3D printing and intraoperative neuronavigation tailoring for skull base reconstruction after extended endoscopic endonasal surgery: proof of concept

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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.

Article Information

Correspondence Walid I. Essayed: Brigham and Women’s Hospital, Harvard Medical School, Boston, MA. wibnessayed@bwh.harvard.edu.

INCLUDE WHEN CITING Published online March 2, 2018; DOI: 10.3171/2017.9.JNS171253.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

© AANS, except where prohibited by US copyright law.

Headings

Figures

  • View in gallery

    Extended skull base models: segmentation, printing, tailoring, and implantation steps.

  • View in gallery

    Tailored skull base models: segmentation, printing, and implantation steps.

  • View in gallery

    Extended skull base model (Ex-model) and tailored model (T-model), with abrupt and gradual center/edge material interface.

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    Prostheses modeling and postprocessing. Figure is available in color online only.

  • View in gallery

    Navigation transfer diagram.

  • View in gallery

    Photograph demonstrating navigation over the printed model. The inset shows a magnified view of the pointer being navigated over the model using the handles as landmarks. After transferring the registration to the Ex-model, it is possible to navigate on the prosthesis as if it were the patient skull base, allowing one to tailor the Ex-model to the defect.

  • View in gallery

    Ex-model cadaver implantation and 3D rendering (corresponds to Video 1).

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