compared to 19/20 (IQR 18.5-19.5) for experts (p < 0.05). Conclusion The RetrosigmoidBox benchtop simulator has a high degree of content and construct validity and moderate face validity. The changing landscape of neurosurgical training mean that simulators are likely to become increasingly important in the delivery of high-quality education. We demonstrate the validity of a Task-Specific Outcome Measure score for performance assessment of a simulated approach to the CPA.
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Affiliation(s)
- Simon C. Williams
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), London, UK
| | - Razna Ahmed
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), London, UK
- Queen Square Institute of Neurology, University College London, London, UK
| | - Joseph Darlington Davids
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
- Institute of Global Health Innovation and Hamlyn Centre for Robotics Surgery, Imperial College London, London, UK
| | - Jonathan P. Funnell
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), London, UK
| | - John Gerrard Hanrahan
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), London, UK
| | - Hugo Layard Horsfall
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), London, UK
| | - William Muirhead
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), London, UK
| | - Federico Nicolosi
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Lewis Thorne
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - Hani J. Marcus
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), London, UK
| | - Patrick Grover
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
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Ahmed R, Muirhead W, Williams SC, Bagchi B, Datta P, Gupta P, Salvadores Fernandez C, Funnell JP, Hanrahan JG, Davids JD, Grover P, Tiwari MK, Murphy M, Marcus HJ. A synthetic model simulator for intracranial aneurysm clipping: validation of the UpSurgeOn AneurysmBox. Front Surg 2023; 10:1185516. [PMID: 37325417 PMCID: PMC10264641 DOI: 10.3389/fsurg.2023.1185516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 05/17/2023] [Indexed: 06/17/2023] Open
Abstract
Background and objectives In recent decades, the rise of endovascular management of aneurysms has led to a significant decline in operative training for surgical aneurysm clipping. Simulation has the potential to bridge this gap and benchtop synthetic simulators aim to combine the best of both anatomical realism and haptic feedback. The aim of this study was to validate a synthetic benchtop simulator for aneurysm clipping (AneurysmBox, UpSurgeOn). Methods Expert and novice surgeons from multiple neurosurgical centres were asked to clip a terminal internal carotid artery aneurysm using the AneurysmBox. Face and content validity were evaluated using Likert scales by asking experts to complete a post-task questionnaire. Construct validity was evaluated by comparing expert and novice performance using the modified Objective Structured Assessment of Technical Skills (mOSATS), developing a curriculum-derived assessment of Specific Technical Skills (STS), and measuring the forces exerted using a force-sensitive glove. Results Ten experts and eighteen novices completed the task. Most experts agreed that the brain looked realistic (8/10), but far fewer agreed that the brain felt realistic (2/10). Half the expert participants (5/10) agreed that the aneurysm clip application task was realistic. When compared to novices, experts had a significantly higher median mOSATS (27 vs. 14.5; p < 0.01) and STS score (18 vs. 9; p < 0.01); the STS score was strongly correlated with the previously validated mOSATS score (p < 0.01). Overall, there was a trend towards experts exerting a lower median force than novices, however, these differences were not statistically significant (3.8 N vs. 4.0 N; p = 0.77). Suggested improvements for the model included reduced stiffness and the addition of cerebrospinal fluid (CSF) and arachnoid mater. Conclusion At present, the AneurysmBox has equivocal face and content validity, and future versions may benefit from materials that allow for improved haptic feedback. Nonetheless, it has good construct validity, suggesting it is a promising adjunct to training.
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Affiliation(s)
- Razna Ahmed
- Queen Square Institute of Neurology, University College London, London, United Kingdom
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), University College London, London, United Kingdom
| | - William Muirhead
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), University College London, London, United Kingdom
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Simon C. Williams
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), University College London, London, United Kingdom
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Biswajoy Bagchi
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), University College London, London, United Kingdom
- Nanoengineered Systems Laboratory, Department of Mechanical Engineering, University College London, London, United Kingdom
| | - Priyankan Datta
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), University College London, London, United Kingdom
- Nanoengineered Systems Laboratory, Department of Mechanical Engineering, University College London, London, United Kingdom
| | - Priya Gupta
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), University College London, London, United Kingdom
- Nanoengineered Systems Laboratory, Department of Mechanical Engineering, University College London, London, United Kingdom
| | - Carmen Salvadores Fernandez
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), University College London, London, United Kingdom
- Nanoengineered Systems Laboratory, Department of Mechanical Engineering, University College London, London, United Kingdom
| | - Jonathan P. Funnell
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), University College London, London, United Kingdom
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - John G. Hanrahan
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), University College London, London, United Kingdom
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Joseph D. Davids
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, United Kingdom
- Institute of Global Health Innovation and Hamlyn Centre for Robotics Surgery, Imperial College London, London, United Kingdom
| | - Patrick Grover
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Manish K. Tiwari
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), University College London, London, United Kingdom
- Nanoengineered Systems Laboratory, Department of Mechanical Engineering, University College London, London, United Kingdom
| | - Mary Murphy
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Hani J. Marcus
- Queen Square Institute of Neurology, University College London, London, United Kingdom
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), University College London, London, United Kingdom
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, United Kingdom
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Joseph FJ, Vanluchene HER, Bervini D. Simulation training approaches in intracranial aneurysm surgery-a systematic review. Neurosurg Rev 2023; 46:101. [PMID: 37131015 PMCID: PMC10154262 DOI: 10.1007/s10143-023-01995-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 03/20/2023] [Accepted: 04/07/2023] [Indexed: 05/04/2023]
Abstract
BACKGROUND With the increasing complexity and decreasing exposure to intracranial aneurysm surgery, training and maintenance of the surgical skills have become challenging. This review elaborated on simulation training for intracranial aneurysm clipping. METHODS A systematic review was performed according to the PRISMA guidelines to identify studies on aneurysm clipping training using models and simulators. The primary outcome was the identification of the predominant modes of the simulation process, models, and training methods associated with a microsurgical learning curve. The secondary outcomes included assessments of the validation of such simulators and the learning capability from the use of such simulators. RESULTS Of the 2068 articles screened, 26 studies met the inclusion criteria. The chosen reports used a wide range of simulation approaches including ex vivo methods (n = 6); virtual reality (VR) platforms (n = 11); and static (n = 6) and dynamic (n = 3) 3D-printed aneurysm models (n = 6). The ex vivo training methods have limited availability, VR simulators lack haptics and tactility, while 3D static models lack important microanatomical components and the simulation of blood flow. 3D dynamic models including pulsatile flow are reusable and cost-effective but miss microanatomical components. CONCLUSIONS The existing training methods are heterogenous and do not realistically simulate the complete microsurgical workflow. The current simulations lack certain anatomical features and crucial surgical steps. Future research should focus on developing and validating a reusable, cost-effective training platform. No systematic validation method exists for the different training models, so there is a need to build homogenous assessment tools and validate the role of simulation in education and patient safety.
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Affiliation(s)
- Fredrick J Joseph
- Image Guided Therapy, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland.
| | - Hanne E R Vanluchene
- Image Guided Therapy, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - David Bervini
- Department of Neurosurgery, Bern University Hospital and University of Bern, Bern, Switzerland
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Berdida DJE, Elero FSL, Donato MFT, Dungo MKS, Dunque NIO, Dy KJE, Elarmo RAGF, Espineli JMB, Espineli VJG. Filipino nursing students' use of low-cost simulators during the COVID-19 pandemic: A summative content analysis of YouTube videos. TEACHING AND LEARNING IN NURSING : OFFICIAL JOURNAL OF THE NATIONAL ORGANIZATION FOR ASSCIATE DEGREE NURSING 2023; 18:134-143. [PMID: 35999891 PMCID: PMC9388447 DOI: 10.1016/j.teln.2022.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 08/15/2022] [Indexed: 02/08/2023]
Abstract
This study examined Filipino nursing students' use of household materials as low-cost simulators and how they aid in online return demonstrations. Summative content analysis guided this study. We collected uploaded YouTube videos (n = 14) depicting Filipino nursing students using low-cost simulators in their skills demonstration. We used Bengtsson's approach to content analysis to analyze the data. Four themes of low-cost simulators were identified: home and hardware, health and beauty, creative articles, and entertainment. The categories under home and hardware were tools, containers, furniture, and packaging. Health and beauty low-cost simulators were toiletries and medical supplies. Creative articles included fabrics, clothing accessories, and stationeries. Entertainment low-cost-simulators had toys and computer accessories. During the COVID-19 pandemic, our research uncovered home equipment employed as low-cost simulators to help nursing students' online simulation of skills demonstration. We recommend further investigation of whether students learned using low-cost simulators.
