Patient-Specific Three-Dimensional Model for a Safe Surgical Pathway in Sacral Chondrosarcoma

Abstract

Sacral tumors are amongst the most challenging procedures to treat because of the complex anatomy. This study determined whether patient-specific models change preoperative planning decisions made in preparation for en bloc resection of complex sacral mass surgical procedures. Imaging showed a big encapsulated mass at the S2-3 level involving the neural foramina and obscuring the nerve roots. High-resolution images were acquired and utilized to generate a patient-specific 3D tumor model. The visual and tactile inspection of 3D models allowed the best anatomical understanding, with faster and clearer comprehension of the surgical anatomy. The 3D sacral model was for observation of previously unapparent anatomical details; with this new technology, surgeon can observe their planned surgical intervention, explore the patient-specific anatomy and extension of the tumor, and sharpen their procedure choices. Moreover, multiple planes showed how far the angles on the plane would extend for osteotomy of the sacrum. Another result was identifying correct guides and safe venture landmarks. The study helped to establish safe osteotomy line wherever the nerve roots were retained and enabled osteotomy by preserving bilaterally the S1 and S2 nerve roots for wide excision of wide excision of primary sacral tumor to get adequate bowel and bladder functions. Finally, it helped to determine whether or not the remaining bone in the sacrum is sufficient for spinopelvic stability and needed fixation. It was decided spinopelvic fixation was not necessary for this case. Surgical intervention of sacral tumors varies depending on the tumor, its size, extension, and location. Surgery can have profound risks including unnecessary nerve root resection spinopelvic instability and suboptimal oncological resection. 3D models help to transfer complex anatomical information to clinicians and provide guidance in the preoperative planning stage, for intraoperative navigation and for surgical training purposes.

Individualised 3d-printed Landmarks as Floating Duating Duoys for Poor Man's See-through Neuro-navigation in High Grade Glioma Surgery

“…Decrease in the duration of the operation, the amount of bleeding, use of less uoroscopy shot, use of appropriate splint and surgery are shared operative experiences [16,17]. 3D-printed models have been used successfully in the planning of the surgery, and it has been seen that it has increased the cohesion of the team in the operations performed with interdisciplinary surgeons and has contributed greatly to the training of assistants [10,12,13,15].…”

“…3D-model-assisted resection has been proposed as bene cial for the resection of malignant tumors in anatomical regions where it is di cult to reach rm margins from which to remove the tumor. Resections of bone tumors with irregular borders located in regions with complex anatomy such as pelvis, sacrum and mediastinum, reaching the surgical margins with adequate navigation, were successfully performed with 3D-model assisted navigation [12,13].…”

“…In cancer surgery, a clear understanding of the target anatomy (size, margin and neighborhood volume) should be obtained in the preoperative setting with planning the operation accordingly [10,11]. Algorithm landmarks in the oncological surgical approaches of other branches such as orthopedics, plastic and reconstructive surgery are xed and unchanging guide points like bone [12,13]. By measuring between these points and calculating the angles once-in-a-time, the same surgical navigation is always valid.…”