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3D Printing and Intraoperative Neuronavigation Tailoring for Skull Base Reconstruction after Extended Endoscopic Endonasal Surgery: Proof of Concept.

Institution:
1Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
2Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
3Department of Radiation Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
4 Wyss Institute for Biologically Inspired Engineering, Harvard University, Cambridge, MA, USA.
Publication Date:
Mar-2018
Journal:
J Neurosurg
Pages:
1-8
Citation:
J Neurosurg. 2018 Mar 2:1-8
PubMed ID:
29498576
PMCID:
PMC6119650
Keywords:
3D, endoscopic, extended endonasal surgery, neuronavigation, printing, prostheses and implants, reconstructive surgical procedures, skull base reconstruction, surgical technique
Appears in Collections:
NCIGT, NAC, SPL
Sponsors:
P41 EB015898/EB/NIBIB NIH HHS/United States
P41 EB015902/EB/NIBIB NIH HHS/United States
R01 NS049251/NS/NINDS NIH HHS/United States
R25 CA089017/CA/NCI NIH HHS/United States
Generated Citation:
Essayed W.I., Unadkat P., Hosny A., Frisken S., Rassi M.S., Mukundan S., Weaver J.C., Al-Mefty O., Golby A.J., Dunn I.F. 3D Printing and Intraoperative Neuronavigation Tailoring for Skull Base Reconstruction after Extended Endoscopic Endonasal Surgery: Proof of Concept. J Neurosurg. 2018 Mar 2:1-8 PMID: 29498576. PMCID: PMC6119650.
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OBJECTIVE Endoscopic endonasal approaches are increasingly performed for the surgical treatment of multiple skull base pathologies. Preventing postoperative CSF leaks remains a major challenge, particularly in extended approaches. In this study, the authors assessed the potential use of modern multimaterial 3D printing and neuronavigation to help model these extended defects and develop specifically tailored prostheses for reconstructive purposes. METHODS Extended endoscopic endonasal skull base approaches were performed on 3 human cadaveric heads. Preprocedure and intraprocedure CT scans were completed and were used to segment and design extended and tailored skull base models. Multimaterial models with different core/edge interfaces were 3D printed for implantation trials. A novel application of the intraoperative landmark acquisition method was used to transfer the navigation, helping to tailor the extended models. RESULTS Prostheses were created based on preoperative and intraoperative CT scans. The navigation transfer offered sufficiently accurate data to tailor the preprinted extended skull base defect prostheses. Successful implantation of the skull base prostheses was achieved in all specimens. The progressive flexibility gradient of the models' edges offered the best compromise for easy intranasal maneuverability, anchoring, and structural stability. Prostheses printed based on intraprocedure CT scans were accurate in shape but slightly undersized. CONCLUSIONS Preoperative 3D printing of patient-specific skull base models is achievable for extended endoscopic endonasal surgery. The careful spatial modeling and the use of a flexibility gradient in the design helped achieve the most stable reconstruction. Neuronavigation can help tailor preprinted prostheses.