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Bisighini B, Di Giovanni P, Scerrati A, Trovalusci F, Vesco S. Fabrication of Compliant and Transparent Hollow Cerebral Vascular Phantoms for In Vitro Studies Using 3D Printing and Spin-Dip Coating. MATERIALS (BASEL, SWITZERLAND) 2022; 16:166. [PMID: 36614505 PMCID: PMC9821401 DOI: 10.3390/ma16010166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 12/12/2022] [Accepted: 12/20/2022] [Indexed: 06/17/2023]
Abstract
Endovascular surgery through flow diverters and coils is increasingly used for the minimally invasive treatment of intracranial aneurysms. To study the effectiveness of these devices, in vitro tests are performed in which synthetic vascular phantoms are typically used to reproduce in vivo conditions. In this paper, we propose a manufacturing process to obtain compliant and transparent hollow vessel replicas to assess the mechanical behaviour of endovascular devices and perform flow measurements. The vessel models were obtained in three main steps. First, a mould was 3D-printed in a water-soluble material; two techniques, fusion deposition modelling and stereolithography, were compared for this purpose. Then, the mould was covered with a thin layer of silicone through spin-dip coating, and finally, when the silicone layer solidified, it was dissolved in a hot water bath. The final models were tested in terms of the quality of the final results, the mechanical properties of the silicone, thickness uniformity, and transparency properties. The proposed approach makes it possible to produce models of different sizes and complexity whose transparency and mechanical properties are suitable for in vitro experiments. Its applicability is demonstrated through idealised and patient-specific cases.
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Affiliation(s)
- Beatrice Bisighini
- Mines Saint-Etienne, Université Lyon, Université Jean Monnet, Etablissement Français du Sang, INSERM, U1059 Sainbiose, Centre CIS, F-42023 Saint-Etienne, France
- Department of Enterprise Engineering, University Tor Vergata, Via del Politecnico 1, 00133 Rome, Italy
- Predisurge, 10 Rue Marius Patinaud, Grande Usine Creative 2, 42000 Saint-Etienne, France
| | | | - Alba Scerrati
- Department of Translational Medicine, University of Ferrara, Via Luigi Borsari 46, 44121 Ferrara, Italy
| | - Federica Trovalusci
- Department of Enterprise Engineering, University Tor Vergata, Via del Politecnico 1, 00133 Rome, Italy
| | - Silvia Vesco
- Department of Enterprise Engineering, University Tor Vergata, Via del Politecnico 1, 00133 Rome, Italy
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Ostaș D, Almășan O, Ileșan RR, Andrei V, Thieringer FM, Hedeșiu M, Rotar H. Point-of-Care Virtual Surgical Planning and 3D Printing in Oral and Cranio-Maxillofacial Surgery: A Narrative Review. J Clin Med 2022; 11:jcm11226625. [PMID: 36431101 PMCID: PMC9692897 DOI: 10.3390/jcm11226625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 11/04/2022] [Accepted: 11/05/2022] [Indexed: 11/11/2022] Open
Abstract
This paper provides an overview on the use of virtual surgical planning (VSP) and point-of-care 3D printing (POC 3DP) in oral and cranio-maxillofacial (CMF) surgery based on a literature review. The authors searched PubMed, Web of Science, and Embase to find papers published between January 2015 and February 2022 in English, which describe human applications of POC 3DP in CMF surgery, resulting in 63 articles being included. The main review findings were as follows: most used clinical applications were anatomical models and cutting guides; production took place in-house or as "in-house-outsourced" workflows; the surgeon alone was involved in POC 3DP in 36 papers; the use of free versus paid planning software was balanced (50.72% vs. 49.27%); average planning time was 4.44 h; overall operating time decreased and outcomes were favorable, though evidence-based studies were limited; and finally, the heterogenous cost reports made a comprehensive financial analysis difficult. Overall, the development of in-house 3D printed devices supports CMF surgery, and encouraging results indicate that the technology has matured considerably.
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Affiliation(s)
- Daniel Ostaș
- Department of Oral and Cranio-Maxillofacial Surgery, “Iuliu Hațieganu” University of Medicine and Pharmacy, 33 Moților Street, 400001 Cluj-Napoca, Romania
| | - Oana Almășan
- Department of Prosthetic Dentistry and Dental Materials, “Iuliu Hațieganu” University of Medicine and Pharmacy, 32 Clinicilor Street, 400006 Cluj-Napoca, Romania
| | - Robert R. Ileșan
- Department of Oral and Cranio-Maxillofacial Surgery, University Hospital Basel, 21 Spitalstrasse, 4031 Basel, Switzerland
- Medical Additive Manufacturing Research Group (Swiss MAM), Department of Biomedical Engineering, University of Basel, 16 Gewerbestrasse, 4123 Allschwil, Switzerland
- Correspondence:
| | - Vlad Andrei
- Department of Oral Rehabilitation, Faculty of Dentistry, “Iuliu Hațieganu” University of Medicine and Pharmacy, 15 Victor Babes Street, 400012 Cluj-Napoca, Romania
| | - Florian M. Thieringer
- Department of Oral and Cranio-Maxillofacial Surgery, University Hospital Basel, 21 Spitalstrasse, 4031 Basel, Switzerland
- Medical Additive Manufacturing Research Group (Swiss MAM), Department of Biomedical Engineering, University of Basel, 16 Gewerbestrasse, 4123 Allschwil, Switzerland
| | - Mihaela Hedeșiu
- Department of Maxillofacial Surgery and Implantology, “Iuliu Hațieganu” University of Medicine and Pharmacy, 37 Cardinal Iuliu Hossu, 400029 Cluj-Napoca, Romania
| | - Horațiu Rotar
- Department of Oral and Cranio-Maxillofacial Surgery, “Iuliu Hațieganu” University of Medicine and Pharmacy, 33 Moților Street, 400001 Cluj-Napoca, Romania
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Algin O, Keles A, Oto C. Cerebrovascular modelling for the management of aneurysm embolization using an intrasaccular flow diverter made by 3D printing. Pol J Radiol 2022; 87:e557-e562. [PMID: 36420125 PMCID: PMC9673973 DOI: 10.5114/pjr.2022.120520] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 04/04/2022] [Indexed: 09/18/2023] Open
Abstract
PURPOSE Using 3-dimensional (3D) printers, the creation of patient-specific models is possible before and after a therapeutic intervention. There are many articles about replicas for training and simulation of aneurysm clipping. However, no paper has focused on 3D replicas obtained from 3-tesla 3D time of flight (3D-TOF) MR angiography for intrasaccular flow diverter (WEB device) embolization of the cerebral aneurysms. In this paper, we aimed to investigate the feasibility of 3D printing models obtained from 3-tesla 3D-TOF data in the management and training of WEB-assisted embolization procedures. CASE PRESENTATION We presented a longitudinal case report with several 3D-TOF MRA prints over time. Three-tesla 3D-TOF data were converted into STL and G-code files using an open-source (3D-Slicer) program. We built patient-specific realistic 3D models of a patient with a middle cerebral artery trifurcation aneurysm, which were able to demonstrate the entire WEB device treatment procedure in the pre-intervention and post-intervention periods. The aneurysmatic segment was well displayed on the STL files and the 3D replicas. They allowed visualization of the aneurysmatic segment and changes within a 6-year follow-up period. We successfully showed the possibility of fast, cheap, and easy production of replicas for demonstration of the aneurysm, the parent vessels, and post-intervention changes in a simple way using an affordable 3D printer. CONCLUSIONS 3D printing is useful for training the endovascular team and the patients, understanding the aneurysm/parent vessels, and choosing the optimal embolization technique/device. 3D printing will potentially lead to greater interventionalist confidence, decreased radiation dose, and improvements in patient safety.
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Affiliation(s)
- Oktay Algin
- Yildirim Beyazit University, Ankara, Turkey
- National MR Research Center (UMRAM), Bilkent University, Ankara, Turkey
| | - Ayse Keles
- Yildirim Beyazit University, Ankara, Turkey
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11
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Muirhead WR, Layard Horsfall H, Khan DZ, Koh C, Grover PJ, Toma AK, Castanho P, Stoyanov D, Marcus HJ, Murphy M. Microsurgery for intracranial aneurysms: A qualitative survey on technical challenges and technological solutions. Front Surg 2022; 9:957450. [PMID: 35990100 PMCID: PMC9386123 DOI: 10.3389/fsurg.2022.957450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 07/06/2022] [Indexed: 11/24/2022] Open
Abstract
Introduction Microsurgery for the clipping of intracranial aneurysms remains a technically challenging and high-risk area of neurosurgery. We aimed to describe the technical challenges of aneurysm surgery, and the scope for technological innovations to overcome these barriers from the perspective of practising neurovascular surgeons. Materials and Methods Consultant neurovascular surgeons and members of the British Neurovascular Group (BNVG) were electronically invited to participate in an online survey regarding surgery for both ruptured and unruptured aneurysms. The free text survey asked three questions: what do they consider to be the principal technical barriers to aneurysm clipping? What technological advances have previously contributed to improving the safety and efficacy of aneurysm clipping? What technological advances do they anticipate improving the safety and efficacy of aneurysm clipping in the future? A qualitative synthesis of responses was performed using multi-rater emergent thematic analysis. Results The most significant reported historical advances in aneurysm surgery fell into five themes: (1) optimising clip placement, (2) minimising brain retraction, (3) tissue handling, (4) visualisation and orientation, and (5) management of intraoperative rupture. The most frequently reported innovation by far was indocyanine green angiography (84% of respondents). The three most commonly cited future advances were hybrid surgical and endovascular techniques, advances in intraoperative imaging, and patient-specific simulation and planning. Conclusions While some surgeons perceive that the rate of innovation in aneurysm clipping has been dwarfed in recent years by endovascular techniques, surgeons surveyed highlighted a broad range of future technologies that have the potential to continue to improve the safety of aneurysm surgery in the future.
