3D printer [Neurosurgery Wiki]

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====== 3D printer ======

see [[3D printing]].

A 3D printer is a type of industrial robot.
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{{ ::3d_printing.jpg?400|}}

Developing new surgical [[instruments]] is challenging. While making surgical instruments could be a good field of application for [[3D printer]]s, attempts to do so have proven limited. 

Yang et al. designed a new [[endoscope]]-assisted [[spine surgery]] system, and using a 3D printer, attempted to create a complex surgical instrument and to evaluate the feasibility thereof. Developing the new surgical instruments using a 3D printer consisted of two parts: one part was the creation of a prototype instrument, and the other was the production of a patient model. 

They designed a new endoscope-assisted spine surgery system with a [[cannula]] for the endoscope and working instruments and extra cannula that could be easily added. Using custom-made patient-specific 3D models, they conducted discectomies for paramedian and foraminal discs with both the newly designed spine surgery system and conventional [[tubular]] surgery. The new spine surgery system had an extra portal that can be well bonded in by a magnetic connector and greatly expanded the range of access for instruments without unnecessary bone destruction. In a foraminal discectomy, the newly designed spine surgery system showed less [[facet]] resection, compared to conventional surgery. 

They were able to develop and demonstrate the usefulness of a new [[endoscope-assisted spine surgery system]] relying on 3D printing technology. Using the extra portal, the usability of endoscope-assisted surgery could be greatly increased. They suggested that 3D printing technology can be very useful for the realization and evaluation of complex surgical instrument systems
((Yang HS, Park JY. 3D Printer Application for Endoscope-Assisted Spine Surgery 
Instrument Development: From Prototype Instruments to Patient-Specific 3D Models.
Yonsei Med J. 2020 Jan;61(1):94-99. doi: 10.3349/ymj.2020.61.1.94. PubMed PMID:
31887805.
)).
----


Disruptive technologies are rare phenomena. However, when they do come about, they have the potential to change the course of entire industries. Such is the case with the new three-dimensional (3D) printing technology from Carbon3D Inc. (Redwood City, California, USA), dubbed Continuous Liquid Interface Production (CLIP). With its innovative approach to additive manufacturing, CLIP has the potential to usurp and revolutionize 3D printing, with reverberations into several fields, including neurologic surgery
((Aoun RJ, Hamade YJ, Zammar SG, Patel NP, Bendok BR. Futuristic
Three-Dimensional Printing and Personalized Neurosurgery. World Neurosurg. 2015
Oct;84(4):870-1. doi: 10.1016/j.wneu.2015.08.010. Epub 2015 Aug 20. PubMed PMID: 
26299265.
)).

A technique using an industrial rapid prototyping process by three-dimensional (3D) printing was developed, from which accurate spatial models of the nasal cavity, paranasal sinuses (sphenoid sinus in particular), and intrasellar/pituitary pathology were produced, according to the parameters of an individual patient. Image-guided surgical (IGS) techniques on two different platforms were used during endoscopic transsphenoidal surgery to test and validate the anatomical accuracy of the sinus models by comparing the models with radiological images of the patient on IGS.
RESULTS:
It was possible to register, validate, and navigate accurately on these models using commonly available navigation stations, matching accurately the anatomy of the model to the IGS images
((Waran V, Menon R, Pancharatnam D, Rathinam AK, Balakrishnan YK, Tung TS, Raman
R, Prepageran N, Chandran H, Rahman ZA. The creation and verification of cranial 
models using three-dimensional rapid prototyping technology in field of
transnasal sphenoid endoscopy. Am J Rhinol Allergy. 2012 Sep-Oct;26(5):e132-6.
doi: 10.2500/ajra.2012.26.3808. PubMed PMID: 23168144.))


Neurosurgeons regularly plan their surgery using magnetic resonance imaging (MRI) images, which may show a clear distinction between the area to be resected and the surrounding healthy brain tissue depending on the nature of the pathology. However, this distinction is often unclear with the naked eye during the surgical intervention, and it may be difficult to infer depth and an accurate volumetric interpretation from a series of MRI image slices.


