3D-printed head Model in skull base surgery training

• Evaluating the impact of a hand-crafted 3D-Printed head Model and virtual reality in skull base surgery training
• Real Stiffness and Vividness Reproduction of Anatomic Structures Into the 3-Dimensional Printed Models Contributes to Improved Simulation and Training in Skull Base Surgery
• Handmade models for aneurysm surgery: A useful tool for training
• Development of a CT-Compatible, Anthropomorphic Skull and Brain Phantom for Neurosurgical Planning, Training, and Simulation
• Development of 3-dimensional printed simulation surgical training models for endoscopic endonasal and transorbital surgery
• 3D Printing for Complex Cranial Surgery Education: Technical Overview and Preliminary Validation Study
• Primary Dural Repair via an Endoscopic Endonasal Corridor: Preliminary Development of a 3D-Printed Model for Training
• Simulation training in endoscopic skull base surgery: A scoping review

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

1. Anatomical Accuracy

1. Derived from high-resolution CT or MRI scans to replicate patient-specific anatomy.
2. Captures intricate details of the skull base, including foramina, sinuses, and neurovascular structures.

2. Materials

1. Combination of rigid and flexible materials mimics bone, cartilage, and soft tissues.
2. Radiopaque materials can be incorporated to simulate imaging characteristics.

3. Customization

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

1. Surgical Approach Practice

1. Enables rehearsal of transnasal, transcranial, or combined approaches.
2. Provides a risk-free environment to refine skills.

2. Drilling and Bone Removal

1. Models can simulate the tactile feedback of drilling, essential for skull base procedures.
2. Promotes understanding of spatial relationships and depth perception.

3. Endoscopic Training

1. High-fidelity models allow the practice of endoscopic navigation through the sinonasal corridor.
2. Surgeons can develop hand-eye coordination and learn to manage confined spaces.

4. Team Training

1. Facilitates coordination between surgeons and assistants in simulated operating room settings.
2. Enhances communication and workflow efficiency.

1. Safety

1. Eliminates the risks associated with cadaveric dissection (e.g., infection, ethical concerns).
2. Reduces reliance on cadaveric specimens, which can be scarce and expensive.

2. Reproducibility

1. Identical models ensure standardized training experiences for multiple learners.

3. Cost-Effectiveness

1. Lowers long-term costs compared to maintaining cadaver labs.
2. Reduces the need for travel to access training facilities.

4. Immediate Feedback

1. Models can include embedded sensors to track tool usage and provide performance metrics.

1. Integration with Augmented Reality (AR)

1. Combining AR with 3D-printed models for interactive overlays of anatomical labels or real-time guidance.

2. Biomimetic Models

1. Advancements in materials science could lead to even more realistic tissue simulations, including bleeding or pulsating vessels.

3. Individualized Patient Models

1. 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.

While cadaveric dissections remain the cornerstone of education in skull base surgery, they are associated with high costs, difficulty acquiring specimens, 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 ¹⁾

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 ²⁾.

Endoscopic skull base surgery training.