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Affiliation(s)
- W. R. Muirhead
- Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, London, United Kingdom
- The Wellcome Centre for Interventional and Surgical Sciences, University College London, London, United Kingdom
| | - H. Layard Horsfall
- Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, London, United Kingdom
- The Wellcome Centre for Interventional and Surgical Sciences, University College London, London, United Kingdom
| | - D. Z. Khan
- Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, London, United Kingdom
- The Wellcome Centre for Interventional and Surgical Sciences, University College London, London, United Kingdom
| | - C. Koh
- Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, London, United Kingdom
- The Wellcome Centre for Interventional and Surgical Sciences, University College London, London, United Kingdom
| | - P. J. Grover
- Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - A. K. Toma
- Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - P. Castanho
- Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - D. Stoyanov
- The Wellcome Centre for Interventional and Surgical Sciences, University College London, London, United Kingdom
| | - H. J. Marcus
- Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, London, United Kingdom
- The Wellcome Centre for Interventional and Surgical Sciences, University College London, London, United Kingdom
| | - M. Murphy
- Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, London, United Kingdom
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12
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Schwandt E, Kockro R, Kramer A, Glaser M, Ringel F. Presurgical selection of the ideal aneurysm clip by the use of a three-dimensional planning system. Neurosurg Rev 2022; 45:2887-2894. [PMID: 35546216 PMCID: PMC9349090 DOI: 10.1007/s10143-022-01794-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 03/19/2022] [Accepted: 04/19/2022] [Indexed: 11/25/2022]
Abstract
Aneurysm occlusion rate after clipping is higher than after endovascular treatment. However, a certain percentage of incompletely clipped aneurysms remains. Presurgical selection of the proper aneurysm clips could potentially reduce the rate of incomplete clippings caused by inadequate clip geometry. The aim of the present study was to assess whether preoperative 3D image-based simulation allows for preoperative selection of a proper aneurysm clip for complete occlusion in individual cases. Patients harboring ruptured or unruptured cerebral aneurysms prior to surgical clipping were analyzed. CT angiography images were transferred to a 3D surgical-planning station (Dextroscope®) with imported models of 58 aneurysm clips. Intracranial vessels and aneurysms were segmented and the virtual aneurysm clips were placed at the aneurysm neck. Operating surgeons had information about the selected aneurysm clip, and patients underwent clipping. Intraoperative clip selection was documented and aneurysm occlusion rate was assessed by postoperative digital subtraction angiography. Nineteen patients were available for final analysis. In all patients, the most proximal clip at the aneurysm neck was the preselected clip. All aneurysms except one were fully occluded, as assessed by catheter angiography. One aneurysm had a small neck remnant that did not require secondary surgery and was occluded 15 months after surgery. 3D image-based preselection of a proper aneurysm clip can be translated to the operating room and avoids intraoperative clip selection. The associated occlusion rate of aneurysms is high.
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Affiliation(s)
- Eike Schwandt
- Department of Neurosurgery, University Medical Center Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Ralf Kockro
- Department of Neurosurgery, Klinik Hirslanden, Zurich, Switzerland
| | - Andreas Kramer
- Department of Neurosurgery, University Medical Center Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Martin Glaser
- Department of Neurosurgery, University Medical Center Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Florian Ringel
- Department of Neurosurgery, University Medical Center Mainz, Langenbeckstr. 1, 55131, Mainz, Germany.
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García Feijoo P, Carceller F, Isla Guerrero A, Sáez-Alegre M, Gandía González ML. Beyond Classic Anastomoses Training Models: Overview of Aneurysm Creation in Rodent Vessel Model. Front Surg 2022; 9:884675. [PMID: 35521434 PMCID: PMC9062134 DOI: 10.3389/fsurg.2022.884675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 03/14/2022] [Indexed: 11/29/2022] Open
Abstract
Nowadays, due to the decline in the number of microsurgical clippings for cerebral aneurysms and revascularization procedures, young neurosurgeons have fewer opportunities to participate and train on this type of surgery. Vascular neurosurgery is a demanding subspecialty that requires skills that can only be acquired with technical experience. This background pushes the new generations to be ready for such challenging cases by training hard on different available models, such as synthetic tubes, chicken wings, or placenta vessels. Although many training models for vascular neurosurgery have been described worldwide, one of the best is the rodent vessels model. It offers pulsation, coagulation, and real blood flow conditions in a physiologic atmosphere that mimics perfectly the intracranial human vessels environment, especially in terms of size. However, the current differences in governmental different regulations about the use of living animals in medical experimentation and the social awareness, as well as the lack of financial support, cause more difficulties for neurosurgeons to start with that kind of training. In this review, we describe the tools and techniques as basic steps for vascular microsurgery training by using rodent models, that provide an accurate copy of brain vessels environment under stable conditions. The initial three classical known microanastomoses for neurosurgeons are end-to-end, end-to-side, and side-to-side, but in literature, there have been described other more complex exercises for training and investigation, such as aneurysm models. Although there is still little data available, we aim to summarize and discuss aneurysm's training models and reviewed the current literature on the subject and its applications, including a detailed description of the techniques.
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14
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Chawla S, Devi S, Calvachi P, Gormley WB, Rueda-Esteban R. Evaluation of simulation models in neurosurgical training according to face, content, and construct validity: a systematic review. Acta Neurochir (Wien) 2022; 164:947-966. [PMID: 35122126 PMCID: PMC8815386 DOI: 10.1007/s00701-021-05003-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 08/30/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Neurosurgical training has been traditionally based on an apprenticeship model. However, restrictions on clinical exposure reduce trainees' operative experience. Simulation models may allow for a more efficient, feasible, and time-effective acquisition of skills. Our objectives were to use face, content, and construct validity to review the use of simulation models in neurosurgical education. METHODS PubMed, Web of Science, and Scopus were queried for eligible studies. After excluding duplicates, 1204 studies were screened. Eighteen studies were included in the final review. RESULTS Neurosurgical skills assessed included aneurysm clipping (n = 6), craniotomy and burr hole drilling (n = 2), tumour resection (n = 4), and vessel suturing (n = 3). All studies assessed face validity, 11 assessed content, and 6 assessed construct validity. Animal models (n = 5), synthetic models (n = 7), and VR models (n = 6) were assessed. In face validation, all studies rated visual realism favourably, but haptic realism was key limitation. The synthetic models ranked a high median tactile realism (4 out of 5) compared to other models. Assessment of content validity showed positive findings for anatomical and procedural education, but the models provided more benefit to the novice than the experienced group. The cadaver models were perceived to be the most anatomically realistic by study participants. Construct validity showed a statistically significant proficiency increase among the junior group compared to the senior group across all modalities. CONCLUSION Our review highlights evidence on the feasibility of implementing simulation models in neurosurgical training. Studies should include predictive validity to assess future skill on an individual on whom the same procedure will be administered. This study shows that future neurosurgical training systems call for surgical simulation and objectively validated models.
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Affiliation(s)
- Shreya Chawla
- Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Sharmila Devi
- Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Faculty of Life Sciences and Medicine, King's College London, London, UK
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Paola Calvachi
- Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA
| | - William B Gormley
- Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Roberto Rueda-Esteban
- Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
- Universidad de los Andes School of Medicine, Bogotá, Colombia.
