The use of three-dimensional anatomical patient-specific printed models in surgical clipping of intracranial aneurysm: A pilot study

Abstract

Background: In the present study, we aim to develop simulation models based on computed tomography angiography images of intracranial aneurysms (IAs) and their parent vessels using three-dimensional (3D) printing technology. The study focuses on the value of these 3D models in presurgical planning and intraoperative navigation and ultimately their impact on patient outcomes. To the best of our knowledge, this is the first report of its kind from a war-torn country, like Iraq. Methods: This is a prospective study of a series of 11, consecutively enrolled, patients suffering from IAs for the period between February and September 2019. The study represents a collaboration between the two major neurosurgical centers in Baghdad/Iraq; Neurosciences Teaching Hospital and Neurosurgery Teaching Hospital. We analyzed the data of eleven patients with IAs treated by microsurgical clipping. These data include patient demographics, clinical, surgical, and outcomes along with the data of the 3D-printed replica used in these surgeries. All cases were operated on by one surgeon. Results: Our study included 11 patients, with a total of 11 aneurysms clipped. The mean age was 44 ± 8, with a median of 42.5 and a range of 35–61 years. About 60% of our patients were female with a female-to-male ratio of 1:5. About 60% of the aneurysms were located at the anterior communicating artery (Acom) while the remaining 40% were equally distributed between the posterior communicating and internal carotid arteries bifurcation. The standard pterional approach was followed in 50% of cases, whereas the other 50% of patients were treated through the lateral supraorbital approach. About 90% (n = 9) of the patients had a Glasgow Outcome Scale (GOS) of 5 and 10% had a GOS of 4. The 3D-printed models successfully replicated the aneurysm size, location, and relation to the parent vessel with 100% accuracy and were used for intraoperative guidance. The average production time was 24–48 h and the production cost was 10–20 US dollars. Conclusion: 3D printing is a promising technology that is rapidly penetrating the field of neurosurgery. In particular, the use of 3D-printed patient-matched, anatomically accurate replicas of the cerebral vascular tree is valuable adjunct to the microsurgical clipping of IAs, and our study conclusions support this concept. However, both the feasibility and clinical utility of 3D printing remain the subject of much, ongoing investigations.

3D Printing of Rapid, Low-Cost and Patient-Specific Models of Brain Vasculature for Use in Preoperative Planning in Clipping of Intracranial Aneurysms

“…Literature on the use of 3D-printed models as a prompt prototyping technique is on the rise, predominantly due to the increased accessibility, ease of use, and affordability of 3D printers [ 11 , 12 , 13 , 14 ]. Many publications indicate the potential application of 3D printing in the modeling of intracranial aneurysms and its benefits preoperatively [ 3 , 4 , 5 , 11 , 15 , 16 , 17 ]. Invitro models of the biological effect of complex-flow stress on endothelial lining, hemodynamic aneurysm growth, aneurysm rupture, and treatments are just a few of the many instances in which researchers relied on 3D-printed models to both present and educate others on their research findings [ 18 , 19 , 20 , 21 , 22 ].…”

“…In all these studies, there was not any significant difference between preoperative imaging and printed models, suggesting that these printed models are anatomically accurate [ 3 , 4 , 29 , 31 ]. In this study, only the location and orientation of aneurysm corresponding to the parent vessels were assessed, and we found an accurate reflection of intraoperative anatomy, with no further stress on the surrounding structures and small perforators [ 15 , 31 ].…”

3D Printed Models—A Useful Tool in Endovascular Treatment of Intracranial Aneurysms

“…The models were printed using a UV-LCD printer with a higher quality resolution and a good surface finishing (Figure 4) compared to FDM (Fused Deposition Modelling) technology mainly used in other aneurysm printing studies [15,20]. We also had a very good time interval (a mean of 3 h) from data acquisition to the completed model compared with Błaszczyk et al who disclosed a time-lapse of approximately 4 h [21] or Faraj et al who disclosed a time-lapse of 24 to 28 h [14].…”

“…In neurosurgery, the preoperative benefits of 3D printed models of intracranial aneurysms have been demonstrated in many reports [ 12 , 13 , 14 ] and also their role in surgical training and patient education [ 15 , 16 , 17 ]. The physical models provide an overview of the complete anatomy of the aneurysm, the relationship with the arterial branching pattern, aspects that were found to be accurate in comparison to the intraoperative reality.…”

PubMed-indexed neurosurgical research productivity of Iraq-based neurosurgeons

“…Between 2003 and 2021, a total of 52 PubMed indexed papers were published from Iraq. [1,2,[4][5][6][7][8][9][10]20,24,[21][22][23][24][25][26][27][28][29][30][31][32][33][34] All publications have been clustered in the period of 2012-2021. From 2012 to 2016, only four papers were published, one per year.…”