Additive Manufacturing of 3D Biomodels as Adjuvant in Intracranial Aneurysm Clipping

Abstract

One of the main difficulties in intracranial aneurysms (IA) surgery refers to the choice of the appropriate clip(s) to be implanted. Although the imaging exams currently available ensure visualization of IA's morphology, they do not bring an accurate reference positioning for the surgeon in executing the surgery procedure nor efficiently contribute to planning the surgery. Unfortunately, for IA's largely inaccessible regions, there is not an efficient method of treatment planning. Therefore, we propose a novel method that allows the generation of a 3D biomodel of the IA region under investigation using additive manufacturing technology (AM). Thus, a physical copy of the IA is produced and offers the surgeon a full view of the anatomy of that region of the brain. The aim of this study is the creation of a flexible 3D physical model (elastomer) through the AM technique, in order to allow the clip selection prior to the surgery. DICOM angio‐CT images from eight patients who underwent IA surgery were transformed into STL format and then built on a 3D printer. Preoperative surgical clip selection was performed and then compared with those used in surgery. At the end of the study, all 3D IA biomodels were reproduced for microsurgical clipping selection and it was possible to predict the metal clip to be used in the surgery. In addition, the proposed methodology helps to clarify the surgical anatomy and to avoid excessive manipulation of the intracranial arteries and prolonged surgical time. The major advantage of this technology is that the surgeon can closely study complex cerebrovascular anatomy from any perspective using realistic 3D biomodels, which can be handheld, allowing simulation of intraoperative situations and anticipation of surgical challenges.

Application of 3D Printing in Preoperative Planning

“…A retrospective study used CT angiography to generate 3D-printed models and determine their efficacy in simulating the reality of the surgical suite. The models demonstrated accurate aneurysm clip sizing in comparison to the actual clips used during surgery and proved beneficial towards replicating patient morphology [36]. In addition, simulation of cerebrovascular intervention for educational and clinical purposes is possible thanks to the advent of 3D-printed vascular networks.…”

Artificial Organs 2019: A year in review

“…André Leal et al of the Pontifícia Universidade Católica do Paraná, Curitiba, Paraná, Brazil investigated additive manufacturing (AM) of 3D biomodels as adjuvant in intracranial aneurysm (IA) clippings. A physical copy of the IA is produced and offers the surgeon a full view of the anatomy of that region of the brain.…”

Three-dimensional printing applications in the neurosurgery: A pilot study

“…In 1986 Jane Cloward Oliver de Witte and Alaine Le Mehaute from issued a patent for 3D printer, and in the same year, Charlies started his own company in California (3D System). They released their first commercial project in 1988 named SLA-1 Stereolithography [2].…”