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15
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Tanaka R, Liew BS, Yamada Y, Sasaki K, Miyatani K, Komatsu F, Kawase T, Kato Y, Hirose Y. Depiction of Cerebral Aneurysm Wall by Computational Fluid Dynamics (CFD) and Preoperative Illustration. Asian J Neurosurg 2022; 17:43-49. [PMID: 35873850 PMCID: PMC9298587 DOI: 10.1055/s-0042-1749148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction
Preoperative illustration is a part of an important exercise to study the configuration, direction, and presence of any perforations, and is the weakest point in the wall of the cerebral aneurysm. The same illustration is used to study the surrounding brain structures to decide the best and safe surgical approach prior to any surgical procedure. With the evolution of the aneurysm wall study and study of flow dynamic within the involved artery and its aneurysm wall using computational fluid dynamics (CFD), a better surgical plan can be formulated to improve the flow dynamics. As one of the clinical applications of CFD, we propose a study using a composite image that combines preoperative illustration and CFD, which is traditionally widely used in neurosurgery.
Methods and Materials
We study the use of illustrations of the unruptured cerebral aneurysm of internal carotid-posterior communicating (ICPC) artery and anterior communicating artery (AcomA) treated at our hospital. The combinations of both preoperative illustrations and CFD images by using “ipad Pro” were used.
Result and Conclusion
Medical illustration in the preoperative study of unruptured cerebral aneurysm with combinations of CFD and surrounding brain structures is helpful to decide the surgical approaches and successful surgical treatments.
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Affiliation(s)
- Riki Tanaka
- Department of Neurosurgery, Fujita Health University Bantane Hospital, Nagoya, Aichi, Japan
| | - Boon Seng Liew
- Department of Neurosurgery, Fujita Health University Bantane Hospital, Nagoya, Aichi, Japan
| | - Yasuhiro Yamada
- Department of Neurosurgery, Fujita Health University Bantane Hospital, Nagoya, Aichi, Japan
| | - Kento Sasaki
- Department of Neurosurgery, Fujita Health University Bantane Hospital, Nagoya, Aichi, Japan
| | - Kyosuke Miyatani
- Department of Neurosurgery, Fujita Health University Bantane Hospital, Nagoya, Aichi, Japan
| | - Fuminari Komatsu
- Department of Neurosurgery, Fujita Health University Bantane Hospital, Nagoya, Aichi, Japan
| | - Tsukasa Kawase
- Department of Neurosurgery, Fujita Health University Bantane Hospital, Nagoya, Aichi, Japan
| | - Yoko Kato
- Department of Neurosurgery, Fujita Health University Bantane Hospital, Nagoya, Aichi, Japan
| | - Yuichi Hirose
- Department of Neurosurgery, Fujita Health University Bantane Hospital, Nagoya, Aichi, Japan
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Guarino S, Marchese E, Ponticelli GS, Scerrati A, Tagliaferri V, Trovalusci F. Additive Manufacturing for Neurosurgery: Digital Light Processing of Individualized Patient-Specific Cerebral Aneurysms. MATERIALS 2021; 14:ma14206057. [PMID: 34683649 PMCID: PMC8539393 DOI: 10.3390/ma14206057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 09/25/2021] [Accepted: 10/07/2021] [Indexed: 12/27/2022]
Abstract
This study aims at demonstrating the feasibility of reproducing individualized patient-specific three-dimensional models of cerebral aneurysms by using the direct light processing (DLP) 3D printing technique in a low-time and inexpensive way. Such models were used to help neurosurgeons understand the anatomy of the aneurysms together with the surrounding vessels and their relationships, providing, therefore, a tangible supporting tool with which to train and plan surgical operations. The starting 3D models were obtained by processing the computed tomography angiographies and the digital subtraction angiographies of three patients. Then, a 3D DLP printer was used to print the models, and, if acceptable, on the basis of the neurosurgeon’s opinion, they were used for the planning of the neurosurgery operation and patient information. All the models were printed within three hours, providing a comprehensive representation of the cerebral aneurysms and the surrounding structures and improving the understanding of their anatomy and simplifying the planning of the surgical operation.
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Affiliation(s)
- Stefano Guarino
- Department of Engineering, University of Rome “Niccolò Cusano”, Via Don Carlo Gnocchi 3, 00166 Rome, Italy; (S.G.); (G.S.P.)
| | - Enrico Marchese
- Department of Neurosurgery, Catholic University of Rome, L.go A. Gemelli 8, 00100 Rome, Italy;
| | - Gennaro Salvatore Ponticelli
- Department of Engineering, University of Rome “Niccolò Cusano”, Via Don Carlo Gnocchi 3, 00166 Rome, Italy; (S.G.); (G.S.P.)
| | - Alba Scerrati
- Department of Transalational Medicine, University of Ferrara, Via Aldo Moro 8, 44124 Ferrara, Italy
- Correspondence:
| | - Vincenzo Tagliaferri
- Department of Enterprise Engineering, University of Rome Tor Vergata, Via del Politecnico 1, 00133 Rome, Italy; (V.T.); (F.T.)
| | - Federica Trovalusci
- Department of Enterprise Engineering, University of Rome Tor Vergata, Via del Politecnico 1, 00133 Rome, Italy; (V.T.); (F.T.)
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17
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Properties and Characteristics of Three-Dimensional Printed Head Models Used in Simulation of Neurosurgical Procedures: A Scoping Review. World Neurosurg 2021; 156:133-146.e6. [PMID: 34571242 DOI: 10.1016/j.wneu.2021.09.079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 09/15/2021] [Accepted: 09/16/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Intracranial surgery can be complex and high risk. Safety, ethical and financial factors make training in the area challenging. Head model 3-dimensional (3D) printing is a realistic training alternative to patient and traditional means of cadaver and animal model simulation. OBJECTIVE To describe important factors relating to the 3D printing of human head models and how such models perform as simulators. METHODS Searches were performed in PubMed, the Cochrane Library, Scopus, and Web of Science. Articles were screened independently by 3 reviewers using Covidence software. Data items were collected under 5 categories: study information; printers and processes; head model specifics; simulation and evaluations; and costs and production times. RESULTS Forty articles published over the last 10 years were included in the review. A range of printers, printing methods, and substrates were used to create head models and tissue types. Complexity of the models ranged from sections of single tissue type (e.g., bone) to high-fidelity integration of multiple tissue types. Some models incorporated disease (e.g., tumors and aneurysms) and artificial physiology (e.g., pulsatile circulation). Aneurysm clipping, bone drilling, craniotomy, endonasal surgery, and tumor resection were the most commonly practiced procedures. Evaluations completed by those using the models were generally favorable. CONCLUSIONS The findings of this review indicate that those who practice surgery and surgical techniques on 3D-printed head models deem them to be valuable assets in cranial surgery training. Understanding how surgical simulation on such models affects surgical performance and patient outcomes, and considering cost-effectiveness, are important future research endeavors.
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Legnani E, Gallo P, Pezzotta F, Padelli F, Faragò G, Gioppo A, Gentili L, De Martin E, Fumagalli ML, Cavaliere F, Bruzzone MG, Milani P, Santaniello T. Additive Fabrication of a Vascular 3D Phantom for Stereotactic Radiosurgery of Arteriovenous Malformations. 3D PRINTING AND ADDITIVE MANUFACTURING 2021; 8:217-226. [PMID: 36654837 PMCID: PMC9828616 DOI: 10.1089/3dp.2020.0305] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
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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Affiliation(s)
- Elisa Legnani
- CIMAINA and Department of Physics, University of Milano, Milan, Italy
- Direct3D, Milan, Italy
| | - Pasqualina Gallo
- Fondazione I.R.C.C.S. Istituto Neurologico Carlo Besta, Milan, Italy
| | - Federico Pezzotta
- CIMAINA and Department of Physics, University of Milano, Milan, Italy
| | - Francesco Padelli
- Fondazione I.R.C.C.S. Istituto Neurologico Carlo Besta, Milan, Italy
| | - Giuseppe Faragò
- Fondazione I.R.C.C.S. Istituto Neurologico Carlo Besta, Milan, Italy
| | - Andrea Gioppo
- Fondazione I.R.C.C.S. Istituto Neurologico Carlo Besta, Milan, Italy
| | - Lorenzo Gentili
- CIMAINA and Department of Physics, University of Milano, Milan, Italy
| | - Elena De Martin
- Fondazione I.R.C.C.S. Istituto Neurologico Carlo Besta, Milan, Italy
| | | | | | | | - Paolo Milani
- CIMAINA and Department of Physics, University of Milano, Milan, Italy
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Tenewitz C, Le RT, Hernandez M, Baig S, Meyer TE. Systematic review of three-dimensional printing for simulation training of interventional radiology trainees. 3D Print Med 2021; 7:10. [PMID: 33881672 PMCID: PMC8059217 DOI: 10.1186/s41205-021-00102-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 04/08/2021] [Indexed: 12/13/2022] Open
Abstract
RATIONALE AND OBJECTIVES Three-dimensional (3D) printing has been utilized as a means of producing high-quality simulation models for trainees in procedure-intensive or surgical subspecialties. However, less is known about its role for trainee education within interventional radiology (IR). Thus, the purpose of this review was to assess the state of current literature regarding the use of 3D printed simulation models in IR procedural simulation experiences. MATERIALS AND METHODS A literature query was conducted through April 2020 for articles discussing three-dimensional printing for simulations in PubMed, Embase, CINAHL, Web of Science, and the Cochrane library databases using key terms relating to 3D printing, radiology, simulation, training, and interventional radiology. RESULTS We identified a scarcity of published sources, 4 total articles, that appraised the use of three-dimensional printing for simulation training in IR. While trainee feedback is generally supportive of the use of three-dimensional printing within the field, current applications utilizing 3D printed models are heterogeneous, reflecting a lack of best practices standards in the realm of medical education. CONCLUSIONS Presently available literature endorses the use of three-dimensional printing within interventional radiology as a teaching tool. Literature documenting the benefits of 3D printed models for IR simulation has the potential to expand within the field, as it offers a straightforward, sustainable, and reproducible means for hands-on training that ought to be standardized.
