Implantation of 3D-Printed Patient-Specific Aneurysm Models into Cadaveric Specimens: A New Training Paradigm to Allow for Improvements in Cerebrovascular Surgery and Research

Abstract

Aim. To evaluate the feasibility of implanting 3D-printed brain aneurysm model in human cadavers and to assess their utility in neurosurgical research, complex case management/planning, and operative training. Methods. Two 3D-printed aneurysm models, basilar apex and middle cerebral artery, were generated and implanted in four cadaveric specimens. The aneurysms were implanted at the same anatomical region as the modeled patient. Pterional and orbitozygomatic approaches were done on each specimen. The aneurysm implant, manipulation capabilities, and surgical clipping were evaluated. Results. The 3D aneurysm models were successfully implanted to the cadaveric specimens' arterial circulation in all cases. The features of the neck in terms of flexibility and its relationship with other arterial branches allowed for the practice of surgical maneuvering characteristic to aneurysm clipping. Furthermore, the relationship of the aneurysm dome with the surrounding structures allowed for better understanding of the aneurysmal local mass effect. Noticeably, all of these observations were done in a realistic environment provided by our customized embalming model for neurosurgical simulation. Conclusion. 3D aneurysms models implanted in cadaveric specimens may represent an untapped training method for replicating clip technique; for practicing certain approaches to aneurysms specific to a particular patient; and for improving neurosurgical research.

Ex Vivo Aneurysm models mimicking real cases for the preoperative training of the clipping technique

“…The virtual reality model for training, even if the most expensive, around 300000$ for a surgery rehearsal platform is the farthest away from the real surgery. [2,7,12,13] All of these experimental methods of training have their shortcomings. the synthetic and the virtual models are far from reaching the real feel sense one can develop only training with real vessels and also one cannot train dissecting around the aneurysm using these models.…”

Challenges in creating dissectible anatomical 3D prints for surgical teaching

“…In addition to anatomical realism, it will be desirable in the long-term for 3D prints for surgical simulation to replicate layers/planes (Benet et al 2015;Kurenov et al 2015; Mowry et al 2015;Ryan et al 2015Ryan et al , 2016Schmauss et al 2015;Souzaki et al 2015;Olivieri et al 2016;Tai et al 2016;Vakharia et al 2016). Surgeons often operate along tissue planes to minimise trauma, as suggested by the quip: 'intimate knowledge of the correct plane distinguishes the master from the pedestrian surgeon' (Kirk, 2010).…”

“…) and simulator training (Benet et al. ; Ryan et al. , ), and attitudes toward image donation for 3D printing in anatomy education as oppposed to body donation may be more favourable (Abouhashem et al.…”

“…Three-dimensional (3D) printing is now a widely used tool in pre-operative planning (Arvier et al 1994;Berry et al 1997;Potamianos et al 1998;Petzold et al 1999;Chang et al 2003;Seitz et al 2004;Mahaisavariya et al 2006;Jacobs et al 2008;Singare et al 2009;Honiball, 2010;Giovinco et al 2012;Krishnan et al 2012;Tam et al 2012;Klein et al 2013;Zein et al 2013;Duncan et al 2015;Huang et al 2015;Rose et al 2015b), surgical teaching (Cohen & Reyes, 2015;Huang et al 2015;Scawn et al 2015) and simulator training (Benet et al 2015;Ryan et al 2015Ryan et al , 2016, and attitudes toward image donation for 3D printing in anatomy education as oppposed to body donation may be more favourable (Abouhashem et al 2017). Creating multi-material 3D prints that mechanically resemble real tissues is a primary focus within these educational domains (Mori et al 2010;Hochman et al 2013Hochman et al , 2015aLipton et al 2014;Rose et al 2015a,b), yet models that precisely match the biomechanical and visual qualities of human tissue do not currently exist.…”

Dual Endoscopic Endonasal Transsphenoidal and Precaruncular Transorbital Approaches for Clipping of the Cavernous Carotid Artery: A Cadaveric Simulation

“…Simulated training for the treatment of aneurysms has provided enhanced trainee comfort with endoscopic instrumentation and greater appreciation of relevant intraoperative anatomical landmarks. 13 The benefits for neurosurgical and otolaryngology residents is apparent in that skill set can be learned and improved upon in a safe environment without jeopardizing patient care. 14 The literature supports that improvements can be obtained through endoscopic simulation exercises and that these improvements are maintained in the operative arena.…”