3D-printed head Model in skull base surgery training [Neurosurgery Wiki]

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====== 3D-printed head Model in skull base surgery training ======

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[[3D-printed head model]]s are transforming [[skull base surgery training]] by providing a highly accurate, reproducible, and cost-effective way for [[neurosurgeon]]s to practice [[complex]] procedures. 


===== Key Features of 3D-Printed Head Models =====

1. **Anatomical Accuracy**
   - Derived from high-resolution CT or MRI scans to replicate patient-specific anatomy.
   - Captures intricate details of the [[skull base]], including [[foramina]], [[sinus]]es, and [[neurovascular]] [[structure]]s.

2. **Materials**
   - Combination of rigid and flexible materials mimics [[bone]], [[cartilage]], and [[soft tissue]]s.
   - [[Radiopaque]] materials can be incorporated to simulate imaging characteristics.

3. **Customization**
   - Pathology-specific models (e.g., tumors, vascular anomalies) can be produced for targeted training.
   - Allows practice on unique anatomical challenges.

===== Applications in Skull Base Surgery Training =====

1. **Surgical Approach Practice**
   - Enables rehearsal of [[transnasal]], [[transcranial]], or combined approaches.
   - Provides a risk-free environment to refine skills.

2. **Drilling and Bone Removal**
   - Models can simulate the tactile [[feedback]] of [[drilling]], essential for [[skull base]] [[procedure]]s.
   - Promotes understanding of spatial relationships and depth perception.

3. **Endoscopic Training**
   - High-fidelity models allow the practice of [[endoscopic]] navigation through the sinonasal corridor.
   - Surgeons can develop hand-eye coordination and learn to manage confined spaces.

4. **Team Training**
   - Facilitates [[coordination]] between surgeons and assistants in simulated [[operating room]] settings.
   - Enhances [[communication]] and [[workflow]] [[efficiency]].

===== Advantages of 3D-Printed Models =====

1. **Safety**
   - Eliminates the risks associated with [[cadaveric dissection]] (e.g., infection, ethical concerns).
   - Reduces reliance on [[cadaveric]] [[specimen]]s, which can be scarce and expensive.

2. **Reproducibility**
   - Identical models ensure standardized training experiences for multiple learners.

3. **Cost-Effectiveness**
   - Lowers long-term costs compared to maintaining cadaver labs.
   - Reduces the need for travel to access training facilities.

4. **Immediate Feedback**
   - [[Model]]s can include embedded [[sensor]]s to track tool usage and provide [[performance]] [[metrics]].

===== Future Developments =====

1. **Integration with [[Augmented Reality]] (AR)**
   - Combining AR with [[3D]]-[[print]]ed [[model]]s for interactive overlays of anatomical labels or real-time guidance.

2. **Biomimetic Models**
   - Advancements in materials science could lead to even more realistic [[tissue simulation]]s, including bleeding or pulsating vessels.

3. **Individualized Patient Models**
   - Rapid [[prototyping]] for [[preoperative planning]] and [[simulation]] tailored to individual cases.

3D-printed head models are revolutionizing surgical education, particularly in challenging fields like skull base surgery. They bridge the gap between theoretical knowledge and real-world application, ultimately enhancing patient safety and surgical outcomes.

===== Prospective educational intervention studies =====

While cadaveric [[dissection]]s remain the cornerstone of [[education]] in [[skull base surgery]], they are associated with high [[cost]]s, difficulty acquiring [[specimen]]s, and a lack of [[pathology]] in anatomical samples. 
A study by Mellal et al. evaluated the impact of a hand-crafted three-dimensional (3D)-printed [[head model]] and [[virtual reality]] (VR) in enhancing [[skull base surgery training]].

Research question: How effective are 3D-printed models and VR in enhancing training in skull base surgery?

Materials and methods: A two-day skull base training course was conducted with 12 neurosurgical trainees and 11 faculty members. The course used a 3D-printed head model, VR simulations, and cadaveric dissections. The 3D model included four tumors and was manually assembled to replicate tumor-modified neuroanatomy. Trainees performed surgical approaches, with pre-and post-course self-assessments to evaluate their knowledge and skills. Faculty provided feedback on the model's educational value and accuracy. All items were rated on a 5-point scale.

Results: Trainees showed significant improvement in understanding spatial relationships and surgical steps, with scores increasing from 3.40 ± 0.70 to 4.50 ± 0.53 for both items. Faculty rated the educational value of the model with a score of 4.33 ± 0.82 and a score of 5.00 ± 0.00 for recommending the 3D-printed model to other residents. However, realism in soft tissue simulations received lower ratings.

[[Virtual reality]] and [[3D]]-printed models enhance anatomical understanding and [[skull base surgery training]]. These tools offer a [[cost-effective]], [[realistic]], and accessible alternative to [[cadaveric training]], though further refinement in [[soft tissue]] [[realism]] is needed
((Mellal A, González-López P, Giammattei L, George M, Starnoni D, Cossu G, Cornelius JF, Berhouma M, Messerer M, Daniel RT. Evaluating the [[impact]] of a hand-crafted [[3D-Printed head Model]] and [[virtual reality]] in [[skull base surgery training]]. Brain Spine. 2024 Dec 12;5:104163. doi: 10.1016/j.bas.2024.104163. PMID: 39802866; PMCID: PMC11718289.))
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Watanabe et al. developed a [[3D-printed head model]] simulating the [[neurosurgical technique]] applied in [[skull base surgery]] (SBS), especially to reproduce visually the surgical field together with the mechanical properties of tissues as perceived by the surgeon through procedures performance on a model.

The Young modulus representing the degree of stiffness was measured for the tissues of anesthetized animals and printing materials. The stiffness and vividness of models were adjusted appropriately for each structure. Empty spaces were produced inside the models of brains, venous sinuses, and tumors. The 3D printed models were created in 7 cases of SBS-planned patients and were used for surgical simulation.

The Young modulus of pig's brain ranged from 5.56 to 11.01 kPa and goat's brain from 4.51 to 13.69 kPa, and the dura of pig and goat values were 14.00 and 24.62 kPa, respectively. Although the softest printing material had about 20 times of Young modulus compared with the animal brain, the hollow structure of the brain model gave a soft sensation resembling the real organ and helped bridge the gap between Young moduli values. A dura/tentorium-containing model was practical to simulate the real maneuverability at surgery.

The stiffness/vividness modulated 3D printed model provides an advanced realistic environment for training and simulation of a wide range of SBS procedures
((Watanabe N, Watanabe K, Fujimura S, Karagiozov KL, Mori R, Ishii T, Murayama Y, Akasaki Y. Real [[Stiffness]] and [[Vividness]] Reproduction of Anatomic Structures Into the 3-Dimensional [[Printed Model]]s Contributes to Improved [[Simulation]] and [[Training]] in [[Skull Base Surgery]]. Oper Neurosurg (Hagerstown). 2023 May 1;24(5):548-555. doi: 10.1227/ons.0000000000000583. Epub 2023 Feb 13. PMID: 36786751.)).

===== Endoscopic skull base surgery training =====
[[Endoscopic skull base surgery training]].