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Affiliation(s)
- Chase Tenewitz
- Mercer University School of Medicine, Savannah, GA, USA.
| | - Rebecca T Le
- University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | | | - Saif Baig
- UF Health Jacksonville, Jacksonville, FL, USA
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Błaszczyk M, Jabbar R, Szmyd B, Radek M. 3D Printing of Rapid, Low-Cost and Patient-Specific Models of Brain Vasculature for Use in Preoperative Planning in Clipping of Intracranial Aneurysms. J Clin Med 2021; 10:jcm10061201. [PMID: 33805774 PMCID: PMC8000886 DOI: 10.3390/jcm10061201] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 03/06/2021] [Accepted: 03/11/2021] [Indexed: 12/23/2022] Open
Abstract
We developed a practical and cost-effective method of production of a 3D-printed model of the arterial Circle of Willis of patients treated because of an intracranial aneurysm. We present and explain the steps necessary to produce a 3D model from medical image data, and express the significant value such models have in patient-specific pre-operative planning as well as education. A Digital Imaging and Communications in Medicine (DICOM) viewer is used to create 3D visualization from a patient’s Computed Tomography Angiography (CTA) images. After generating the reconstruction, we manually remove the anatomical components that we wish to exclude from the print by utilizing tools provided with the imaging software. We then export this 3D reconstructions file into a Standard Triangulation Language (STL) file which is then run through a “Slicer” software to generate a G-code file for the printer. After the print is complete, the supports created during the printing process are removed manually. The 3D-printed models we created were of good accuracy and scale. The median production time used for the models described in this manuscript was 4.4 h (range: 3.9–4.5 h). Models were evaluated by neurosurgical teams at local hospital for quality and practicality for use in urgent and non-urgent care. We hope we have provided readers adequate insight into the equipment and software they would require to quickly produce their own accurate and cost-effective 3D models from CT angiography images. It has become quite clear to us that the cost-benefit ratio in the production of such a simplified model is worthwhile.
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21
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Poupart O, Conti R, Schmocker A, Pancaldi L, Moser C, Nuss KM, Sakar MS, Dobrocky T, Grützmacher H, Mosimann PJ, Pioletti DP. Pulsatile Flow-Induced Fatigue-Resistant Photopolymerizable Hydrogels for the Treatment of Intracranial Aneurysms. Front Bioeng Biotechnol 2021; 8:619858. [PMID: 33553124 PMCID: PMC7855579 DOI: 10.3389/fbioe.2020.619858] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 12/22/2020] [Indexed: 11/13/2022] Open
Abstract
An alternative intracranial aneurysm embolic agent is emerging in the form of hydrogels due to their ability to be injected in liquid phase and solidify in situ. Hydrogels have the ability to fill an aneurysm sac more completely compared to solid implants such as those used in coil embolization. Recently, the feasibility to implement photopolymerizable poly(ethylene glycol) dimethacrylate (PEGDMA) hydrogels in vitro has been demonstrated for aneurysm application. Nonetheless, the physical and mechanical properties of such hydrogels require further characterization to evaluate their long-term integrity and stability to avoid implant compaction and aneurysm recurrence over time. To that end, molecular weight and polymer content of the hydrogels were tuned to match the elastic modulus and compliance of aneurysmal tissue while minimizing the swelling volume and pressure. The hydrogel precursor was injected and photopolymerized in an in vitro aneurysm model, designed by casting polydimethylsiloxane (PDMS) around 3D printed water-soluble sacrificial molds. The hydrogels were then exposed to a fatigue test under physiological pulsatile flow, inducing a combination of circumferential and shear stresses. The hydrogels withstood 5.5 million cycles and no significant weight loss of the implant was observed nor did the polymerized hydrogel protrude or migrate into the parent artery. Slight surface erosion defects of 2–10 μm in depth were observed after loading compared to 2 μm maximum for non-loaded hydrogels. These results show that our fine-tuned photopolymerized hydrogel is expected to withstand the physiological conditions of an in vivo implant study.
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Affiliation(s)
- Oriane Poupart
- Laboratory of Biomechanical Orthopedics, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Riccardo Conti
- Department of Chemistry and Applied Biosciences, Swiss Federal Institute of Technology, Zurich, Switzerland
| | - Andreas Schmocker
- Department of Chemistry and Applied Biosciences, Swiss Federal Institute of Technology, Zurich, Switzerland.,Laboratory of Applied Photonics Devices, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland.,Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Lucio Pancaldi
- Institute of Mechanical Engineering, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Christophe Moser
- Laboratory of Applied Photonics Devices, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Katja M Nuss
- Musculoskeletal Research Unit, Department of Molecular Mechanisms of Disease, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Mahmut S Sakar
- Institute of Mechanical Engineering, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Tomas Dobrocky
- Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Hansjörg Grützmacher
- Department of Chemistry and Applied Biosciences, Swiss Federal Institute of Technology, Zurich, Switzerland
| | - Pascal J Mosimann
- Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, Bern, Switzerland.,Department of Diagnostic and Interventional Neuroradiology, Alfried Krupp Hospital, Essen, Germany
| | - Dominique P Pioletti
- Laboratory of Biomechanical Orthopedics, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
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Grall P, Ferri J, Nicot R. Surgical training 2.0: A systematic approach reviewing the literature focusing on oral maxillofacial surgery - Part I. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2021; 122:411-422. [PMID: 33524605 DOI: 10.1016/j.jormas.2021.01.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 12/04/2020] [Accepted: 01/11/2021] [Indexed: 11/18/2022]
Abstract
PURPOSE Many technologies are emerging in the medical field. Having an overview of the technological arsenal available to train new surgeons seems very interesting to guide subsequent surgical training protocols. METHODS This article is a systematic approach reviewing new technologies in surgical training, in particular in oral and maxillofacial surgery. This review explores what new technologies can do compared to traditional methods in the field of surgical education. A structured literature search of PubMed was performed in adherence to PRISMA guidelines. The articles were selected when they fell within predefined inclusion criteria while respecting the key objectives of this systematic review. We looked at medical students and more specifically in surgery and analysed whether exposure to new technologies improved their surgical skills compared to traditional methods. Each technology is reviewed by highlighting its advantages and disadvantages and studying the feasibility of integration into current practice. RESULTS The results are encouraging. Indeed, all of these technologies make it possible to reduce the learning time, the operating times, the operating complications and increase the enthusiasm of the students compared to more conventional methods. The start-up cost, the complexity to develop new models, and the openness of mind necessary for the integration of these technologies are all obstacles to immediate development. The main limitations of this review are that many of the studies have been carried out on small numbers, they are not interested in acquiring knowledge or skills over the long term and obviously there is a publication bias. CONCLUSION Surgical education methods will probably change in the years to come, integrating these new technologies into the curriculum seems essential so as not to remain on the side. This first part therefore reviews, open field camera, telemedicine and 3D printing. This systematic review is registered on PROSPERO.
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Affiliation(s)
- Patrick Grall
- University of Lille, CHU Lille, Department of Oral and Maxillofacial Surgery, F-59000 Lille, France.
| | - Joël Ferri
- University of Lille, CHU Lille, INSERM, Department of Oral and Maxillofacial Surgery, U1008 - Controlled Drug Delivery Systems and Biomaterials, F-59000 Lille, France.
| | - Romain Nicot
- University of Lille, CHU Lille, INSERM, Department of Oral and Maxillofacial Surgery, U1008 - Controlled Drug Delivery Systems and Biomaterials, F-59000 Lille, France.