MRI data are used to create affordable patient-specific 3-dimensional (3D) scale models of the brain which clearly indicate the location and extent of a tumour relative to brain surface features and important adjacent structures.

This is achieved using custom software and rapid prototyping. In addition, functionally eloquent areas identified using functional MRI are integrated into the 3D models.

Preliminary in vivo results are presented for 2 patients. The accuracy of the technique was estimated both theoretically and by printing a geometrical phantom, with mean dimensional errors of less than 0.5 mm observed.

This may provide a practical and cost-effective tool which can be used for training, and during neurosurgical planning and intervention
((Spottiswoode BS, van den Heever DJ, Chang Y, Engelhardt S, Du Plessis S,
Nicolls F, Hartzenberg HB, Gretschel A. Preoperative three-dimensional model
creation of magnetic resonance brain images as a tool to assist neurosurgical
planning. Stereotact Funct Neurosurg. 2013;91(3):162-9. doi: 10.1159/000345264.
Epub 2013 Feb 27. PubMed PMID: 23446024.
)).


The advent of multimaterial 3D printers allows the creation of neurosurgical models of a more realistic nature, mimicking real tissues. Warren et al. used the latest generation of 3D printer to create a model, with an inbuilt pathological entity, of varying consistency and density. Using this model the authors were able to take trainees through the basic steps, from navigation and planning of skin flap to performing initial steps in a craniotomy and simple tumor excision. As the technology advances, models of this nature may be able to supplement the training of neurosurgeons in a simulated operating theater environment, thus improving the training experience
((Waran V, Narayanan V, Karuppiah R, Owen SL, Aziz T. Utility of multimaterial
3D printers in creating models with pathological entities to enhance the training
experience of neurosurgeons. J Neurosurg. 2014 Feb;120(2):489-92. doi:
10.3171/2013.11.JNS131066. Epub 2013 Dec 10. PubMed PMID: 24321044.)).

====Articles====
Aoun RJ, Hamade YJ, Zammar SG, Patel NP, Bendok BR. Futuristic
Three-Dimensional Printing and Personalized Neurosurgery. World Neurosurg. 2015
Oct;84(4):870-1. doi: 10.1016/j.wneu.2015.08.010. Epub 2015 Aug 20. PubMed PMID: 
26299265
((Aoun RJ, Hamade YJ, Zammar SG, Patel NP, Bendok BR. Futuristic
Three-Dimensional Printing and Personalized Neurosurgery. World Neurosurg. 2015
Oct;84(4):870-1. doi: 10.1016/j.wneu.2015.08.010. Epub 2015 Aug 20. PubMed PMID: 
26299265.
)).

====Indications====
Large format (ie, >25 cm) cranioplasty is a challenging [[procedure]] not only from a cosmesis standpoint, but also in terms of ensuring that the patient's brain will be well-protected from direct trauma. Until recently, when a patient's own cranial flap was unavailable, these goals were unattainable. Recent advances in implant computer-aided design and 3-dimensional (3-D) printing are leveraging other advances in regenerative medicine. It is now possible to 3-D-print patient-specific implants from a variety of polymer, ceramic, or metal components. A skull template may be used to design the external shape of an implant that will become well integrated in the skull, while also providing beneficial distribution of mechanical force in the event of trauma. Furthermore, an internal pore geometry can be utilized to facilitate the seeding of banked allograft cells. Implants may be cultured in a bioreactor along with recombinant growth factors to produce implants coated with bone progenitor cells and extracellular matrix that appear to the body as a graft, albeit a tissue-engineered graft. The growth factors would be left behind in the bioreactor and the graft would resorb as new host bone invades the space and is remodeled into strong bone. As described in a review, such advancements will lead to optimal replacement of cranial defects that are both patient-specific and regenerative
((Bonda DJ, Manjila S, Selman WR, Dean D. The Recent Revolution in the Design
and Manufacture of Cranial Implants: Modern Advancements and Future Directions.
Neurosurgery. 2015 Nov;77(5):814-24. doi: 10.1227/NEU.0000000000000899. PubMed
PMID: 26171578; PubMed Central PMCID: PMC4615389.
)).

===== Unclassified =====

[[3d printer unclassified]]


===== References =====