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Chen PC, Lin JC, Chiang CH, Chen YC, Chen JE, Liu WH. Engineering Additive Manufacturing and Molding Techniques to Create Lifelike Willis' Circle Simulators with Aneurysms for Training Neurosurgeons. Polymers (Basel) 2020; 12:polym12122901. [PMID: 33287397 PMCID: PMC7761873 DOI: 10.3390/polym12122901] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 11/30/2020] [Accepted: 12/02/2020] [Indexed: 11/26/2022] Open
Abstract
Neurosurgeons require considerable expertise and practical experience in dealing with the critical situations commonly encountered during difficult surgeries; however, neurosurgical trainees seldom have the opportunity to develop these skills in the operating room. Therefore, physical simulators are used to give trainees the experience they require. In this study, we created a physical simulator to assist in training neurosurgeons in aneurysm clipping and the handling of emergency situations during surgery. Our combination of additive manufacturing with molding technology, elastic material casting, and ultrasonication-assisted dissolution made it possible to create a simulator that realistically mimics the brain stem, soft brain lobes, cerebral arteries, and a hollow transparent Circle of Willis, in which the thickness of vascular walls can be controlled and aneurysms can be fabricated in locations where they are likely to appear. The proposed fabrication process also made it possible to limit the error in overall vascular wall thickness to just 2–5%, while achieving a Young’s Modulus closely matching the characteristics of blood vessels (~5%). One neurosurgical trainee reported that the physical simulator helped to elucidate the overall process of aneurysm clipping and provided a realistic impression of the tactile feelings involved in this delicate operation. The trainee also experienced shock and dismay at the appearance of leakage, which could not immediately be arrested using the clip. Overall, these results demonstrate the efficacy of the proposed physical simulator in preparing trainees for the rigors involved in performing highly delicate neurological surgical operations.
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Affiliation(s)
- Pin-Chuan Chen
- Department of Mechanical Engineering, National Taiwan University of Science and Technology, Taipei 106, Taiwan; (P.-C.C.); (C.-H.C.); (Y.-C.C.)
- High Speed 3D Printing Research Center, National Taiwan University of Science and Technology, Taipei 106, Taiwan
| | - Jang-Chun Lin
- Department of Radiation Oncology, Shuang Ho Hospital, Taipei Medical University, Taipei 110, Taiwan;
- Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
| | - Chung-Hsuan Chiang
- Department of Mechanical Engineering, National Taiwan University of Science and Technology, Taipei 106, Taiwan; (P.-C.C.); (C.-H.C.); (Y.-C.C.)
| | - Yi-Chin Chen
- Department of Mechanical Engineering, National Taiwan University of Science and Technology, Taipei 106, Taiwan; (P.-C.C.); (C.-H.C.); (Y.-C.C.)
| | - Jia-En Chen
- Medical 3D Printing Center, Tri-Service General Hospital and National Defense Medical Center, Taipei 114, Taiwan;
- Department of Biomedical Engineering, Tri-Service General Hospital and National Defense Medical Center, Taipei 114, Taiwan
| | - Wei-Hsiu Liu
- Department of Neurological Surgery, Tri-Service General Hospital and National Defense Medical Center, Taipei 114, Taiwan
- Department of Surgery, School of Medicine, National Defense Medical Center, Taipei 114, Taiwan
- Correspondence: ; Tel.: +886-2-87927177; Fax: +886-2-87927178
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Serrano C, Fontenay S, van den Brink H, Pineau J, Prognon P, Martelli N. Evaluation of 3D printing costs in surgery: a systematic review. Int J Technol Assess Health Care 2020; 36:1-7. [PMID: 32489157 DOI: 10.1017/s0266462320000331] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVES The use of three-dimensional (3D) printing in surgery is expanding and there is a focus on comprehensively evaluating the clinical impact of this technology. However, although additional costs are one of the main limitations to its use, little is known about its economic impact. The purpose of this systematic review is to identify the costs associated with its use and highlight the first quantitative data available. METHODS A systematic literature review was conducted in the PubMed and Embase databases and in the National Health Service Economic Evaluation Database (NHS EED) at the University of York. Studies that reported an assessment of the costs associated with the use of 3D printing for surgical application and published between 2009 and 2019, in English or French, were included. RESULTS Nine studies were included in our review. Nine types of costs were identified, the three main ones being printing material costs (n = 6), staff costs (n = 3), and operating room costs (n = 3). The printing cost ranged from less than U.S. dollars (USD) 1 to USD 146 (in USD 2019 values) depending on the criteria used to calculate this cost. Three studies evaluated the potential savings generated by the use of 3D printing technology in surgery, based on operating time reduction. CONCLUSION This literature review highlights the lack of reliable economic data on 3D printing technology. Nevertheless, this review makes it possible to identify expenditures or items that should be considered in order to carry out more robust studies.
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Affiliation(s)
- Carole Serrano
- University Paris-Saclay, GRADES, Faculty of Pharmacy, 5 rue Jean-Baptiste Clément, 92290Châtenay-Malabry, France
| | - Sarah Fontenay
- Pharmacy Department, Georges Pompidou European Hospital, AP-HP, 20 rue Leblanc, 75015Paris, France
| | - Hélène van den Brink
- University Paris-Saclay, GRADES, Faculty of Pharmacy, 5 rue Jean-Baptiste Clément, 92290Châtenay-Malabry, France
| | - Judith Pineau
- Pharmacy Department, Georges Pompidou European Hospital, AP-HP, 20 rue Leblanc, 75015Paris, France
| | - Patrice Prognon
- Pharmacy Department, Georges Pompidou European Hospital, AP-HP, 20 rue Leblanc, 75015Paris, France
| | - Nicolas Martelli
- University Paris-Saclay, GRADES, Faculty of Pharmacy, 5 rue Jean-Baptiste Clément, 92290Châtenay-Malabry, France
- Pharmacy Department, Georges Pompidou European Hospital, AP-HP, 20 rue Leblanc, 75015Paris, France
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25
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3D-printed Titanium Prosthetic Reconstruction of the C2 Vertebra: Techniques and Outcomes of Three Consecutive Cases. Spine (Phila Pa 1976) 2020; 45:667-672. [PMID: 31809469 DOI: 10.1097/brs.0000000000003360] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Three patients were treated at our center with patient-specific three-dimensional (3D)-printed titanium prostheses for the reconstruction of structurally compromised C2 vertebrae. OBJECTIVE To describe our surgical and device design approach to these clinical scenarios and evaluate their outcomes. SUMMARY OF BACKGROUND DATA There are a limited but increasing number of case reports and series describing the use of 3D-printed prostheses for high cervical surgery. METHODS We have collated and reviewed three cases using patient-specific 3D-printed prostheses. RESULTS We report two cases arising from neoplastic destruction; one resulting from metastatic medullary thyroid carcinoma, and the other from multiple myeloma. We additionally describe a case of C2 compromise as a complication of rheumatoid arthritis. All patients included in this report achieved successful surgical outcomes and symptom relief without significant complication. Clinical and radiological follow-up has demonstrated good outcomes in all cases up to 14-months postprocedure. CONCLUSIONS These cases describe successful use of custom 3D-printed prostheses for reconstruction of the anterior vertebral column through C2, and add to the emerging body of literature detailing the use of custom prostheses for complex spinal surgery. LEVEL OF EVIDENCE 4.
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27
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A Systematic Review of Simulation-Based Training in Neurosurgery, Part 1: Cranial Neurosurgery. World Neurosurg 2020; 133:e850-e873. [DOI: 10.1016/j.wneu.2019.08.262] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 08/23/2019] [Indexed: 01/10/2023]
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A workflow to generate physical 3D models of cerebral aneurysms applying open source freeware for CAD modeling and 3D printing. INTERDISCIPLINARY NEUROSURGERY-ADVANCED TECHNIQUES AND CASE MANAGEMENT 2019. [DOI: 10.1016/j.inat.2019.02.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Nagassa RG, McMenamin PG, Adams JW, Quayle MR, Rosenfeld JV. Advanced 3D printed model of middle cerebral artery aneurysms for neurosurgery simulation. 3D Print Med 2019; 5:11. [PMID: 31372773 PMCID: PMC6743137 DOI: 10.1186/s41205-019-0048-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 07/12/2019] [Indexed: 11/11/2022] Open
Abstract
Background Neurosurgical residents are finding it more difficult to obtain experience as the primary operator in aneurysm surgery. The present study aimed to replicate patient-derived cranial anatomy, pathology and human tissue properties relevant to cerebral aneurysm intervention through 3D printing and 3D print-driven casting techniques. The final simulator was designed to provide accurate simulation of a human head with a middle cerebral artery (MCA) aneurysm. Methods This study utilized living human and cadaver-derived medical imaging data including CT angiography and MRI scans. Computer-aided design (CAD) models and pre-existing computational 3D models were also incorporated in the development of the simulator. The design was based on including anatomical components vital to the surgery of MCA aneurysms while focusing on reproducibility, adaptability and functionality of the simulator. Various methods of 3D printing were utilized for the direct development of anatomical replicas and moulds for casting components that optimized the bio-mimicry and mechanical properties of human tissues. Synthetic materials including various types of silicone and ballistics gelatin were cast in these moulds. A novel technique utilizing water-soluble wax and silicone was used to establish hollow patient-derived cerebrovascular models. Results A patient-derived 3D aneurysm model was constructed for a MCA aneurysm. Multiple cerebral aneurysm models, patient-derived and CAD, were replicated as hollow high-fidelity models. The final assembled simulator integrated six anatomical components relevant to the treatment of cerebral aneurysms of the Circle of Willis in the left cerebral hemisphere. These included models of the cerebral vasculature, cranial nerves, brain, meninges, skull and skin. The cerebral circulation was modeled through the patient-derived vasculature within the brain model. Linear and volumetric measurements of specific physical modular components were repeated, averaged and compared to the original 3D meshes generated from the medical imaging data. Calculation of the concordance correlation coefficient (ρc: 90.2%–99.0%) and percentage difference (≤0.4%) confirmed the accuracy of the models. Conclusions A multi-disciplinary approach involving 3D printing and casting techniques was used to successfully construct a multi-component cerebral aneurysm surgery simulator. Further study is planned to demonstrate the educational value of the proposed simulator for neurosurgery residents.
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Affiliation(s)
- Ruth G Nagassa
- Department of Anatomy and Developmental Biology, Monash University, Clayton, VIC, Australia.
| | - Paul G McMenamin
- Department of Anatomy and Developmental Biology, Monash University, Clayton, VIC, Australia
| | - Justin W Adams
- Department of Anatomy and Developmental Biology, Monash University, Clayton, VIC, Australia
| | - Michelle R Quayle
- Department of Anatomy and Developmental Biology, Monash University, Clayton, VIC, Australia
| | - Jeffrey V Rosenfeld
- Monash Institute of Medical Engineering, Monash University, Clayton, VIC, Australia.,Department of Neurosurgery, The Alfred Hospital, Melbourne, VIC, Australia.,Department of Surgery, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, MD, USA
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30
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Lechanoine F, Smirnov M, Armani-Franceschi G, Carneiro P, Cottier P, Destrieux C, Maldonado IL. Stereoscopic Images from Computed Tomography Angiograms. World Neurosurg 2019; 128:259-267. [PMID: 31078804 DOI: 10.1016/j.wneu.2019.04.257] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 04/29/2019] [Accepted: 04/30/2019] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To present an adaptation of the anaglyph photography technique to be used with radiological images from computed tomography angiograms, enabling stereoscopic visualization of a patient's individual abnormal vascular anatomy for teaching, case discussion, or surgical planning purposes. METHODS Traditional anaglyph procedures with actual objects yield 2 independent photographs, simulating the image perceived by each eye. Production of anaglyphs from angiograms involve 3 basic procedures: volume rendering, image capture, and image fusion. Volume renderings were reconstructed using a free, open-source DICOM (Digital Imaging and Communications in Medicine) reader. Subsequently, the virtual object was positioned to mimic the operator's angle of view, and different perspectives of the reconstructed volume could be obtained through exclusively horizontal rotation. The 2 images were then fused after their color composition was modified so that each eye would perceive only 1 image when using anaglyph glasses. RESULTS Forty-three angiograms were reviewed for the purpose of this study and a total of 6 examinations were selected for illustration of the technique. Stereoscopic display was possible for all of them and in the 3 types of support tested: computer monitor, tablet, and smartphone screens. CONCLUSIONS Anaglyph display of computed tomography angiograms is an effective and low-cost alternative for the stereoscopic visualization of a patient's individual intracranial vascular anatomy.
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Affiliation(s)
- François Lechanoine
- UMR 1253, iBrain, Université de Tours, Inserm, Tours, France; Neurosurgery Department, CHU Grenoble Alpes, Grenoble, France; Université Grenoble Alpes, Grenoble, France
| | - Mykyta Smirnov
- UMR 1253, iBrain, Université de Tours, Inserm, Tours, France
| | | | - Pedro Carneiro
- Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Brazil
| | - Philippe Cottier
- UMR 1253, iBrain, Université de Tours, Inserm, Tours, France; CHRU de Tours, Tours, France
| | - Christophe Destrieux
- UMR 1253, iBrain, Université de Tours, Inserm, Tours, France; CHRU de Tours, Tours, France
| | - Igor Lima Maldonado
- UMR 1253, iBrain, Université de Tours, Inserm, Tours, France; Departamento de Biomorfologia, Instituto de Ciências da Saúde, Universidade Federal da Bahia, Salvador, Brazil; CHRU de Tours, Tours, France; Le Studium Loire Valley Institute for Advanced Studies, Orleans, France.
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Javan R, Ellenbogen AL, Greek N, Haji-Momenian S. A prototype assembled 3D-printed phantom of the glenohumeral joint for fluoroscopic-guided shoulder arthrography. Skeletal Radiol 2019; 48:791-802. [PMID: 29948036 DOI: 10.1007/s00256-018-2979-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Revised: 05/07/2018] [Accepted: 05/14/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To describe the methodology of constructing a three-dimensional (3D) printed model of the glenohumeral joint, to serve as an interventional phantom for fluoroscopy-guided shoulder arthrography training. MATERIALS AND METHODS The osseous structures, intra-articular space and skin surface of the shoulder were digitally extracted as separate 3D meshes from a normal CT arthrogram of the shoulder, using commercially available software. The osseous structures were 3D-printed in gypsum, a fluoroscopically radiopaque mineral, using binder jet technology. The joint capsule was 3D printed with rubber-like TangoPlus material, using PolyJet technology. The capsule was secured to the humeral head and glenoid to create a sealed intra-articular space. A polyamide mold of the skin was printed using selective laser sintering. The joint was stabilized inside the mold, and the surrounding soft tissues were cast in silicone of varying densities. Fluoroscopically-guided shoulder arthrography was performed using anterior, posterior, and rotator interval approaches. CT arthrographic imaging of the phantom was also performed. RESULTS A life-size phantom of the glenohumeral joint was constructed. The radiopaque osseous structures replicated in-vivo osseous corticomedullary differentiation, with dense cortical bone and less dense medullary cancellous bone. The glenoid labrum was successfully integrated into the printed capsule, and visualized on CT arthrography. The phantom was repeatedly used to perform shoulder arthrography using all three conventional approaches, and simulated the in vivo challenges of needle guidance. CONCLUSIONS 3D printing of a complex capsule, such as the glenohumeral joint, is possible with this technique. Such a model can serve as a valuable training tool.
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Affiliation(s)
- Ramin Javan
- Department of Radiology, George Washington University Hospital, 900 23rd St NW, Suite G2092, Washington, DC, 20037, USA.
| | - Amy L Ellenbogen
- Department of Radiology, George Washington University Hospital, 900 23rd St NW, Suite G2092, Washington, DC, 20037, USA
| | - Nicholas Greek
- Clinical Learning and Simulation Skills (CLASS) Center, George Washington University School of Medicine, 2300 I (Eye) Street, NW, Ross Hall 405, Washington, DC, USA
| | - Shawn Haji-Momenian
- Department of Radiology, George Washington University Hospital, 900 23rd St NW, Suite G2092, Washington, DC, 20037, USA
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Bekisz JM, Liss HA, Maliha SG, Witek L, Coelho PG, Flores RL. In-House Manufacture of Sterilizable, Scaled, Patient-Specific 3D-Printed Models for Rhinoplasty. Aesthet Surg J 2019; 39:254-263. [PMID: 29982464 DOI: 10.1093/asj/sjy158] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Rhinoplasty relies on clear patient communication and precise execution of a three-dimensional (3D) plan to achieve optimal results. As 3D imaging and printing continue to grow in popularity within the medical field, rhinoplasty surgeons have begun to leverage these resources as an aid to preoperative planning, patient communication, and the technical performance of this challenging operation. OBJECTIVES Utilizing departmentally available resources and open-access 3D imaging platforms, we have developed an affordable, reproducible protocol for rapid in-house virtual surgical planning (VSP) and subsequent manufacture of 3D-printed rhinoplasty models. METHODS Preoperative 3D photographic images underwent virtual rhinoplasty using a freely available 3D imaging and sculpting program (BlenderTM [Version 2.78, Amsterdam, The Netherlands]). Once the ideal postoperative result was digitally achieved, scaled, sterilizable, and patient-specific 3D models of the preoperative and ideal postoperative result were manufactured in-house using a departmentally owned 3D printer. RESULTS 3D-printed models have successfully been manufactured and employed for 12 patients undergoing rhinoplasty. The average time to prepare a set of pre- and postoperative models was 3 hours, while the printing process required 18 to 24 hours per model. Each set of surgical models can be manufactured at a total materials cost of approximately $5.00. CONCLUSIONS We describe an affordable means to construct sterilizable, scaled, patient-specific 3D-printed models for rhinoplasty. This technique may become of increasing interest to academic and cosmetic centers as hardware costs of 3D printers continue to fall. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Jonathan M Bekisz
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, NY
| | - Hannah A Liss
- Department of Biomaterials and Biomimetics, New York University College of Dentistry, New York, NY
| | - Samantha G Maliha
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, NY
- New York University School of Medicine, New York, NY
| | - Lukasz Witek
- Department of Biomaterials and Biomimetics, New York University College of Dentistry, New York, NY
| | - Paulo G Coelho
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, NY
- Department of Biomaterials and Biomimetics, New York University College of Dentistry, New York, NY
| | - Roberto L Flores
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, NY
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Chepelev L, Wake N, Ryan J, Althobaity W, Gupta A, Arribas E, Santiago L, Ballard DH, Wang KC, Weadock W, Ionita CN, Mitsouras D, Morris J, Matsumoto J, Christensen A, Liacouras P, Rybicki FJ, Sheikh A. Radiological Society of North America (RSNA) 3D printing Special Interest Group (SIG): guidelines for medical 3D printing and appropriateness for clinical scenarios. 3D Print Med 2018; 4:11. [PMID: 30649688 PMCID: PMC6251945 DOI: 10.1186/s41205-018-0030-y] [Citation(s) in RCA: 140] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 09/19/2018] [Indexed: 02/08/2023] Open
Abstract
Medical three-dimensional (3D) printing has expanded dramatically over the past three decades with growth in both facility adoption and the variety of medical applications. Consideration for each step required to create accurate 3D printed models from medical imaging data impacts patient care and management. In this paper, a writing group representing the Radiological Society of North America Special Interest Group on 3D Printing (SIG) provides recommendations that have been vetted and voted on by the SIG active membership. This body of work includes appropriate clinical use of anatomic models 3D printed for diagnostic use in the care of patients with specific medical conditions. The recommendations provide guidance for approaches and tools in medical 3D printing, from image acquisition, segmentation of the desired anatomy intended for 3D printing, creation of a 3D-printable model, and post-processing of 3D printed anatomic models for patient care.
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Affiliation(s)
- Leonid Chepelev
- Department of Radiology and The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON Canada
| | - Nicole Wake
- Center for Advanced Imaging Innovation and Research (CAI2R), Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, NYU School of Medicine, New York, NY USA
- Sackler Institute of Graduate Biomedical Sciences, NYU School of Medicine, New York, NY USA
| | | | - Waleed Althobaity
- Department of Radiology and The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON Canada
| | - Ashish Gupta
- Department of Radiology and The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON Canada
| | - Elsa Arribas
- Department of Diagnostic Radiology, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX USA
| | - Lumarie Santiago
- Department of Diagnostic Radiology, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX USA
| | - David H Ballard
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, Saint Louis, MO USA
| | - Kenneth C Wang
- Baltimore VA Medical Center, University of Maryland Medical Center, Baltimore, MD USA
| | - William Weadock
- Department of Radiology and Frankel Cardiovascular Center, University of Michigan, Ann Arbor, MI USA
| | - Ciprian N Ionita
- Department of Neurosurgery, State University of New York Buffalo, Buffalo, NY USA
| | - Dimitrios Mitsouras
- Department of Radiology and The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON Canada
| | | | | | - Andy Christensen
- Department of Radiology and The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON Canada
| | - Peter Liacouras
- 3D Medical Applications Center, Walter Reed National Military Medical Center, Washington, DC, USA
| | - Frank J Rybicki
- Department of Radiology and The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON Canada
| | - Adnan Sheikh
- Department of Radiology and The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON Canada
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34
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Effect of Ultrasonic Vibration on Mechanical Properties of 3D Printing Non-Crystalline and Semi-Crystalline Polymers. MATERIALS 2018; 11:ma11050826. [PMID: 29772802 PMCID: PMC5978203 DOI: 10.3390/ma11050826] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 05/12/2018] [Accepted: 05/15/2018] [Indexed: 11/17/2022]
Abstract
Fused deposition modeling 3D printing has become the most widely used additive manufacturing technology because of its low manufacturing cost and simple manufacturing process. However, the mechanical properties of the 3D printing parts are not satisfactory. Certain pressure and ultrasonic vibration were applied to 3D printed samples to study the effect on the mechanical properties of 3D printed non-crystalline and semi-crystalline polymers. The tensile strength of the semi-crystalline polymer polylactic acid was increased by 22.83% and the bending strength was increased by 49.05%, which were almost twice the percentage increase in the tensile strength and five times the percentage increase in the bending strength of the non-crystalline polymer acrylonitrile butadiene styrene with ultrasonic strengthening. The dynamic mechanical properties of the non-crystalline and semi-crystalline polymers were both improved after ultrasonic enhancement. Employing ultrasonic energy can significantly improve the mechanical properties of samples without modifying the 3D printed material or adjusting the forming process parameters.
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35
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Ji Q, Zhang JM, Liu Y, Li X, Lv P, Jin D, Duan H. A Modular Microfluidic Device via Multimaterial 3D Printing for Emulsion Generation. Sci Rep 2018; 8:4791. [PMID: 29556013 PMCID: PMC5859176 DOI: 10.1038/s41598-018-22756-1] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 02/27/2018] [Indexed: 12/11/2022] Open
Abstract
3D-printing (3DP) technology has been developing rapidly. However, limited studies on the contribution of 3DP technology, especially multimaterial 3DP technology, to droplet-microfluidics have been reported. In this paper, multimaterial 3D-printed devices for the pneumatic control of emulsion generation have been reported. A 3D coaxial flexible channel with other rigid structures has been designed and printed monolithically. Numerical and experimental studies have demonstrated that this flexible channel can be excited by the air pressure and then deform in a controllable way, which can provide the active control of droplet generation. Furthermore, a novel modular microfluidic device for double emulsion generation has been designed and fabricated, which consists of three modules: function module, T-junction module, and co-flow module. The function module can be replaced by (1) Single-inlet module, (2) Pneumatic Control Unit (PCU) module and (3) Dual-inlet module. Different modules can be easily assembled for different double emulsion production. By using the PCU module, double emulsions with different number of inner droplets have been successfully produced without complicated operation of flow rates of different phases. By using single and dual inlet module, various double emulsions with different number of encapsulated droplets or encapsulated droplets with different compositions have been successfully produced, respectively.
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Affiliation(s)
- Qinglei Ji
- State Key Laboratory of Mechanics and Control of Mechanical Structures, Nanjing University of Aeronautics and Astronautics, 29 Yudao Street, Nanjing, 210016, Jiangsu, People's Republic of China.,State Key Laboratory for Turbulence and Complex Systems, Department of Mechanics and Engineering Science, BIC-ESAT, College of Engineering, Peking University, Beijing, 100871, People's Republic of China
| | - Jia Ming Zhang
- State Key Laboratory for Turbulence and Complex Systems, Department of Mechanics and Engineering Science, BIC-ESAT, College of Engineering, Peking University, Beijing, 100871, People's Republic of China
| | - Ying Liu
- State Key Laboratory for Turbulence and Complex Systems, Department of Mechanics and Engineering Science, BIC-ESAT, College of Engineering, Peking University, Beijing, 100871, People's Republic of China
| | - Xiying Li
- State Key Laboratory for Turbulence and Complex Systems, Department of Mechanics and Engineering Science, BIC-ESAT, College of Engineering, Peking University, Beijing, 100871, People's Republic of China
| | - Pengyu Lv
- State Key Laboratory for Turbulence and Complex Systems, Department of Mechanics and Engineering Science, BIC-ESAT, College of Engineering, Peking University, Beijing, 100871, People's Republic of China
| | - Dongping Jin
- State Key Laboratory of Mechanics and Control of Mechanical Structures, Nanjing University of Aeronautics and Astronautics, 29 Yudao Street, Nanjing, 210016, Jiangsu, People's Republic of China
| | - Huiling Duan
- State Key Laboratory for Turbulence and Complex Systems, Department of Mechanics and Engineering Science, BIC-ESAT, College of Engineering, Peking University, Beijing, 100871, People's Republic of China. .,CAPT, HEDPS and IFSA Collaborative Innovation Center of MoE, Peking University, Beijing, 100871, People's Republic of China.
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36
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Tenjin H, Okano Y. Training model for cerebral aneurysm clipping. INTERDISCIPLINARY NEUROSURGERY-ADVANCED TECHNIQUES AND CASE MANAGEMENT 2017. [DOI: 10.1016/j.inat.2017.07.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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